Management and Long-Term Follow-up Outcomes of Appendiceal Neuroendocrine Tumor Patients: Evaluation of Single-Center Data - Turkish Journal of Colorectal Disease

Background and Objectives: We aimed to evaluate early postoperative radiographic changes in sagittal foot alignment following laparoscopic sleeve gastrectomy and to investigate the association between early weight loss and sagittal foot alignment parameters. Materials and Methods: This study included 72 consecutive patients who underwent primary laparoscopic sleeve gastrectomy. Standardized lateral foot radiographs were obtained preoperatively and at the fourth postoperative month. Meary’s angle, calcaneal pitch, and talar declination angle were measured on all radiographs. Demographic and clinical variables, including age, sex, height, body weight, and body mass index (BMI), were recorded. Results: Meary’s angle demonstrated a significant postoperative decrease from 15° (IQR, 8°) to 11° (IQR, 12°) (p < 0.001), indicating improvement in medial longitudinal arch alignment. In contrast, no significant postoperative changes were observed in the calcaneal pitch (p = 0.227) or talar declination angles (p = 0.751). The proportion of patients within the normal range for all measured sagittal alignment parameters increased postoperatively, without showing statistical significance. Statistical analysis revealed that all postoperative sagittal alignment parameters showed significant correlation with preoperative values. Notably, postoperative Meary’s angle demonstrated a very strong positive correlation with preoperative Meary’s angle (r = 0.80, p < 0.001), whereas no significant correlation was identified between postoperative Meary’s angle and either postoperative weight or weight/BMI loss (p > 0.05). Although BMI loss showed a significant correlation with postoperative calcaneal pitch and talar declination angles, these correlations were weak to moderate (r = −0.403, and r = −0.362, respectively). Conclusions: Early postoperative body weight/BMI loss following sleeve gastrectomy is associated with modest, parameter-specific improvements in sagittal foot alignment, primarily reflected by changes in Meary’s angle, suggesting that the medial longitudinal arch may be more responsive to early postoperative unloading than other sagittal alignment parameters. The strong association between preoperative and postoperative measurements underscores the central role of baseline alignment in determining early postoperative outcomes.

AIM: The aim of this study was to investigate the effect of metastatic lymph node ratio (mLNR) on overall survival after curative resection in patients with right-sided colon cancer. METHODS: Patients diagnosed with right-sided colon cancer and treated at Istanbul Teaching and Research Hospital between 2012 and 2017 were retrospectively analyzed. Variables including age, sex, total number of lymph nodes removed, metastatic lymph node ratio, disease stage, tumor location, and patient morbidity were compared with overall survival. Kaplan-Meier survival analysis and Cox regression analysis were used to evaluate the impact of these variables on overall survival. RESULTS: A total of 129 patients were included in this study. By the end of the follow-up period, 51 patients (39.5%) had died. Receiver operating characteristic (ROC) analysis identified a cut-off value for mLNR at 0.0801 (p < 0.001), with 39 patients (30.2%) having an mLNR greater than this threshold. Patients with a high mLNR exhibited significantly shorter overall survival (20.3 months, 95% confidence interval (CI): 12.0–28.6) compared to those with a lower mLNR (106.6 months, 95% CI: 98.4–114.8) (p < 0.001). Furthermore, overall survival was significantly lower in patients with advanced-stage tumors, highlighting the prognostic importance of tumor, node, and metastasis (TNM) staging system. In multivariate Cox regression analysis, TNM stage (hazard ratio (HR) = 50.229, 95% CI: 6.678–372.242, p < 0.001) and mLNR (HR = 3.136, 95% CI: 1.843–5.337, p < 0.001) were identified as independent prognostic factors for overall survival. CONCLUSIONS: This study underscores that in right-sided colon cancer, the mLNR and TNM stage provide critical prognostic insights, independent of the total number of lymph nodes removed. These findings support the use of mLNR as a practical and reliable tool for refining prognostic assessments and guiding personalized treatment strategies, emphasizing its potential role in clinical decision-making.