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Öğe Adult Nesidioblastosis With Hypoglycemia Mimicking an Insulinoma: A Challenging Case(Int College Of Surgeons, 2017) Yurekli, Banu Sarer; Kutbay, Nilufer Ozdemir; Altun, Ilker; Cetinkalp, Sevki; Nart, Deniz; Coker, Ahmet; Ozgen, GokhanIntroduction: Nesidioblastosis is the primary cause of persistent hyperinsulinemic hypoglycemia in infants but it is a rare entity for the adults. Nesidioblastosis is defined as an increase of pancreatic beta cells in number and in size. Case Presentation: We describe a rare case of nesidioblastosis with positive endoscopic ultrasonography result mimicking an insulinoma. A 35-year-old female patient had hypoglycemic episodes with high insulin level. Her investigation revealed low venous plasma glucose, high insulin and C-peptide level with positive 72-hour fasting test suggestive of hyperinsulinemic hypoglycemia. Abdominal computed tomography did not show any mass lesion. Endoscopic ultrasonography revealed a mass lesion sized as 1 cm in diameter in the pancreas. But, insulinoma like lesion couldn't be found intra-operatively. It was decided to perform distal pancreatectomy. After distal pancreatectomy, nesidioblastosis was diagnosed histopathologically. The patient was free from her symptoms after surgery. Conclusion: This case illustrates difficulties and limitations of imaging modalities and false positive result of EUS in a case of nesidioblastosis. When there is no insulinoma like lesion during operation, operation should be performed as gradient guided pancreatectomy by the way of selective arterial calcium injection test.Öğe Autoimmune Pancreatitis and Treatment Approaches with Case Reports(Aves Yayincilik, 2012) Unalp, Omer; Erol, Varlik; Yeniay, Levent; Ozturk, Safak; Coker, AhmetObjective: In this study, we aimed to review retrospectively the data of 10 patient who were treated and followed-up in our clinic and to review the current approaches in the diagnosis and treatment of autoimmune pancreatitis (AIP). Material and Methods: We reviewed 10 patients retrospectively who were operated on and had the diagnosis of AIP histopathologically in the Ege University School of Medicine Department of General Surgery. Results: Between June 2001-November 2010, 10 patients who were diagnosed as AIP were examined retrospectively. Radiologically, a pancreatic mass was found in the pancreatic head with ultrasound in 7 (70%) of 10 patients and suspicious lesions were identified in the head of the pancreas in 3 (30%) patients. All patients were operated on in our clinic with the preliminary diagnosis of pancreatic head tumor; 8 patients underwent Whipple's procedure, 1 patient underwent pylorus preserving pancreaticoduodenectomy, and in 1 patient an exploratory pancreatic biopsy (frozen section) was carried out. Conclusion: Autoimmune pancreatitis is a disease with increasing incidence and characterized by lymphoplasmocytic cell infiltration and fibrosis. Patients with a pancreatic mass, if there is an autoimmune disease or chronic pancreatitis suspected in the detailed history, it is necessary to evaluate patients in terms of AIP serologically to protect the patients from an incoorectng diagnosis and morbidity of surgery.Öğe Can hyperbaric oxygenation decrease doxorubicin hepatotoxicity and improve regeneration in the injured liver?(Springer Japan Kk, 2009) Firat, Ozgur; Kirdok, Ozgur; Makay, Ozer; Caliskan, Cemil; Yilmaz, Funda; Ilgezdi, Savas; Karabulut, Bulent; Coker, Ahmet; Zeytunlu, MuratPortal vein embolization is used in the treatment of hepatocellular cancer, with the purpose of enhancing resectability. However, regeneration is restricted due to hepatocellular injury following chemotherapeutics (e.g. doxorubicin). The aim of this study was to investigate whether hyperbaric oxygenation (HBO) can alleviate the hepatotoxicity of chemotherapy and improve regeneration in the injured liver. Rats were allocated to four experimental groups. Group I rats were subjected to right portal vein ligation (RPVL); rats in groups II and III were administered doxorubicin prior to RPVL, with group III rats being additionally exposed to HBO sessions postoperatively; group IV