Publications by authors named "Isa Aykut Ozdemir"

22 Publications

  • Page 1 of 1

Non-pharmacological interventions for the prevention of postoperative ileus after gynecologic cancer surgery.

Taiwan J Obstet Gynecol 2021 Jan;60(1):9-12

Department of Gynecology and Oncology, Bakirkoy Sadi Konuk Research and Training Hospital, Istanbul, Turkey.

Postoperative ileus (POI) is characterized by impaired gastrointestinal motility after surgery. POI is a major concern for surgeons because it increases hospital stay, the cost of care, and postoperative morbidity in patients who have undergone extensive gynecological oncological surgery. Although several interventions have been proposed and investigated, no effective treatment for the prevention and management of POI has been established. The present review summarizes the current evidence on non-pharmacological interventions, including coffee consumption and chewing gum, used to prevent and treat POI. We obtained studies from MEDLINE, Cochrane Database of Systematic Reviews, ISI Web of Science, and SCOPUS databases.
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http://dx.doi.org/10.1016/j.tjog.2020.11.002DOI Listing
January 2021

Comparison of Postoperative Benign Pelvic Cysts Occurred after Gynecologic or Gyne-oncologic Surgery Treated with Percutaneous Transcatheteric Sclerosant Alcohol Therapy.

Gynecol Minim Invasive Ther 2020 Oct-Dec;9(4):198-203. Epub 2020 Oct 15.

Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, Medipol Mega University Hospital, Istanbul, Turkey.

Objectives: Here, we compare the success of percutaneous transcatheter sclerosant alcohol therapy (PTSAT) for the postoperative treatment of benign pelvic cysts that occurred after gynecologic surgery.

Materials And Methods: The study is a retrospective case-control trial. Gynecological patients who had symptoms due to postoperative pelvic cysts and received PTSAT after gynecologic surgery, between October 2008 and January 2018, were examined in a single training and research hospital in Turkey. Some factors were investigated for associations with postoperative pelvic cyst formation in patients who underwent gynecologic operations for malignancies or benign conditions. Statistical analysis used: The association between two independent and nonnormally distributed continuous variables was analyzed with the Mann-Whitney U-test. Spearman's rho correlation analysis was conducted to determine the correlation of two nonnormally distributed variables. Chi-square (or Fisher's exact test, when more suitable) was used to examine the correlation between categorical variables.

Results: Statistically significant differences were found in terms of the average age was higher in patients with malignancies, and the average postoperative pelvic cyst detection time was higher in patients with benign pelvic cysts. While all patients were treated with PTSAT, repetitive PTSAT was required for seven benign and ten malign cases.

Conclusion: Patients with pelvic cysts that occurred after gynecologic surgery for malignant conditions, large volume pelvic cysts and patients with benign cysts who underwent more than one surgery required recurrent PTSAT.
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http://dx.doi.org/10.4103/GMIT.GMIT_107_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7713659PMC
October 2020

Coffee consumption for recovery of intestinal function after laparoscopic gynecological surgery: A randomized controlled trial.

Int J Surg 2020 Oct 24;82:130-135. Epub 2020 Aug 24.

Department of Gynecology and Oncology, Bakirkoy Sadi Konuk Research and Training Hospital, Istanbul, Turkey.

Backround: To investigate the effect of postoperative coffee consumption on bowel motility after laparoscopic gynecological surgery.

Materials And Methods: In this randomized controlled trial, patients were allocated postoperatively to 3 cups of either coffee or warm water at 6, 12, or 18 h after the operation. Total hysterectomy and bilateral salpingectomy were performed on all patients. In addition, a salpingo-oophorectomy and systematic pelvic with/without para-aortic lymphadenectomy were performed according to clinical indications. The primary endpoint was time to the first passage of flatus after surgery.

Results: A total of 96 patients were enrolled; 49 patients were assigned to the coffee group, and 47 were enrolled in the control group (warm water). The median time to flatus (19 [13-35] vs. 25 [15-42] h; hazard ratio [HR] 1.9, 95% confidence interval [CI], 1.2-2.9; P = 0.0009), median time to defecation (30 [22-54] vs. 38 [26-65] h, HR 2.4, 95% CI, 1.5-3.8; P < 0.0001), and mean time to tolerate food (2 [2-5] vs. 3 [2-8] days, HR 1.5, 95% CI, 1.02-2.3; P = 0.002) were decreased significantly in patients who consumed coffee compared with the control subjects. Postoperative ileus was observed in seven patients (14.9%) in the control group and one patient (2.0%) in the coffee group (P = 0.02). No adverse events were attributed to coffee consumption.

Conclusion: Postoperative coffee intake after laparoscopic gynecological surgery hastened the recovery of gastrointestinal function by reducing the time to the first passage of flatus, time to the first defecation, and time to tolerate a solid diet. This simple, cheap, and well-tolerated treatment merits routine use alongside other existing enhanced recovery pathways in the postoperative setting.
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http://dx.doi.org/10.1016/j.ijsu.2020.08.016DOI Listing
October 2020

Comparison of pain and proper sample status according to usage of tenaculum and analgesia: a randomized clinical trial.

Obstet Gynecol Sci 2020 Jul 19;63(4):506-513. Epub 2020 Jun 19.

Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Medipol University Mega Hospital, Istanbul, Turkey.

