Besler E, et al. Ann Surg Treat Res. 2023 Sep;105(3):165-171. https://doi.org/10.4174/astr.2023.105.3.165

Objective: Thyroid-stimulating hormone/thyrotropin (TSH) is known to induce malignancies and tissue growth of the thyroid gland. While the relationship of higher levels of TSH with advanced stages of cancer had been published in previous studies, the relationship of the tumor with the clinicopathological factors had not been completely evaluated. The aim of the present study was to evaluate the relationship between highly risky clinicopathological factors with preoperative high levels of TSH. Materials and Methods: The records of 89 patients (67 females and 22 males) who underwent surgery for differentiated thyroid cancer between 2011 and 2013 were reviewed. The relationship of preoperative TSH between tumor size, multicentricity, lymphovascular invasion, extrathyroidal extension, central neck metastasis, and lateral neck metastasis was evaluated. Results: The preoperative TSH levels were high in patients with multicentricity (p=0.022), lymphovascular invasion (p=0.018), and central neck metastasis (p=0.002). The prevalence of extrathyroidal extension (p=0.41), lymphovascular invasion (p=0.020), and central metastasis (p=0.009) was significantly high in patients with a TSH level ≥2.5 mIU/L. The preoperative TSH levels were determined as an independent predictive risk factor for central neck metastases (p=0.012) and extrathyroidal extension (p=0.041) in multinomial logistical regression analysis. Conclusion: The power of radiological imaging for the identification of central neck metastases in preoperative evaluation is limited. The preoperative high level of TSH is an independent predictive factor for central metastases and extrathyroidal extension. It can help to predict tumor staging. Furthermore, related with multicentricity and lymphovascular invasion, it can affect the high risk characteristics of the tumor except the stage. The preoperative TSH level can be considered for the probability of preoperative metastases and can contribute to plan the extent of surgery. Cite this article as: Besler E, Citgez B, Aygun N, et al. The relationship of clinicopathological afactors of the tumor with preoperative TSH level in papillary thyroid cancers. Eurasian J Med 2019; 51(1): 8-11.

Anastomotic leaks can be very dangerous in colorectal cancers. Protective loop ileostomy is life-saving in low anterior rectal tumors to prevent pelvic sepsis. The aim of this study is to compare early morbidities for stapled, handsewn closure (end to end) or handsewn closure (anterior wall only) of loop ileostomy, and to further assess efficacy and safety for each technique. Patients who underwent loop ileostomy closure from January 2014 and December 2019 retrospectively were analyzed. Multivariate logistic regression was used to determine the effect of the potential risk factors on the rate of each complication. The patients were divided into three groups based on the anastomoses. The first group included patients who had handsewn anterior closure; the second group included patients who had side-to-side anastomosis using linear stapler, and the third group included patients who had end-to-end handsewn anastomosis. The primary endpoint of the study was the postoperative 30 days. IBM Statistical Package for the Social Sciences (SPSS), version 22.0 (SPSS Inc., Chicago, IL) was used for statistical analysis. A total of 198 patients underwent reversal. There was a statistical difference between the handsewn anterior wall and stapler anastomosis in terms of postoperative ileus and wound infection. The handsewn group was superior to anastomosis with stapler (p: 0.027 and p: 0.042, respectively). A statistical difference was found between handsewn anterior wall closure and handsewn end-to-end anastomosis in terms of postoperative ileus, wound infection, and postoperative hospital stay (p: 0.013, p: 0.037, and p: 0.046, respectively). When stapled anastomosis and handsewn end-to-end anastomosis techniques were compared, a statistical difference was found in terms of postoperative ileus risk (p: 0.043), but no significant difference was found in terms of postoperative wound infection and hospital stay. There was no significant difference in the rate of anastomotic leakage between the handsewn and stapled techniques. The rate of small-bowel obstruction was higher in the handsewn group. As a result, in this study, it was revealed that the handsewn anterior wall closure technique is the best among all ileostomy closure techniques.

The Medical Bulletin of Sisli Etfal Hospital

Background/Objectives: Isolated cecum necrosis (ICN) is a rare disease and there are few reports on it in the literature. We retrospectively analyzed the patients with acute abdomen who had ICN, in terms of etiology, demographic findings, surgery, and prognosis to determine the best treatment approach. Methods: Seven patients with per-operative diagnosis of isolated cecal necrosis were included in the study. Age, gender, comorbidities, symptoms, laboratory data, imaging modalities, time from symptoms to surgery, surgical procedure, hospital stay, morbidity, and mortality were retrospectively analyzed. Results: The median age of the patients and the F/M ratio were 61 years and 2/5, respectively. The most common comorbidity was chronic renal failure, followed by hypertension, diabetes mellitus, and coronary artery disease. The median time from symptom onset to surgery was 1 day. The ileocolic anastomosis was performed in 4 patients and terminal ileostomy in three patients. The morbidity and mortality rates were 28.5% and 14.3%, respectively. The median length of hospital stay was 12 days. Conclusions: ICN should be suspected in elderly patients with comorbidities presenting to the emergency department with an acute abdomen. Computed tomography is an important diagnostic tool. Diagnostic laparoscopy is a good option for definitive diagnosis and end ileostomy is better than anastomosis in patients with bleeding tendency or hypotensive patients with chronic renal failure on dialysis, coronary artery disease, and in the presence of purulent peritonitis to reduce morbidity and mortality.

Background: Signet-ring cell colorectal cancer (SRCC) and colorectal cancer with a signet-ring cell component (SRC) are rare histological subtypes associated with poor prognosis. Although these entities are classified separately based on pathological criteria, it remains unclear whether they differ in clinical behavior and survival outcomes. This study aimed to compare the clinicopathological characteristics and survival of patients with SRCC and SRC. Methods: Patients who underwent surgery for colorectal cancer (CRC) between January 2012 and December 2019 and were diagnosed with SRCC or SRC on histopathological examination were retrospectively included. Demographic, clinical, and survival data were analyzed and compared between the two groups. Results: A total of 32 patients (22 males, 10 females) with SRCC or SRC were included, representing 2.6% (32/1253) of all CRC cases operated at our center. Seven patients (five with SRCC and two with SRC) had synchronous distant metastases, including liver-only metastases (9%), diffuse intra-abdominal seeding (9%), and ovarian metastasis (3%). The mean disease-free survival was 19.2 ± 3.3 months overall, and 17.18 ± 3.61 months for SRCC and 19.3 ± 9 months for SRC. The mean overall survival was 70.9 ± 10.18 months overall, and 65.95 ± 13.77 months for SRCC and 79.20 ± 15.03 months for SRC. No statistically significant difference in overall survival was observed between the groups (p = 0.534). Conclusions: SRCC and SRC demonstrate broadly similar clinicopathological features, with younger age at diagnosis observed in SRCC patients. However, given the limited sample size, the absence of statistically significant differences in survival outcomes should be interpreted with caution and does not imply equivalence. Distant metastasis remains the most important prognostic factor in both groups.