rats was sham-operated. All rats were sacrificed on postoperative day 7, and liver injury was assessed by measuring alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels. Protein synthetic ability was determined based albumin levels and liver regeneration by the mitotic index (MI). The AST and ALT values of group II rats were significantly higher than those of group I, but not those of group III. Rats treated with doxorubicin and HBO (groups II and III) showed slightly but not significant differences in albumin levels than those subjected to only RPVL or sham-operated. The MI was significantly increased in groups I, II, and III, with the MI of group III rats significantly higher than those of group I rats. Based on our results, we conclude that HBO treatment has the potential to diminish doxorubicin-related hepatotoxicity and improve regeneration in the injured liver.Öğe Does matrix metalloproteinase activity predict severity of acute pancreatitis?(Blackwell Publishing, 2006) Aynaci, Murat; Tuncyurek, Pars; Nart, Deniz; Zeytunlu, Murat; Ozutemiz, Omer; Ersoz, Galip; Yilmaz, Funda; Mayer, Jens; Coker, AhmetBackground: Matrix metalloproteinases (MMP) modulate end-organ complications of acute pancreatitis, but the correlation between increased MMP production and histological severity of disease remains unclear. We examined the role of MMD and pancreas histology on experimental acute pancreatitis. Methods: Forty male Wistar albino rats were subjected to cerulein-induced pancreatitis (8, 16, 24 and 32 h groups) or sham treatment. The animals were killed at different time points and pancreatic tissues were harvested to assess MMP (1, 2 and 9) activity and inflammatory changes. Results: Compared with other groups, 8 h group had decreased tissue MMP-1 concentrations. MMP-9 concentrations were lower in 24-h and 32-h groups, as were histological severity scores. MMP-2 activity did not differ among groups. Pancreatitis was prominent in 8-h, 16-h and 24-h groups by means of histology. Conclusion: Induction of pancreatitis by cerulein altered pancreatic MMP levels in the early phase of inflammation. Inhibition of MMP-2 and MMP-9 paralleled histological scores. Therefore, MMP may have a predictive value to assess histological severity.Öğe Effects of hepatectomy and arginine enriched diet on colonic mucosa originatedinflammatory cytokines.(2003) Aydin, C; Coker, Ahmet; Atilla, K; Ozer, Esra Arun; Çoker, Işıl; Huseyinov, Afig…Öğe Gallstone ileus as an unexpected complication of cholelithiasis: diagnostic difficulties and treatment(Turkish Assoc Trauma Emergency Surgery, 2010) Yakan, Savas; Engin, Oemer; Tekeli, Tahsin; Calik, Buelent; Denecli, Ali Galip; Coker, Ahmet; Harman, MustafaBACKGROUND Gallstone ileus is a rare complication of cholelithiasis, mostly in the elderly. The aim of this study was to evaluate our experience with 12 gallstone ileus cases and discuss current opinion as reported in the literature. METHODS Data of 12 patients operated between January 1998 and January 2008 with gallstone ileus were retrospectively studied. RESULTS There were 12 cases (9 F, 75%; 3 M, 25%) with a mean age of 63.6 (50-80) years. Median duration of symptoms before admission to the hospital was 4.1 (1-15) days. Preoperative diagnosis was made in only five cases (41.6%). Enterolithotomy was done in nine cases (75%). Enterolithotomy and resection of the small intestine - required for decubital necrosis from the gallstone - was performed in one case (8.3%). In one case (8.3%), enterolithotomy was completed in one stage with cholecystectomy and closure of the fistula during acute surgery, and in another case (8.3%), enterolithotomy + primary suturing of the jejunal perforation was performed. There were two (16.6%) perioperative mortalities. CONCLUSION Gallstone ileus remains a diagnostic challenge despite advances in imaging techniques, and pre-operative diagnosis is often delayed. Gallstone ileus should be suspected in all cases admitted to the emergency service with acute intestinal obstruction with a history of cholelithiasis, especially in the elderly and females.