Objective: Colposcopic biopsy is a discomfortable procedure. Additionally, it creates negative influence on sexuality. This study aimed to investigate the relationships among tenaculum, pain perception, and biopsy size during colposcopy.

Methods: In total, 228 patients who underwent colposcopy-directed biopsy were included, and randomized into 4 groups based on whether analgesic and tenaculum were used and replaced (tenaculum with n=58/without analgesic n=56, no tenaculum replacement with n=57/without analgesic n=57). Lidocaine hydrochloride (40 mg) plus adrenaline (0.025 mg) was administered in the analgesic groups. The pain was assessed using a linear visual analog scale. The biopsy specimen size was measured in millimeters.

Results: The mean age of the patients was 42.85±8.88 years. The most frequent colposcopy indications were atypical squamous cells of undetermined significance and human papilloma virus-positive results on cervical cytology (30.2%; n=69). Low- and high-grade intraepithelial lesions were noted in 14.91% (n=34) and 10.96% (n=25) women through colposcopy-directed biopsy results, respectively. Tenaculum replacement increased pain perception in the without analgesic group; however, no statistically significant differences were noted between of the groups with and without tenaculum replacement with analgesic. The size and number of biopsy specimens were not associated with tenaculum replacement and analgesic use.

Conclusion: Administration of analgesics decreased discomfort and pain in patients. Tenaculum replacement aided colposcopists in manipulating the cervix. Additionally, administration of analgesics relieved pain in the tenaculum replacement group.

Trial Registration: ClinicalTrials.gov Identifier: NCT03279666.
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http://dx.doi.org/10.5468/ogs.19185DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7393752PMC
July 2020

The impact of concurrent HPV infections on the presentation of high grade cervical intraepithelial lesions.

Ginekol Pol 2020;91(6):324-330. Epub 2020 May 6.

Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Obstetrics and Gynecology, İstanbul, Turkey.

Objectives: We investigate how concurrent high-risk (hr) HPV (human papillomavirus) genotypes affect CIN2-3 risk and evaluate the relationship of different genotype combinations with cervical epithelial lesions.

Material And Methods: This study included HPV positive patients between the ages of 30 and 60 who underwent liquid-based cervical smears and HPV screening through community-based, cervical cancer screening programs between June 2015 and June 2017. The impact of the increase in hrHPV types was calculated by estimating how it changed the odds ratio of CIN2-3 risk.

Results: The rate of multiple concurrent HPV infections was 48.7% in the CIN2-3 group and 58.4% in the CIN1 group. Among patients in the CIN2-3 and CIN1 groups, the most common HPV coinfection was respectively HPV 16+31 and HPV 16+51. The HPV 51 ratio in CIN1 patients was 28.9% and the HPV 51 ratio in the CIN2-3 patient was 6.6%. With every increase in the number of hrHPV infection types, the frequency of CIN2-3 decreased [OR: 0.72, 95% CI: 0.54-0.95]. For all hrHPV combinations, the addition of HPV 16 was associated with a higher risk of CIN2-3.

Conclusions: An increase in number of hrHPV types is associated with lower CIN2-3 risk. Further cohort studies with larger samples are needed to clarify this relationship. The available evidence suggests that HPV 16 genotype plays an important role in patients with high-grade cervical lesions and has a negative impact on the cervix in concurrent multiple HPV infections.
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http://dx.doi.org/10.5603/GP.a2020.0002DOI Listing
May 2020

Comparison of epidural and intravenous route for acute and chronic postoperative pain control in patients with gynecological malignancy.

Agri 2020 Apr;32(2):91-98

Department of Gynecologic Oncology, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey.

Objectives: This study compared the effects of patient-controlled epidural and intravenous analgesia on acute and chronic postoperative pain in patients who were operated on for gynecological malignancy.

Methods: Postoperatively, patient-controlled analgesia was administered via epidural route to Group 1 and the intravenous route to Group 2. Pain was evaluated using the Visual Analog Scale (VAS) in the acute phase at postoperative 24 hours and at 6 months in the chronic phase.

Results: The VAS scores at 24 hours were lower in Group 1 than in Group 2 (3.29 vs 3.93; p<0.05). The VAS scores at 6 months were 2.03 in Group 1 and 2.53 in Group 2, indicating no statistically significant difference (p>0.05). There was no significant difference in the Leeds Assessment of Neuropathic Symptoms and Signs pain scale scores at 6 months (p>0.05).

Conclusion: The results showed that epidural and intravenous analgesia had a similar effect regarding the chronicity of pain but better outcomes were achieved with epidural analgesia in the acute stage.
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http://dx.doi.org/10.14744/agri.2019.26986DOI Listing
April 2020

The role of changes in systemic inflammatory response markers during neoadjuvant chemotherapy in predicting suboptimal surgery in ovarian cancer.

Curr Probl Cancer 2020 08 15;44(4):100536. Epub 2020 Jan 15.

Muğla Sitki Koçman University Education and Research Hospital, Department of Gynecologic Oncology, Muğla, Turkey.

Aim: The aim of this study was to investigate the possibility of using the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, and platelet count and their dynamic changes during chemotherapy to predict suboptimal interval debulking surgery (IDS) in stage IIIC-IVA serous ovarian cancer (OC).

Method: Patients who underwent IDS after neoadjuvant chemotherapy (NAC) for stage IIIC-IVA serous OC at 3 centers between January 2008 and March 2018 were analyzed retrospectively. All women with complete blood counts both at diagnosis (T0) and after the completion of NAC but prior to IDS (T1) were included. An average of 3 weeks passed between IDS and the last cycle of NAC.

