Background: Intensive Care Units (ICUs) provide critical support for patients after major surgery or acute abdominal conditions. Despite medical advances, mortality remains high in surgical ICU patients. This study aimed to identify clinical and biochemical predictors of mortality in surgical patients admitted to a tertiary ICU. Methods: We conducted a retrospective case–control study on 231 adult general surgery patients admitted to a tertiary anesthesia ICU between January 2018 and December 2023. Patients under 18 years or who underwent solid organ transplantation were excluded. Data collected included demographic, clinical, and laboratory parameters such as the Glasgow Coma Scale (GCS), Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA), Hemoglobin-Albumin-Lymphocyte-Platelet (HALP) score, neutrophil-to-lymphocyte ratio (NLR), and C-reactive protein (CRP)/albumin ratio. Patients were divided into mortality and survival groups, with subgroup analyses performed for malignancy, sepsis, and trauma. Receiver operating characteristic (ROC) curve and Cox regression analyses were used to identify mortality predictors. Results: The ICU mortality rate was 64.9%. Significant predictors included age ≥ 58 years (odds ratio [OR] 4.56), body mass index (BMI) > 30 kg/m² (OR 7.62), mean arterial pressure < 70 mmHg (OR 1.66), serum albumin < 21.3 g/L (OR 1.5), APACHE II > 18.5 (OR 2.42), and SOFA > 9.5 (OR 2.68). Mortality was also associated with lower GCS scores, prolonged mechanical ventilation, and inotropic support. The CRP/albumin ratio was significantly elevated in the mortality group (p = 0.024). Other inflammatory markers showed no significant differences. Predictive factors varied among subgroups. Conclusions: Older age, obesity, hypotension, hypoalbuminemia, and high severity scores independently predict mortality in surgical ICU patients. Early risk identification may enhance management and improve outcomes in this population.

Background/Aims: Gastrointestinal stromal tumors (GISTs), the most common mesenchymal tumors in the gastrointestinal tract, are increasingly treated with minimally invasive surgeries. Developed techniques include laparoscopic, endoscopic, and hybrid methods for gastric GIST resection. Our study, focusing on single-incision laparoscopic intragastric resection for gastric GISTs, aims to evaluate its safety, efficacy, and long-term outcomes. Materials and Methods: In a retrospective study of GIST surgery involving 14 patients who underwent single-incision laparoscopic intragastric resections, we analyzed and compared their preoperative demographics, American Society of Anesthesiologists (ASA) scores, tumor size, neoadjuvant treatment, operation duration, hospital stay, mitotic and Ki-67 indexes, and histological features with those of patients who underwent open and laparoscopic wedge resections, to assess the impact on both survival and disease-free survival. Results: Average operation time was 93.07 minutes (range 81-120 minutes). Average blood loss: 67 +- 20 mL (range 40-110 mL). Postoperative hospital stay averaged 6.79 days (range 4-16 days). Strong correlations were observed between preoperative and pathological tumor sizes (P = .001, P < .001). Survival analysis indicated a significant association with ASA scores (P = .031), but not with mitotic index, Ki-67, or tumor size. Average survival was 80.57 months, with no recurrence or metastasis during follow-up. Conclusion: Based on our experience, the single-incision laparoscopic intragastric resection method emerges as a highly efficient, timesaving, and gentle oncological procedure, providing a safe and minimally invasive alternative resulting in shorter hospital stays and excellent long-term outcomes with minimal recurrence. For more definitive conclusions, larger, multicenter, and prospective studies are recommended. Cite this article as: Umman V, KılınÇarslan ö, Temel R, et al. Long-term efficacy of single-incision laparoscopic intragastric resection in treating gastrointestinal stromal tumors. Turk J Gastroenterol. 2024;35(3):193-203.