Öğe Gastroenteropancreatic neuroendocrine tumors: recommendations of Turkish multidisciplinary neuroendocrine tumor study group on diagnosis, treatment and follow-up(Termedia Publishing House Ltd, 2017) Yalcin, Suayib; Bayram, Fahri; Erdamar, Sibel; Kucuk, Oztem; Oruc, Nevin; Coker, AhmetGastroenteropancreatic neuroendocrine tumors (GEPNETs) are a relatively rare, heterogeneous group of diseases in which important advances have been observed in the diagnosis and treatment as well as in our understanding of the biology and genetics of the disease in recent years. Given the insufficient scientific data available on evidence-based management of GEPNETs and the differences in circumstances in individual countries, a multidisciplinary study group was established to provide guidelines for the management of GEPNETS. This study group consisted of a medical oncologist, endocrinologist, surgeon, pathologist, gastroenterologist, and a nuclear medicine specialist, who aimed to prepare a practical guide in the light of existing scientific data and international guidelines, to be used in common clinical practice.Öğe Genetic polymorphisms of inflammatory response gene TNF-alpha and its influence on sporadic pancreatic neuroendocrine tumors predisposition risk(Humana Press Inc, 2014) Karakaxas, Dimitrios; Gazouli, Maria; Coker, Ahmet; Agalianos, Christos; Papanikolaou, Ioannis S.; Patapis, Pavlos; Liakakos, Theodoros; Dervenis, ChristosThe diagnosed incidence of pancreatic neuroendocrine tumors (pNETs) is increasing; however, their etiology remains poorly understood. PNETs are a rare, heterogeneous group of tumors arising from the endocrine cells of the pancreas, and genetic risk factors for sporadic pNETs are inadequately understood. It is known that pNETs secrete biogenic amines, hormones and growth factors, tumor necrosis factor-alpha (TNF-alpha) being one of them. Furthermore, cytokines and other proinflammatory mediators have been implicated in inflammatory pancreatic diseases including pancreatitis and cancer. The aim of our study was to analyze TNF-alpha promoter gene polymorphisms as risk factors for pNETs using germline DNA collected in a population-based case-control study of pancreatic cancer [42 pNET cases, 78 pancreatic ductal adenocarcinoma (PDAC) cases, 17 intraductal papillary mucinous neoplasm (IPMN) and 98 healthy controls] conducted in the Athens, Greece and Izmir, Turkey areas. For subsequent analysis, we excluded cases and controls with known genetic syndromes. The CC genotype at the -1031 position was more frequent in pNET and IPMN patients (p = 0.0002 and p = 0.009, respectively), suggesting its possible role in pNET development. Furthermore, the AA genotype at the -308 position was overrepresented in IPMN cases (p = 0.03), and AA genotype at the -238 position was more frequent in PDAC cases (p = 0.03) compared to healthy individuals. With regard to tumor characteristics, no statistically significant association was detected. Our findings suggest the putative role of TNF-alpha -1031 polymorphism in the development of pNET and IPMN, whereas the -308 polymorphism seems to be overrepresented among IPMN cases and -238 polymorphism among PDAC cases.Öğe Genetic polymorphisms of interleukin 1 beta gene and sporadic pancreatic neuroendocrine tumors susceptibility(Baishideng Publishing Group Inc, 2016) Karakaxas, Dimitrios; Sioziou, Anna; Aravantinos, Gerasimos; Coker, Ahmet; Papanikolaou, Ioannis S.; Liakakos, Theodoros; Dervenis, Christos; Gazouli, MariaAIM: To evaluate the association between the inter-leukin 1 beta (IL-1 beta) polymorphisms and the pancreatic neuroendocrine tumor (pNET) development. METHODS: A case-control study was conducted analyzing IL-1 beta polymorphisms using germline DNA collected in a population-based case-control study of pancreatic cancer (51 pNET cases, 85 pancreatic ductal adenocarcinoma cases, 19 intraductal papillary mucinous neoplasm and 98 healthy controls). RESULTS: The distribution of genotypes for the -511 C/T polymorphism in the pNET patient groups showed significant difference compared to the control group. It is known that the carriers of the IL-1 beta -511T allele have increased concentrations of IL-1 beta. The -511 CT and TT high-expression genotypes were over-represented in pNET patients. CONCLUSION: The findings of this study suggested a possible role of IL-1 beta -511 C/T genotypes in the pathogenesis of pNETs since the presence of the IL-1 beta -511 CT and TT genotypes and the T allele was associated with an increased risk of pNET only.