Results: A total of 214 patients were found suitable for the study. Suboptimal surgery was performed in 25.2% of the patients and optimal surgery was performed in 74.8%. The rate of change in NLR was calculated as [(NLR T0 - NLR T1)/NLR T0] × 100. A higher rate of change in NLR was found in the optimal surgery group. Recovery of thrombocytosis (When platelet count before NAC was >400,000/mm, recovery of thrombocytosis was defined as ≤400,000/mm after NAC.) was found to have 85.7% sensitivity and 64.8% specificity in predicting suboptimal surgery (P < 0.001). According to both multivariate and univariate regression analysis, a large change in NLR (>17%) and recovery of thrombocytosis significantly predicted suboptimal surgery.

Conclusion: To identify the likelihood of suboptimal surgery in advanced stage OC patients who undergo IDS after NAC, the dynamic change in NLR values can be examined.
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http://dx.doi.org/10.1016/j.currproblcancer.2020.100536DOI Listing
August 2020

Preoperative predictors of pelvic and para-aortic lymph node metastases in cervical cancer.

J Cancer Res Ther 2019 Oct-Dec;15(6):1231-1234

Department of Gynecologic Oncology, Mugla Sitki Kocman University, Education and Research Hospital, Mugla, Turkey.

Aim: This study investigated potential preoperative predictors of pelvic lymph node (PLN) and para-aortic LN (PaLN) involvement in cervical cancer (CC).

Materials And Methods: This study retrospectively analyzed 283 patients diagnosed with early (stage IA1-IIA) CC who underwent retroperitoneal LN dissection between January 1992 and February 2015. Several risk factors that are believed to influence PLN and PaLN involvement in CC were analyzed as follows: age >50 years, lymphovascular space invasion (LVSI), tumor size ≥2 cm, hemoglobin <12 g/dL, and nonsquamous cell histologic type.

Results: LVSI (odds ratio [OR] = 11.3, 95% confidence interval [CI] = 5.2-24.3) and tumor size (OR = 3.2, 95% CI = 1.4-7.2) were independent predictors of PLN involvement. None of the factors predicted PaLN involvement in a regression analysis. However, all nine patients who had PaLN involvement also had PLN involvement.

Conclusion: LVSI and tumor size independently increase the risk of PLN involvement.
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http://dx.doi.org/10.4103/jcrt.JCRT_467_17DOI Listing
May 2020

Postoperative nomogram for the prediction of disease-free survival in lymph node-negative stage I-IIA cervical cancer patients treated with radical hysterectomy.

J Obstet Gynaecol 2020 Jul 12;40(5):699-704. Epub 2019 Oct 12.

Department of Gynecology and Oncology, Muğla Sitki Koçman University Education and Research Hospital, Muğla, Turkey.

The purpose of this study was to develop and validate a nomogram for individual prediction of recurrence and disease-free survival (DFS) among lymph node (LN)-negative early-stage (I-IIA) cervical cancer (CC) patients treated with Type B or Type C2 hysterectomy. Data were collected from patients diagnosed with CC between 1995 and 2017 at the Gynecological Oncology Department, Tepecik Training and Research Hospital. A total of 194 cases with stage IA2-IIA CC were evaluated retrospectively. Patients with stage IA2-IIA CC who underwent radical (Type C2) or modified radical (Type B) hysterectomy and pelvic ± paraaortic LN dissection with LN negativity were included in the study. The relationships between prognostic factors such as stage, tumour size, parametrial involvement, vaginal cuff margin, endomyometrial infiltration, and lymphovascular space invasion status and DFS were compared using a univariable Cox regression model. When the nomogram was prepared, the scores of the risk factors were collected, and we observed that scores were at least 0 to a maximum of 414 points. The concordance-index for the nomogram was 0.895 (95% confidence interval, 0.79-0.99). The nomogram based on the indicated prognostic factors yielded excellent results in predicting recurrence in early-stage CC patients without LN metastasis who underwent radical hysterectomy.Impact statement Pathology of radical hysterectomy specimens in patients with early-stage cervical cancer provides information that has predictive prognostic potential. In addition to FIGO stage, other important prognostic factors are lymph node status, tumour size, parametrial involvement, vaginal cuff margin status, endomyometrial infiltration, histological type, patient age, lymphovascular space invasion, histological grade, and depth of cervical stromal invasion. In this study, patients with early-stage cervical cancer who underwent radical and modified radical hysterectomy without retroperitoneal lymph node involvement were evaluated, and recurrence development and factors affecting disease-free survival were investigated. A nomogram consisting of factors influencing disease-free survival was constructed. The total score was determined according to the status of all risk factors. This allowed clear definition of the risk for each patient. A nomogram predicting recurrence in patients with stages IA2-IIA cervical cancer with radical hysterectomy without lymph node involvement has not previously been published. Our study investigated early-stage cervical cancer (CC) patients without lymph node (LN) metastasis. Cox regression analysis was performed with six prognostic factors: FIGO stage, tumour size, parametrial margin infiltration, vaginal cuff margin involvement, endomyometrial infiltration, and LVSI positivity. The nomogram was constructed based on the results of Cox regression. The C-index for the nomogram was 0.895 (95% CI, 0.79-0.99). These results can be considered excellent. The higher concordance index in our study indicates that these six factors may be more valuable in predicting recurrence development in CC patients.
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http://dx.doi.org/10.1080/01443615.2019.1652888DOI Listing
July 2020

Evaluation of the optimal laparoscopic method for benign ovarian mass extraction: a transumbilical route using a bag made from a surgical glove versus a lateral transabdominal route employing a standard endobag.