Background: Peritoneal carcinomatosis (PC) represents an advanced stage of intra-abdominal malignancies with poor prognosis. Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) offers promising outcomes in selected patients. This study evaluated survival and prognostic factors in patients undergoing CRS-HIPEC for malignancy-associated PC. Methods: A retrospective analysis was performed on 116 patients treated with CRS-HIPEC between 2015 and 2023. Data included demographics, tumor origin, peritoneal cancer index (PCI), completeness of cytoreduction (CC) score, complications, and survival outcomes. Kaplan–Meier and Cox regression analyses were used. Results: The mean age was 55.2 years; 61.2% were female. Common primary tumors were colorectal (34.5%), gastric (20.7%), ovarian (17.2%), and appendiceal (16.4%). Mean PCI was 11.9, and complete cytoreduction (CC-0) was achieved in 89.7%. Overall survival was highest in appendiceal (76.9 months) and lowest in gastric cancer (24.7 months). Median disease-free and overall survival were 36 and 43.9 months, respectively. Postoperative complications occurred in 31.8%; mortality was 5.17%. High PCI and incomplete cytoreduction were independently associated with worse survival. Conclusion: CRS-HIPEC provides encouraging survival in selected PC patients, especially with low PCI and complete cytoreduction. Careful patient selection remains key to optimizing outcomes.

Background: Sarcopenia is increasingly recognized as a host-related prognostic factor in gastric cancer; however, its relationship with early postoperative outcomes remains inconsistent. The psoas muscle index (PMI) is a practical CT-based surrogate of skeletal muscle reserves. Methods: This retrospective cohort from two university-based tertiary referral centers included patients who underwent curative-intent upfront gastrectomy for gastric cancer between 2015 and 2020. Patients who received neoadjuvant chemotherapy, or who presented with radiologically bulky lymph nodes or distant metastasis, were excluded. Bilateral psoas muscle areas at L3 were summed and normalized to height squared (mm²/m²). Sex-specific Turkish cut-offs defined low PMI (< 530 mm²/m² men; < 360 mm²/m² women). Early postoperative outcomes and time-specific OS (1-, 3-, 5-year) were compared across PMI-defined categories. Results: A total of 184 patients were included (106 low-PMI; 57.6% and 78 high-PMI; 42.4%). Low PMI was not associated with higher postoperative morbidity: anastomotic leak 4.72% vs 3.85% (p=1.000), surgical-site infection 11.3% vs 10.3% (p=1.000), transfusion requirement 31.1% vs 30.8% (p=1.000), median hospital stay 13 vs 13 days (p=0.379). In contrast, survival clearly diverged: 1-year OS was not significant (80.19% vs 91.03%; p=0.060), whereas 3-year OS (54.72% vs 79.49%; p< 0.001) and 5-year OS (43.40% vs 74.36%; p< 0.001) were markedly inferior in low-PMI patients. In multivariable Cox regression, PMI independently predicted mortality (HR 0.996; p< 0.001). Conclusion: Low PMI was not associated with early morbidity, but it independently identified patients at substantially higher long-term mortality risk, supporting the concept that diminished muscle mass reflects impaired long-term biological reserve rather than short-term surgical vulnerability, and may be incorporated into routine preoperative risk stratification.

Background: Intensive Care Units (ICUs) provide critical support for patients after major surgery or acute abdominal conditions. Despite medical advances, mortality remains high in surgical ICU patients. This study aimed to identify clinical and biochemical predictors of mortality in surgical patients admitted to a tertiary ICU. Methods: We conducted a retrospective case-control study on 231 adult general surgery patients admitted to a tertiary anesthesia ICU between January 2018 and December 2023. Patients under 18 or who underwent solid organ transplantation were excluded. Data collected included demographic, clinical, and laboratory parameters such as Glasgow Coma Scale (GCS), APACHE II, SOFA, HALP scores, neutrophil/lymphocyte ratio (NLR), CRP/albumin ratio, and others. Patients were divided into mortality and survival groups, with subgroup analyses for malignancy, sepsis, and trauma. ROC and Cox regression analyses identified mortality predictors. Results: The ICU mortality rate was 64.9%. Significant predictors included age ≥58 (OR 4.56), BMI >30 (OR 7.62), mean arterial pressure <70 mmHg (OR 1.66), serum albumin 18.5 (OR 2.42), and SOFA >9.5 (OR 2.68). Mortality was significantly associated with lower GCS, prolonged ventilation, inotropic support, and notably, a significantly elevated CRP/albumin ratio in the mortality group (p=0.024). Other inflammatory markers showed no significant difference. Predictive factors varied among subgroups. Conclusion: Older age, obesity, hypotension, hypoalbuminemia, and high severity scores independently predict mortality in surgical ICU patients. Early risk identification may enhance management and improve outcomes in this population.