Öğe Hepatic artery pseudoaneurysm as a cause of gastrointestinal system bleeding: A case report with a brief review of the literature(Aves, 2012) Unalp, Omer Vedat; Karaca, Can Avni; Sezer, Taylan Ozgur; Yeniay, Levent; Sozbilen, Murat; Coker, AhmetA hepatic artery pseudoaneurysm is, by definition, a pulsatile hematoma due to a leakage of blood through a tear or disruption of the arterial wall, and the blood is contained only by the hepatic parenchyma or surrounding hematoma. It can be a very rare cause of gastrointestinal system bleeding. These pseudoaneurysms are usually very well managed by angiographic intervention. However, in some cases, surgery is inevitable. Herein, we present a 63-year-old female presenting with gastrointestinal system bleeding 45 days after surgery for cholangiocarcinoma. She was found to be bleeding from a pseudoaneurysm of the hepatic artery and underwent surgical intervention.Öğe Inflammatory myofibroblastic tumour(Cma-Canadian Medical Assoc, 2009) Firat, Ozgur; Ozturk, Safak; Akalin, Taner; Coker, AhmetInflammatory myofibroblastic tumours (IMTs), previously accepted as a subtype of the group of tumours called inflammatory pseudotumours, are now recognized to comprise their own, discrete diagnosis. Since IMTs can arise from various anatomic locations,(1,2) they concern almost every subspecialty in surgical oncology. The management of these tumours can be challenging because there are no established medical treatment protocols, and tumours can be irresectable owing to their proximity to vital structures. We present the case of a patient whose IMT was removed after 2 trials of chemotherapy after 2 unsuccessful surgeries.Öğe Is it more dangerous to perform inadequate packing?(Bmc, 2008) Aydin, Unal; Yazici, Pinar; Zeytunlu, Murat; Coker, AhmetPeri-hepatic packing procedure, which is the basic damage control technique for the treatment of hepatic hemorrhage, is one of the cornerstones of the surgical strategy for abdominal trauma. The purpose of this study was to evaluate the efficacy of the perihepatic packing procedure by comparing the outcomes of appropriately and inappropriately performed interventions. Trauma patients with liver injury were retrospectively evaluated. The patients who had undergone adequate packing were classified as Group A, and the patients who had undergone inappropriate packing, as Group B. Over a five-year period, nineteen patients underwent perihepatic packing. Thirteen of these patients were referred by other hospitals. Of 13 patients, 9 with inappropriate packing procedure due to insertion of intraabdominal drainage catheter (n=4) and underpacking (n=5) were evaluated in Group B, and the others (n=10) with adequate packing were assessed in Group A. Mean 3 units of blood were transfused in Group A and unpacking procedure was performed in the 24(th) hour. Only 3 (30%) patients required segment resection with homeostasis, and the mortality rate was 20% (2/10 patients). In Group B, 4 patients required repacking in the first 6 hrs. Mean 8 units of blood were transfused until unpacking procedure. The mortality rate was 44% (4/9 patients). The length of intensive care unit stay and requirement of blood transfusion were statistically significantly lower in Group A (p < 0.05). The mortality rate of this group was also lower. However, the difference between the groups for mortality rates was not statistically significant. This study emphasizes that efficacy of the procedure is one of the determinants that affects the results, and inadequate or inappropriate packing may easily result in poor outcome.