J Obstet Gynaecol 2020 Apr 4;40(3):378-381. Epub 2019 Oct 4.

Department of Gynecologic Oncology, Tepecik Education and Research Hospital, Izmir, Turkey.

We compared two transumbilical (TU) routes of surgical specimen retrieval in women with ovarian masses treated via laparoscopy: a bag made from a surgical glove and lateral transabdominal (LTA) retrieval employing a standard endobag. A total of 109 women undergoing laparoscopic surgery to treat benign adnexal masses were retrospectively evaluated between 2014 and 2017. In total, 57 masses were removed via the TU route and 52 via the LTA route. We recorded the ovarian mass size; additional postoperative analgesic drug requirements. Postoperative incisional pain scores were assessed using a 10-cm visual analogue scale (VAS), time to discharge and procedure type. The mean VAS scores at 1 h (5.0 ± 1.7 vs. 6.3 ± 1.3;  < .001); 12 h (0.7 ± 0.8 vs. 1.2 ± 1.1;  = .004); and 24 h (0.1 ± 0.3 vs. 0.7 ± 0.6;  < .001) were lower in the TU-removal group. Furthermore, additional postoperative analgesic drug requirements were significantly higher in the LTA-removal group (10 (19.2%) vs. 3 (5.3%);  = .03). During laparoscopic surgery, removal of an ovarian mass via an umbilical port (compared to a lateral port) causes less postoperative pain and does not increase the risk of wound complications such as infection or hernia.Impact statement Laparoscopy has been used for the last 30 years. Constant improvement in the technique and equipment has allowed extensive, laparoscopic pelvic and abdominal surgery affording better outcomes than open surgery, an improved recovery, less pain, and fewer postoperative complications. However, mass removal remains a concern. Most laparoscopic specimens are larger than the initial trocar incision. Minimally invasive, adnexal mass surgery usually requires a trocar at least 10 mm wide to remove the mass. Alternatively, adnexal mass extraction from the abdominal cavity can proceed via a suprapubic, umbilical, or vaginal route. During laparoscopic surgery, ovarian mass removal through an umbilical port using an endobag made from a surgical glove is useful due to the method requiring little funds, is easy to do, and results in a lower amount of postoperative pain than a removal via a lateral port using a standard endobag. A transumbilical route using a bag made from a surgical glove is easy, economical, and causes less postoperative pain to the patient than removal via a lateral port employing a standard endobag.
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http://dx.doi.org/10.1080/01443615.2019.1623765DOI Listing
April 2020

Do estrogen, progesterone, P53 and Ki67 receptor ratios determined from curettage materials in endometrioid-type endometrial carcinoma predict lymph node metastasis?

Curr Probl Cancer 2020 02 26;44(1):100498. Epub 2019 Jul 26.

Muğla Sitki Koçman University Education and Research Hospital, Department of Gynecology and Oncology, Muğla, Turkey.

Aim: Estrogen receptor (ER), progesterone receptor (PR), and Ki-67 and P53 receptor levels in endometrial curettage material were investigated for their ability to predict lymph node (LN) involvement in patients with endometrioid-type endometrial cancer (EEC).

Methods: This retrospective study was based on a review of the records of patients who were diagnosed with EEC and underwent both hysterectomy and systematic retroperitoneal lymphadenectomy at the Gynecologic Oncology Clinic of Tepecik Training and Research Hospital, Turkey, between January 2008 and August 2017.

Results: The curettage materials of 138 EEC patients were analyzed for ER, PR and P53 and Ki-67 receptor levels. According to the pathology results, the median pelvic LN count was 20 (range: 12-49) and the para-aortic LN count was 14 (10-46). Retroperitoneal LN involvement was present in 18 patients (13.0%). The association of LN involvement with all receptors was significant. The combined ratio of the 2 groups of markers ([P53 + Ki67]/[ER + PR]) (≥0.71) was an independent risk factor for LN involvement. In addition, in a univariate logistic regression analysis all receptors were significant predictors of LN involvement.

Conclusions: In the detection of LN involvement, determination of the receptor status in curettage material has a high sensitivity and specificity. In EEC patients, receptor levels in curettage materials can be evaluated to detect LN involvement preoperatively.
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http://dx.doi.org/10.1016/j.currproblcancer.2019.07.003DOI Listing
February 2020

Comparison of laparoendoscopic single-site (LESS) surgery and conventional multiport laparoscopic (CMPL) surgery for hysterectomy: long-term outcomes of abdominal incisional scar.

J Obstet Gynaecol 2020 Feb 26;40(2):217-221. Epub 2019 Jul 26.

Department of Obstetrics and Gynecology, Oldenburg University, Oldenburg, Germany.

