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Objectives: Clinicians are in need of guidance that will ease the application of medical nutrition therapy. In order to facilitate the application and success of medical nutrition therapy, the Turkish Clinical Enteral & Parenteral Nutrition Society (KEPAN) planned a report that is short, is clear, and has clear-cut recommendations that will guide health care professionals in the indications, choice, practical application, follow-up, and stopping of enteral nutrition., Methods: The enteral nutrition consensus report on enteral nutrition use in medical nutrition therapy was developed by a study group (12 working group academicians and 17 expert group academicians) under the organization of KEPAN. The enteral nutrition consensus report was generated in 5 online and face-to-face phases from December 2019 through October 2022. At the end (Delphi rounds), a total of 24 questions and subjects, recommendations, and comments were sent to the enteral nutrition working group and the expert group via e-mail. They were asked to score the criteria by using the Likert scale., Results: The first round of the study resulted in acceptance of all 24 recommendations. None of the criteria was rejected. Only some minor editing for wording was recommended by the panelists during the first and second rounds of the Delphi study. The final report was sent to all 29 panelists and was approved without any revision suggestions., Conclusion: This report provides 24 clear-cut recommendations in a question-answer format. We believe that this report could have a significant effect on the optimum use of enteral nutrition in the context of medical nutrition therapy when clinicians manage everyday patients., Competing Interests: Declaration Of Competing Interest We have no conflicts of interest to declare., (Copyright © 2023. Published by Elsevier Inc.)

Objective: To test the efficacy of including albumin in the Memorial Sloan Kettering Cancer Center (MKSCC) nomogram (MSKCC+A) on predicting the overall survival., Study Design: Descriptive study., Place and Duration of Study: Ankara Training and Research Hospital & Ataturk Training and Research Hospital, Turkey, in 2020, on patients who were operated between 2009 and 2014 to confirm the 5-year survival results., Methodology: Patients who underwent R0 resection for colon cancer were evaluated. For each patient in the cohort, the 5-year probability of survival was calculated and compared with actual, using the AJCC (American Joint Committee on Cancer), MSKCC and MSKCC+A estimation systems obtained using logistic regression. The performance of the estimation methods was evaluated by the ROC analysis., Results: Two hundred and thirty-nine patients were studied. When the patients with more than 5-year overall survival were compared, the AJCC, MSKCC, and enhanced MSKCC survival scores were significantly higher. AUC = 0.699 for the AJCC staging system, AUC = 0.702 for the MKSCC nomogram, and AUC = 0.777 when the albumin level was added to the MKSCC system., Conclusions: The use of the MSKCC overall survival nomogram in patients with colon cancer appears useful for both clinicians and patients. The prognostic power of this calculator was found to be further enhanced by including the preoperative serum albumin level as an extra variable in the nomogram., Key Words: Nomograms, Neoplasm grading, Survival, Colon cancer, Serum albumin.

Objectives: Nomograms and scoring systems in gastric cancers have been mainly developed based on adequate lymph node (lN) dissections. This study aimed to perform external validation of a nomogram developed for predicting overall survival (OS) in gastric cancer patients with insufficient number of examined LNs (eLNs) and to evaluate its usability as compared with the 8 th American Joint Committee on Cancer (AJCC)'s Tumor-Node-Metastasis staging system., Methods: Medical records of 262 patients undergoing complete surgical resection for gastric cancers and having pathologically confirmed diagnosis were retrospectively reviewed. The study included 104 (39.7%) patients (82 males, median age, 60.3 years) with insufficient number of eLNs (<16). The 5-year OS rate was calculated using the nomogram and according to the AJCC system., Results: The median follow-up period was 37.4 months (range: 0.9-122.9). Of the patients, 69 (66.3%) died and 35 (33.7%) achieved 5-year survival within the follow-up period. The nomogram and the AJCC system predicted OS were significantly lower in patients who died than in those who achieved 5-year survival (p<0.001 for both). According to the receiver operative characteristics-curve, the area under the curve for the nomogram (0.801; 95% CI, 0.715-0.887; p<0.001) was larger than that for the AJCC system (0.754; 95% CI, 0.659-0.849; p<0.001)., Conclusion: The nomogram developed for gastric cancer patients with insufficient number of eLNs (<16) was effective in predicting 5-year OS in our cohort and was superior to the AJCC system., Competing Interests: Conflict of Interest: None declared. Authorship Contributions: Concept – M.K., M.O.Y.; Design – M.K., M.O.Y., B.B., R.H.G.; Supervision – R.H.G.; Materials – M.K., M.O.Y., R.H.G; Data collection &/or processing – M.K., M.O.Y.; Analysis and/or interpretation – M.K., B.B.; Literature search – M.K., M.O.Y.; Writing – M.K., M.O.Y., B.B., R.H.G.; Critical review – M.K., M.O.Y., B.B., R.H.G., (©Copyright 2022 by The Medical Bulletin of Sisli Etfal Hospital - Available online at www.sislietfaltip.org.)