Öğe Isolated Late Recurrence of Renal Cell Carcinoma in the Inferior Vena Cava(Akad Doktorlar Yayinevi, 2010) Kazimi, Mircelal; Uguz, Alper; Yakan, Savas; Nart, Deniz; Zeytunlu, Murat; Goker, Erdem; Coker, AhmetRenal cell carcinoma is an urologic malignancy with poor prognosis. Local invasion and distant metastasis determine the prognosis of the disease. Dissemination to inferior vena cava via renal vein is seen in 4-10% of the patients. The role of radiotherapy and chemotherapy is limited, surgery is the only curative treatment option and patients with liver metastasis also benefit from surgery. In patients with vena cava trombosis, cavotomy and trombectomy should be done to prolong survival, if nodal or visseral metastasis is not present. Surgical procedure differs according to location of trombus in inferior vena cava. In our case report, a patient treated with right nephrectomy due to renal cell carcinoma 3 years ago who was re-operated for vena caval trombus is mentioned. Operation was done without using Pringle technique (clamping of hepatic pedicle) by mobilization of the liver with piggy back technique, and after cavotomy and trombus excision, defect in vena cava was reconstructed with PTFE prosthetic graft. Here, we report this case and discuss it in the light of current literature.Öğe Laparoscopic cholecystectomy in a patient with situs inversus totalis(W J G Press, 2006) Aydin, Unal; Unalp, Omer; Yazici, Pinar; Gurcu, Baris; Sozbilen, Murat; Coker, AhmetCurrently, laparoscopic cholecystectomy is an undoubtfully optimal treatment of cholelithiasis. What about performing this procedure on a patient with situs inversus totalis and what are the difficulties of this operation for a right-handed surgeon? We presented a 35-year-old man with unknown situs inversus totalis who was admitted with epigastric pain and digestive problems. Ultrasonography and computed tomography of the abdomen confirmed the diagnosis of a gallstone. Besides, the liver and gallbladder were on the left side and the spleen was on the right. All systems were left-right reversal as mirror image in all diagnostic studies. Laparoscopic cholecystectomy was safely performed, despite of difficulties of situs inversus. The patient was discharged on postoperative day 1. It should be considered that existence of other anomalies may easily cause uninvited injuries. In the patients with situs inversus, laparoscopic cholecystectomy can be safely managed by an experienced surgeon through laparoscopy, and also hepatobiliary surgery. (c) 2006 The WJG Press. All rights reserved.Öğe Life-threatening abdominal injury during a soccer game: a rare clinical case(Turkish Assoc Trauma Emergency Surgery, 2011) Kara, Eray; Icoz, Gokhan; Ersin, Sinan; Coker, AhmetSoccer (football) is a popular sport worldwide and can result in severe abdominal injuries. Nevertheless, the necessity of surgical intervention for abdominal organ injuries has been reported rarely. We report a case who was injured during a soccer game who underwent abdominal surgery. Distal subtotal pancreatectomy, splenectomy, cholecystectomy, and choledochotomy + T-tube drainage were performed. He was discharged on the postoperative seventh day without any complication.Öğe Management of iatrogenic bile duct injuries: Multiple logistic regression analysis of predictive factors affecting morbidity and mortality(Turkish Surgical Assoc, 2018) Ekmekcigil, Ela; Unalp, Omer; Uguz, Alper; Hasanov, Ruslan; Bozkaya, Halil; Kose, Timur; Parildar, Mustafa; Ozutemiz, Omer; Coker, AhmetObjective: latrogenic bile duct injuries remain a challenge for the surgeons to overcome. The predictive factors affecting morbidity and mortality are important for determining the best management modality. Material and Methods: The patients who referred to Ege University Faculty of Medicine after laparoscopy associated iatrogenic bile duct injury are grouped according to Strasberg-Bismuth classification system. The type and number of prior attempts, concomitant complications, and treatment modalities are analyzed using the SPSS version 18 IBM, Chicago, IL, USA), The variables with p<0.10 were considered for univariate analysis and then evaluated for predictive factors by forward Logistic Regression method using multiple logistic regression analysis. Results: According to the analysis of 105 patients who were referred during 2004-2014, the type and number of prior attempts are considered predictive factors in sepsis. In multiple logistic regression analysis, abscess formation, concomitant vascular injury, and serum bilirubin level are significantly effective in predicting mortality. Conclusion: The management of iatrogenic bile duct injuries should be carefully planned with a multidisciplinary approach, The predictive factors affecting morbidity and mortality are important in determining the best modality for managing iatrogenic bile duct injuries, Abscess formation, vascular injury, and serum bilirubin level are the potential risk factors. Therefore, we can strongly recommend immediate assessment of patients for prompt diagnosis and referring to an HPB center, to avoid further injuries.