There is scarcity of data about the long-term results such as port-site hernia, body image scale and cosmesis scale outcomes between laparoendoscopic single-site (LESS) surgery and conventional multiport laparoscopy (CMPL) for hysterectomy. Eighty women, who underwent total hysterectomy by the LESS ( = 40) and CMPL ( = 40) technique due to benign and malign gynecological disorders, were evaluated with a cosmesis and body image questionnaire in an age-matched cohort study.Median follow-up time was 25 (6-30) months in both groups. The mean age of the patients was 49.3 ± 6.3 years. The mean body image scale scores were 5.3 ± 0.6 and 5.5 ± 1.2 in the LESS and CMPL groups, respectively ( = 0.268). The mean cosmesis and scar scale scores were significantly higher in the LESS group compared to the CMPL group ( = .011 and  < .001, respectively). Port-site hernia was detected in two patients in the LESS group, but not in the CMPL group. There was no cuff dehiscence in the LESS nor in the CMPL group. The LESS technique provides better cosmesis when compared with the CMPL technique. The body image perceptions in the two groups were similar. Women who wish to undergo the LESS surgery should be informed about the risk of incisional hernia.Impact statement Short-term results of LESS hysterectomy such as complication rates, additional port requirement, conversion to CMPL or laparotomy, pain score and analgesic use were evaluated in various studies. Several studies have been published on the safety and efficacy of single-port laparoscopic hysterectomy (LH); however, it has been unclear whether single-port LH offers benefits over multiport LH regarding long-term patient satisfaction and cosmetic satisfaction. In this prospective cohort study, we aimed to compare long-term results (at least six months) of abdominal incisional scar between LESS and CMPL surgery for hysterectomy. The LESS technique provides better cosmesis when compared with the CMPL technique, although, the body image perceptions in the two groups were similar. LESS technique can be offered as an option for hysterectomy since it provides better long-term cosmesis compared to CMPL.
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http://dx.doi.org/10.1080/01443615.2019.1606183DOI Listing
February 2020

Impact of pre-operative walking on post-operative bowel function in patients with gynecologic cancer.

Int J Gynecol Cancer 2019 10 19;29(8):1311-1316. Epub 2019 Jul 19.

Mugla Sitki Kocman Universitesi, Mugla, Turkey.

Background: There is a paucity of data on whether pre-operative walking and functional capacity has a direct association with post-operative gastrointestinal function in patients who have undergone surgery to treat gynecologic cancers.

Objective: To explore the relationship between pre-operative walking and post-operative recovery of bowel function.

Methods: This randomized trial was performed from January 1, 2018 to August 31, 2018. All patients had a diagnosis of endometrial or ovarian cancer and were scheduled for comprehensive staging. Group A served as the control group who did not walk regularly on the last night before surgery. Patients in group B walked for 30 min at an average speed of 3 km/h from 20.00 to 20.30 and 21.30. to 22.00 on the last night before surgery under the supervision of a nurse or doctor. The study was registered with clinicaltrials.gov (no: NCT03553121).

Results: A total of 85 patients were enrolled: 43 patients were assigned to the walking group and 42 to the control group. There were no significant differences in demographics between the groups. Median age was 57.3±8.5 in the control and 59.9±9.1 in the walking group. In addition, 28 patients had endometrial cancer and 14 had ovarian cancer in the control group. 33 patients and 10 patients in the walking group had endometrial and ovarian cancer, respectively. The mean time to first flatus was shorter in the walking group than in the control group (32.5±10.4 vs 40.6±16.9 hours, respectively; p=0.010). In addition, the time to first defecation was significantly shorter in the walking group (62.8±26.7 vs 91.4±51.8 hours; p=0.002). Patients who walked before surgery were less likely to have post-operative paralytic ileus (25.0% vs 60.7%; p=0.003). Walking before the operative period and laparoscopic surgery independently protected against the development of post-operative paralytic ileus.

Conclusion: Walking before surgery expedited time to bowel motility and ability to tolerate food. In addition, this method significantly decreased the risk of post-operative paralytic ileus.We consider that walking before surgery may be integrated into the pre-operative management of patients under going surgery for gynecologic cancers.

Clinical Trial Registration: clinicaltrial.org record number: NCT03553121.
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http://dx.doi.org/10.1136/ijgc-2019-000633DOI Listing
October 2019

Stage IB1 cervical cancer treated with modified radical or radical hysterectomy: does size determine risk factors?

Ginekol Pol 2018 ;89(12):667-671

Mersin State Hospital, Department of Obstetrics and Gynecology, Mersin, Turkey.

Objectives: This study was performed to investigate prognostic factors status at smaller tumors in patients with stageIB1 cervical cancer (CC) who underwent modified radical or radical hysterectomy.

Matherial And Metods: Data from patients diagnosed with CC between January 1995 and January 2017 at the GynecologicalOncology Department, Tepecik Training and Research Hospital and Bakirkoy Dr. Sadi Konuk Training and Research Hospital,Istanbul, Turkey, were investigated. A total of 182 stage IB1 CC cases were evaluated retrospectively.

Results: Patients were divided into two groups according to tumor size (< 2 cm and ≥ 2 cm). There were no complicationsassociated with the operation in patients with a tumor size < 2 cm. Among patients with a tumor size ≥ 2 cm, however, 0.9% (n = 1) developed bladder laceration, 0.9% (n = 1) rectum laceration, and 0.9% (n = 1) pulmonary emboli (P = 0.583). The rates of intermediate risk factors (depth of stromal invasion and lymphovascular space invasion) were significantly higher and lymph node involvement significantly more frequent in patients with a tumor size ≥ 2 cm. However, there were no significant differences in parametrial invasion or vaginal margin involvement between the two groups.