Objectives: This study reports the results of a single center experience on the use of pharmacological venous thromboembolism (VTE) prophylaxis in laparoscopic cholecystectomy patients., Background: The prevention of VTE is of crucial importance in surgical practice. However, the severity of thromboembolism risk and the necessity of thromboprophylaxis for laparoscopic cholecystectomy is still being debated., Methods: The data of the patients, who underwent laparoscopic cholecystectomy for symptomatic cholelitiasis in a single center between the years 2005 and 2015 were analysed retrospectively for incidents of symptomatic VTE and bleeding complications. Fisher Exact Test was used to compare the outcomes of the patients who did and did not receive thromboprophylaxis., Results: Of the 1485 patients who were included in the study, 307 (20.67 %) having a low VTE risk, did not receive any thromboprophylaxis; while 1178 (79.33 %) with a medium, high or a very high risk received VTE prophylaxis. A bleeding complication occurred in 14 (1.18 %) patients receiving prophylaxis and in 2 (0.65 %) patients not receiving prophylaxis (p = 0.548). No patients in this study experienced clinically symptomatic VTE., Conclusions: The findings of this study indicate that the selective use of thromboprophylaxis does not significantly increase the risk of bleeding after laparoscopic cholecystectomy and probably decreases the incidence of symptomatic thrombotic complications (Ref. 18) Keywords: laparoscopic cholecystectomy, bleeding, venous thromboemboly, prophylaxis, low molecular weight heparin.

Background: Disease-related malnutrition (DRM) represents a critical public health concern. Therefore, Fight Against Malnutrition (FAM) should be a state priority, but the degree to which this is true appears to differ considerably among European countries. The aim of this study was to put the problem into perspective by comparing the prevalence of malnutrition in countries from opposite parts of the continent., Methods: Six countries-Croatia, Estonia, Greece, Lithuania, Poland, and Turkey-participated in the study. A short questionnaire was used to assess DRM: its prevalence, the current situation in hospitals, regulations for reimbursement, and general healthcare circumstances. Data from ESPEN's NutritionDay 2006 were used to broaden the perspective., Results: At admission in October 2012, 4068 patients were assessed. The study was performed in 160 hospitals and 225 units with 9143 beds. The highest proportions of patients with 3 or more points on the Nutritional Risk Screening 2002 were observed in Estonia (80.4%) and Turkey (39.4%), whereas the lowest were in Lithuania (14.2%). The provision of nutrition support was best in Turkey (39.4% required intervention, 34.4% received intervention) and Poland (21.9% and 27.8%, respectively). Nutrition support teams (NSTs) are active in some countries, whereas in others they virtually do not exist., Conclusion: The prevalence of malnutrition was quite high in some countries, and the nutrition approach differed among them. It could be the result of the lack of reimbursement, inactive or nonexistent NSTs, and low nutrition awareness. Those facts confirmed that the continuation of FAM activities is necessary., (© 2013 American Society for Parenteral and Enteral Nutrition.)

Technical difficulties during colorectal surgery increase the complication rates. We introduce a modified single stapler technique for patients in whom technical problems are encountered while performing double stapler technique. Before pelvic dissection, descending colon is divided at minimum 10 cm proximal to the tumoral segment. Tumor specific mesorectal excision is performed and two purse string sutures are placed at the distal margin with an interval of 1 - 2 cm. After introducing a circular stapler via the anus, the distal purse string suture is tied around the central shaft of the stapler and the proximal purse string suture around the colonic lumen. After the resection is completed between the two sutures, the anvil shaft is connected to the central shaft and the stapler is closed and fired. None of the patients had an anastomotic leak. This technique may be a safe alternative particularly in patients with narrow pelvis and distal tumors.