Öğe Omega-3 fatty acids inhibit oxidative stress in a rat model of liver regeneration(Korean Surgical Society, 2017) Firat, Ozgur; Makay, Ozer; Yeniay, Levent; Gokce, Goksel; Yenisey, Cigdem; Coker, AhmetPurpose: Lipid peroxidation and consequent reactive oxygen species in the setting of oxidative stress have crucial roles in liver regeneration, which may adversely affect the regeneration itself and lead to liver failure. The aim of the current study is to investigate whether omega-3 fatty acid supplementation inhibits oxidative stress in an experimental model of liver regeneration. Methods: Forty rats were allocated to four groups. Rats in group A received a sham operation. Rats in group B were subjected to right portal vein ligation (RPVL) and saline infusion. Rats in groups C and D were subjected to RPVL and total parenteral nutrition (TPN) with an all-in-one admixture containing a soybean oil based lipid emulsion. Rats in group D were additionally supplemented with omega-3 fatty acid infusion. Oxidative stresses in the blood and liver were measured by glutathione, superoxide dismutase, catalase, glutathione peroxidase, malondialdehyde, and nitric oxide. Results: Omega-3 supplementation to the TPN solution significantly corrected alterations in the blood and tissue concentrations of oxidants and anti-oxidants during regeneration (P < 0.05). Conclusion: Omega-3 fatty acid supplementation to the TPN solution revealed promising results in removal of oxidative stress that emerges during liver regeneration.Öğe The optimal treatment of hydatid cyst of the liver: Radical surgery with a significant reduced risk of recurrence(Turkish Soc Gastroenterology, 2008) Aydin, Uenal; Yazici, Pinar; Oenen, Zafer; Oezscy, Mustafa; Zeytunlu, Murat; Kilic, Murat; Coker, AhmetBackground/aims: The management of hydatid cyst of the liver, which is still endemic in Turkey, varies from medical treatment or percutaneous drainage to different surgical procedures. In this study, we aimed to compare the efficacy of radical surgical procedures and conservative interventions with respect to recurrence rates. Methods: Patients who underwent any type of surgical treatment between March 1994 and March 2007 due to liver cyst hydatid were retrospectively evaluated. Data collection included demographic variables, diagnostic methods, surgical procedures, and morbidity and mortality rates. Results: 242/258 (93.8%) patients with liver hydatid cyst underwent surgery, and the characteristics of 221 (91.3%) (123 female, 98 male) of these patients matched the criteria of the study. The mean age of the patients was 51 years (18-82 years). The diagnostic methods primarily included abdominal ultrasonography and computed tomography with a rate of 61.8% and magnetic resonance imaging in 12% of the patients. The patients were divided into two groups with respect to the treatment modality: Group A (n=92) - radical surgical treatment and Group B (n=129) - conservative surgery. The overall rate of recurrence was 15.3%. In Group B, this rate was 24% (n=31), whereas only 3.2% of the patients (n=3) in Group A had recurrence in the follow-up (p<0.05). The morbidity rate of the patients who underwent radical surgical modalities was also significantly lower. Conclusions: Although conservative surgical procedures are considered simpler and safer to perform, the rate of postoperative complications such as biliary fistula, residual cavity and recurrence, and cavity suppuration has been reported to be about 35%. On the other hand, radical surgery can be performed with low risk of recurrence (3.2%). We believe radical surgical procedures present a lower rate of recurrence and less morbidity, and thus should be the surgical treatment of choice for hepatic hydatid disease.