Conclusions: Intermediate risk factors and lymph node metastasis were significantly less frequent in patients with small tumors measuring < 2 cm. However, although parametrial involvement and vaginal margin involvement were less common in patients with small tumors compared with large tumors (≥ 2 cm), the differences were not significant.
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http://dx.doi.org/10.5603/GP.a2018.0112DOI Listing
August 2019

Isolated pulmonary metastases in patients with cervical cancer and the factors affecting survival after recurrence.

Ginekol Pol 2018;89(11):593-598

Mersin State Hospital, Department of Obstetrics and Gynecology, Mersin, Turkey.

Objectives: The aim of this study was to assess the treatment options and survival of uterine cervical cancer (UCC) patients who develop isolated pulmonary metastases (IPM) and to establish risk factors for IPM.

Material And Methods: Data from patients diagnosed with UCC between June 1991 and January 2017 at the Gynecological Oncology Department, Tepecik Training and Research Hospital, were investigated. In total, 43 cases with IPM were evaluated retrospectively. Additionally, 172 control patients diagnosed with UCC without recurrence were matched according to the International Federation of Gynecology and Obstetrics (FIGO) 2009 stage when the tumor was diagnosed. They wereselected using a dependent random sampling method.

Results: Of the 890 patients with UCC, 43 (4.8%) had IPM. The presence of lymphovascular space invasion (LVSI) and a mid-corpuscular volume (MCV) < 80 fL were statistically significant prognostic factors for IPM development in UCC patientsaccording to univariate regression analyses, and the presence of LVSI, a hemoglobin level < 12 g/dL, and an MCV < 80 fLwere statistically significant according to the multivariate regression analyses. We were unable to assess the role of lymph node status (involvement or reactive) as a prognostic factor in the development of IPM, because only seven patients (16.2%) in the case group underwent lymph node dissection.

Conclusions: IPM typically develops within the first 3 years after the diagnosis of UCC, and survival is generally poor. An MCV < 80 fL and the presence of LVSI are significant risk factors for IPM development.
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http://dx.doi.org/10.5603/GP.a2018.0102DOI Listing
February 2019

Does the 'equal management of equal risks' model cause overtreatment in patients with positive cervical cytology results for ASCUS/non-HPV16/18 oncogenic types?

Diagn Cytopathol 2019 Feb 16;47(2):105-109. Epub 2018 Nov 16.

Department of Obstetrics and Gynaecology, Bakirkoy Dr. Sadi Konuk Teaching and Research Hospital, Istanbul, Turkey.

Objectives: According to the American Society of Colposcopy and Cervical Pathology (ASCCP), cervical cytology patients who test positive for atypical squamous cells of undetermined significance (ASCUS) and the human papilloma virus (HPV) positive are recommended to undergo colposcopies. This study compared the colposcopic biopsy evaluation results of patients with positive cervical cytology results for ASCUS and HPV with regards to their HPV genotypes.

Methods: This study included 179 patients who underwent cervical cancer screening tests between June 2015 and June 2017 and whose results displayed positive cervical cervical cytology results for ASCUS and HPV. Cytological samples were classified using the Bethesda system in liquid-based specimens. The Hybrid Capture II system was used to define the HPV-DNA. Colposcopic diagnoses and biopsy results were compared in terms of the outcomes of the Pap test and HPV genotypes.

Results: There were 107 ASCUS/HPV16/18-positive patients. Of the HPV 16/18 positive patients; 28 (26.1%) patients were detected with CIN1, 8 (7.5%) patients were detected with CIN2, 6 (6%) patients were detected with CIN3, and 1 (0.9%) patient was detected with cervical cancer. Of the 72 non-HPV 16-18 positive patients; 8 (11%) patients were detected with CIN1 and 2 (2.7%) patients were detected with CIN2.

Conclusion: This study believes that the ASCCP recommendations, which state that a 'colposcopy should be performed on all women with positive cytology for ASCUS/non-HPV16/18 oncogenic types', is required to be revised. This will reduce the rate of the colposcopy procedures by 40% in women with ASCUS/HPV positivity.
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http://dx.doi.org/10.1002/dc.24029DOI Listing
February 2019

Effect of the pulmonary recruitment maneuver on pain after laparoscopic gynecological oncologic surgery: a prospective randomized trial.

J Gynecol Oncol 2018 Nov;29(6):e92

Department of Gynecologic Oncology, Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey.

Objective: To evaluate the effectiveness of the pulmonary recruitment maneuver (PRM) at the end of the operation to decrease laparoscopy-induced abdominal or shoulder pain after gynecological oncologic surgery.

Methods: In total, 113 women undergoing laparoscopic surgery for malignant or premalignant gynecological lesions were assigned randomly to two groups: the PRM group (the patient was placed in the Trendelenburg position (30°) and the PRM, consisting of two manual pulmonary inflations to a maximum pressure of 40 cmH₂O) (n=54) and the control group (n=52). Postoperative shoulder and abdominal pain was assessed 12, 24, and 48 hours later using a visual analog scale (0-10). In addition, the incidence of post-discharge nausea and vomiting was recorded until 48 hours after discharge.