Öğe Perceptions of porta-celiac vascular models for hepatic surgery and their use in residency training(Springer France, 2021) Ozer, Mehmet Asim; Uguz, Alper; Unalp, Omer Vedat; Coker, Ahmet; Govsa, Figen; Guler, Ezgi; Pinar, YeldaBackground Primary aspect of hepatic navigation surgery is the identification of source vascular details to preserve healthy liver which has a vascular anatomy quite challenging for the young surgeons. The purpose was to determine whether three-dimensional (3D) vascular pattern models of preoperative computed tomography (CT) images will assist resident-level trainees for hepatic surgery. Methods This study was based on the perception of residents who were presented with 5 different hepatic source vascular patterns and required to compare their perception level of CT, and 1:1 models in terms of importance of variability, differential of patterns and preoperative planning. Results All residents agree that models provided better understanding of vascular source and improved preplanning. Five stations provided qualitative assessment with results showing the usefulness of porta-celiac models when used as anatomical tools in preplanning (p = 0.04), simulation of interventional procedures (p = 0.02), surgical education (p = 0.01). None of the cases had scored less than 8.5. Responses related to understanding variations were significantly higher in the perception of the 3D model in all cases, furthermore 3D models were more useful for seniors in more complex cases 3 and 5. Some open-ended answers: "The 3D model can completely change the operation plan" One of the major factors for anatomical resection of liver transplantation is the positional relationship between the hepatic arteries and the portal veins. Conclusion The plastic-like material presenting the hepatic vascularity enables the visualization of the origin, pattern, shape, and angle of the branches with appropriate spatial perception thus making it well-structured.Öğe Postoperative gemcitabine alone and concurrent with radiation therapy in locally advanced pancreatic carcinoma(Sage Publications Ltd, 2010) Ozkok, Serdar; Demirci, Senem; Yalman, Deniz; Zeytunlu, Murat; Nart, Deniz; Yuzer, Yildiray; Coker, Ahmet; Goker, ErdemAims and background. To evaluate the treatment results of gemcitabine alone and concurrent with radiotherapy after R0/R1 resection of locally advanced pancreatic cancer. Methods and study design. From 1999 to 2005, 55 patients with stage II resected pancreatic cancer treated with gemcitabine-based radiochemotherapy were retrospectively evaluated. Initially, one cycle of induction gemcitabine was administered and followed by weekly gemcitabine concurrent with radiotherapy. After the completion of radiochemotherapy, patients received 3 additional courses of gemcitabine. Results. Thirteen patients were stage IIA and 42 were stage JIB. Forty-six patients (83.6%) had RO and 9 patients (16.4%) had R1 resection. All of the patients received induction chemotherapy and radiotherapy, all but 3 received concurrent radiochemotherapy, and 46 (84%) patients received maintenance chemotherapy. During induction, concurrent and maintenance phases of the protocol, 11%, 13.5% and 19.5% of the patients had at least one grade 3 toxicity, respectively. Within a median 47 months (range, 34-105) of follow-up, 4 (7.3%) patients had isolated local recurrence, 5 (9%) patients had local recurrence and distant metastases, and 27 (49%) had only distant metastases. Median disease-free survival and overall survival were 13 (range, 4-105) and 19 months (range, 6-105), respectively. In multivariate analysis, nodal stage, AJCC stage and number of lymph nodes dissected were the significant factors affecting disease-free survival whereas Karnofsky performance status was the only significant factor for overall survival. Conclusions. The prognosis for pancreatic cancer remains poor despite adjuvant radiochemotherapy. More aggressive treatments should be considered in patients with unfavorable prognostic factors. Free full text available at www.tumorionline.it