Results: Postoperative shoulder pain at 12 and 24 hours was significantly less severe in the PRM group (2.2±0.5 and 2.0±0.4) than in the control group (4.0±0.5 and 3.9±0.4; both p<0.001). The PRM significantly reduced the severity of upper abdominal pain at 12 and 24 h compared with the control group (3.1±0.4 and 2.9±0.4 vs. 5.9±0.5 and 4.9±0.5; both p<0.001). The analgesic requirement during the postoperative period was similar in the two groups (control group, 78.8%; PRM group, 75.9%; p=0.719).

Conclusion: The PRM effectively and safely reduced postoperative shoulder and upper abdominal pain levels in patients undergoing laparoscopic gynecological oncologic surgery. Trial registry at ClinicalTrials.gov, NCT01940042.
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http://dx.doi.org/10.3802/jgo.2018.29.e92DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6189425PMC
November 2018

Management of Vertebral Metastasis in Patients With Uterine Cervical Cancer.

Int J Gynecol Cancer 2018 07;28(6):1191-1195

Department of Gynecology and Oncology, Muğla Sitki Koçman University Education and Research Hospital, Muğla, Turkey.

Aim: We sought to identify risk factors and management options for uterine cervical cancer (UCC) patients with a vertebral metastasis (VM) treated over the course of 23 years.

Methods: Among 844 UCC patients, 18 were diagnosed with a VM. Thirty-six control patients with UCC but without recurrence were matched to these 18 in terms of stage and histological tumor type using a dependent random sampling method. A logistic regression analysis was used to identify factors prognostic of VM; the results are presented as odds ratios with 95% confidence intervals (CIs).

Results: The mean survival time after VM treatment commenced was 12.1 ± 2.7 months (95% CI, 5.3-12.6 months) in patients who received chemotherapy (CT) and 15.0 ± 2.3 months (95% CI, 9.7-14.2 months) in those treated via chemoradiotherapy (CRT) (P = 0.566). In patients who underwent CT, the 1- and 2-year survival rates after recurrence were 19.2% and 0%, respectively. However, these figures were 50% and 8.3% in those treated via CRT. Both lymphovascular space invasion and mean corpuscular volume were risk factors for VM. Cox regression analysis showed that these prognostic factors had no effect on survival duration after recurrence. The locations and percentages of vertebra metastasis were as follows: 11.1% lumbar 4, 27.7% lumbar 5, 22.2% lumbar 4-5, 16.7% lumbar 3-4-5, 5.6% lumbar 2-3, 5.6% lumbar 2-3-4, 5.6% lumbar 3-4-5/sacral 1, and 5.6% thoracic 11-12/lumbar 1-2.

Conclusions: We found that patients with lymphovascular space invasion were at high risk of isolated VM and that the survival times after CT and CRT were similar. Because most VMs are seen in the vertebral space within the borders of radiation therapy, borders of external beam radiotherapy should be carefully determined for each patient.
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http://dx.doi.org/10.1097/IGC.0000000000001273DOI Listing
July 2018

Is the measurement of the size of uterine lesions with positron emission tomography consistent in pre- and postmenopausal periods in endometrioid-type endometrial cancer?

Turk J Obstet Gynecol 2018 Mar 29;15(1):60-64. Epub 2018 Mar 29.

Muğla Sıtkı Koçman University, Training and Research Hospital, Department of Gynecology and Oncology, Muğla, Turkey.

Objective: We aimed to investigate the correlation of the size and volume of uterine tumors obtained using positron emission tomography/computed tomography (PET/CT) and pathology specimens in patients with endometrioid-type endometrial cancer (EEC) in the premenopausal period, and to compare the results with those of postmenopausal women. In the premenopausal period, the endometrium uses more glucose than in the postmenopausal period. Therefore, the measurement of uterine tumor size using PET/CT in the premenopausal period may normally be different.

Materials And Methods: In this retrospective study, we reviewed the records of patients who were diagnosed as having EEC and underwent hysterectomy. Only patients who underwent preoperative PET/CT imaging were included in the study. The thickness and volume of the uterine lesion, and its maximum standardized uptake value as obtained using PET/CT and hysterectomy pathology specimens were recorded.

Results: Tumor size (p=0.051) and volume (p=0.404) were not found to be correlated with the imaging method used in premenopausal women and pathologic specimens. However, there was a correlation in postmenopausal women (p<0.001 for tumor size and p<0.001 for tumor volume). PET/CT has higher sensitivity, specificity, and positive predictive value in the postmenopausal period in the detection of >20 mm uterine tumors.

Conclusion: PET/CT has a limited role in the measurement of the size of uterine lesions in all patients, especially in the premenopausal period; therefore, we recommend that frozen-section examinations be used intraoperatively to decide on lymph node dissection.
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http://dx.doi.org/10.4274/tjod.64188DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5894538PMC
March 2018

Laparoendoscopic Single-Site Sentinel Lymph Node Detection in Endometrial Cancer.

J Minim Invasive Gynecol 2018 Jul - Aug;25(5):776. Epub 2017 Nov 13.

Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Bakırköy Dr. Sadi Konuk Education and Research Hospital, Health Sciences University, İstanbul, Turkey.

Study Objective: To demonstrate the feasibility of sentinel lymph node (SLN) biopsy using a laparoendoscopic single-site (LESS) approach in endometrial cancer (EC).

Design: A step-by-step video demonstration of the surgical procedure (Canadian Task Force Classification III).

Setting: The satisfaction of patients who undergo LESS hysterectomy is greater than that reported by patients who undergo multiport laparoscopic hysterectomy, owing to better cosmesis and reduced postoperative analgesic requirements [1]. SLN biopsy is associated with significantly lower estimated blood loss, shorter operation time, and less morbidity compared with systematic lymphadenectomy [2]. LESS surgery can be more feasible and safer with the use of SLN biopsy compared with complete lymphadenectomy in patients with early-stage EC.

Interventions: This 69-year-old woman with grade 2 endometrioid EC underwent SLN mapping followed by LESS SLN biopsy, total hysterectomy, and bilateral salpingo-oophorectomy. Before the umbilical incision was made, 1.25 mg/mL of indocyanine green was injected into the cervical stroma at the 3 o'clock and 9 o'clock positions to both deep and superficial levels. A 10-mm 30° standard-length optical camera for near-infrared fluorescence imaging was used. The total operative time was 75 minutes, and the estimated blood loss was 20 mL. SLNs were detected bilaterally between proximal parts of the external iliac arteries and veins. After SLN resection, total hysterectomy and bilateral salpingo-oophorectomy were performed. No postoperative complications occurred. The patient was discharged at 30 hours after surgery. In the final pathology, stage 1A G2 EC was detected.

Conclusion: LESS SLN biopsy and TLH-BSO is a feasible procedure and sentinel lymph node concept may increase the use of LESS in EC.
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http://dx.doi.org/10.1016/j.jmig.2017.10.035DOI Listing
August 2019

Effects of coffee consumption on gut recovery after surgery of gynecological cancer patients: a randomized controlled trial.

Am J Obstet Gynecol 2017 Feb 22;216(2):145.e1-145.e7. Epub 2016 Oct 22.

Department of Gynecologic Oncology, Tepecik Education and Research Hospital, Gaziler Street, Izmir, Turkey.

Background: Paralytic ileus that develops after elective surgery is a common and uncomfortable complication and is considered inevitable after an intraperitoneal operation.

Objective: The purpose of this study was to investigate whether coffee consumption accelerates the recovery of bowel function after complete staging surgery of gynecologic cancers.

Study Design: In this randomized controlled trial, 114 patients were allocated preoperatively to either postoperative coffee consumption with 3 times daily (n=58) or routine postoperative care without coffee consumption (n=56). Total abdominal hysterectomy and bilateral salpingo-oophorectomy with systematic pelvic and paraaortic lymphadenectomy were performed on all patients as part of complete staging surgery for endometrial, ovarian, cervical, or tubal cancer. The primary outcome measure was the time to the first passage of flatus after surgery. Secondary outcomes were the time to first defecation, time to first bowel movement, and time to tolerance of a solid diet.

Results: The mean time to flatus (30.2±8.0 vs 40.2±12.1 hours; P<.001), mean time to defecation (43.1±9.4 vs 58.5±17.0 hours; P<.001), and mean time to the ability to tolerate food (3.4±1.2 vs 4.7±1.6 days; P<.001) were reduced significantly in patients who consumed coffee compared with control subjects. Mild ileus symptoms were observed in 17 patients (30.4%) in the control group compared with 6 patients (10.3%) in the coffee group (P=.01). Coffee consumption was well-tolerated and well-accepted by patients, and no intervention-related side-effects were observed.

Conclusion: Coffee consumption after total abdominal hysterectomy and systematic paraaortic lymphadenectomy expedites the time to bowel motility and the ability to tolerate food. This simple, cheap, and well-tolerated treatment should be added as an adjunct to the postoperative care of gynecologic oncology patients.
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http://dx.doi.org/10.1016/j.ajog.2016.10.019DOI Listing
February 2017

Differentiated therapy in pre- and postmenopausal adnexal torsion based on malignancy rates: A retrospective multicentre study over five years.

Int J Surg 2016 May 19;29:95-100. Epub 2016 Mar 19.

Department of Obstetrics and Gynecology, Hacettepe University School of Medicine, Ankara, Turkey.

Introduction: The purpose of this study was to investigate the clinical presentation, intra and postoperative outcomes in pre and postmenopausal women who underwent operations for adnexal torsion, and to define our experience diagnosing and managing postmenopausal women with adnexal torsion.

Methods: One hundred and fifty-seven patients who underwent operation with a diagnosis of adnexal torsion were analyzed according to demographic characteristics, menopausal status, preoperative signs and symptoms, surgical findings and applied surgical procedures, and pathological results in four tertiary centers.

Results: The main indication for surgery for the postmenopausal women was pelvic mass (58% vs. 40%), while for premenopausal women the main indication was suspicion of torsion (55% vs. 24%), (each p < 0.001). The duration of time between being admitted to the hospital and entering operating room as well as the duration of surgery and postoperative hospitalization were statistically longer in the postmenopausal group (each p < 0.001). While extensive surgeries were performed for 68% of the postmenopausal group, this was required for only 3% of the premenopausal group. Functional cysts were the most common pathologic finding in premenopausal women, and only 2 cases of malignancy (1.6%) were seen as opposed to the postmenopausal group, where malignancy was diagnosed in 16% of cases (p < 0.001).

Discussion: Adnexal torsion in postmenopausal women is an uncommon event. Malignancy risk should be considered before operation.

Conclusion: The malignancy rate was 16% in postmenopausal women with adnexal torsion. Thus, extensive surgeries are more common in postmenopausal women with adnexal torsion.
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http://dx.doi.org/10.1016/j.ijsu.2016.03.042DOI Listing
May 2016
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