Publications by authors named "Kayhan Tarim"

9 Publications

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Genitalia Preserving Robotic Radical Cystectomy with Intracorporeal Studer Pouch Formation in the Female: Experience in 5 Cases.

Robot Surg 2021 28;8:1-7. Epub 2021 Apr 28.

Koç University, School of Medicine, Department of Urology, Istanbul, Turkey.

We present operative, postoperative, oncologic and functional outcomes of genital tract sparing robot-assisted laparoscopic radical cystectomy, bilateral extended pelvic lymph node (LN) dissection and intracorporeal Studer pouch construction on five female patients with bladder cancer. One of the cases had concomitant nephroureterectomy performed due to a non-functioning kidney. Median patient age, mean operation time, median estimated blood loss and mean duration of hospital stay were 59 (39-78), 462 ± 25, 400 (50-970), 8.8 ± 2.5, respectively. Pathologic stages were pTis (n=1), pT1 (n=1), pT3 (n=1), pT4a (n=1) and pT4b (n=1). Mean LN yield was 32.4 ± 8.9. Positive surgical margins were detected in 2 patients with pT4 diseases. Only minor complications developed that were resolved with medical treatment. Two patients had no, 1 patient had mild, and 2 patients had moderate daytime incontinence. One patient had good, 3 patients had fair, and 1 had poor night-time incontinence. This complex robotic surgery can be performed safely with acceptable short-term surgical, oncological and functional outcomes.
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http://dx.doi.org/10.2147/RSRR.S300598DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8092426PMC
April 2021

Is elective cancer surgery feasible during the lock-down period of the COVID-19 pandemic? Analysis of a single institutional experience of 404 consecutive patients.

J Surg Oncol 2021 Jun 23;123(7):1495-1503. Epub 2021 Feb 23.

Department of General Surgery, School of Medicine, Koc University, Istanbul, Turkey.

Background: We aimed to assess the feasibility and short-term clinical outcomes of surgical procedures for cancer at an institution using a coronavirus disease 2019 (COVID-19)-free surgical pathway during the peak phase of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic.

Materials And Methods: This was a single-center study, including cancer patients from all surgical departments, who underwent elective surgical procedures during the first peak phase between March 10 and June 30, 2020. The primary outcomes were the rate of postoperative SARS-CoV-2 infection and 30-day pulmonary or non-pulmonary related morbidity and mortality associated with SARS-CoV-2 disease.

Results: Four hundred and four cancer patients fulfilling inclusion criteria were analyzed. The rate of patients who underwent open and minimally invasive procedures was 61.9% and 38.1%, respectively. Only one (0.2%) patient died during the study period due to postoperative SARS-CoV2 infection because of acute respiratory distress syndrome. The overall non-SARS-CoV2 related 30-day morbidity and mortality rates were 19.3% and 1.7%, respectively; whereas the overall SARS-CoV2 related 30-day morbidity and mortality rates were 0.2% and 0.2%, respectively.

Conclusions: Under strict institutional policies and measures to establish a COVID-19-free surgical pathway, elective and emergency cancer operations can be performed with acceptable perioperative and postoperative morbidity and mortality.
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http://dx.doi.org/10.1002/jso.26436DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8013582PMC
June 2021

Ga-PSMA-11 Positron Emission Tomography/Computed Tomography for Primary Lymph Node Staging Before Radical Prostatectomy: Central Review of Imaging and Comparison with Histopathology of Extended Lymphadenectomy.

Eur Urol Focus 2021 Mar 25;7(2):288-293. Epub 2021 Jan 25.

Department of Urology, Koc University Hospital, Istanbul, Turkey; Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.

Background: Results from prospective trials have shown higher accuracy of prostate-specific membrane antigen (PSMA)-based positron emission tomography (PET)/computed tomography (CT) in detection of lymph node metastasis (LNM) compared to conventional imaging.

Objective: To evaluate the accuracy of Ga-PSMA-11 PET/CT for LNM detection in patients undergoing radical prostatectomy (RP) and extended pelvic lymph node dissection (PLND).

Design, Setting, And Participants: Between June 2014 and November 2020, 96 patients with Ga-PSMA PET/CT for primary staging underwent RP and extended PLND.

Outcome Measurements And Statistical Analysis: The results from Ga-PSMA PET/CT were compared with histologic data from primary PLND in 96 patients. All Ga-PSMA PET/CT scans were centrally reviewed.

Results And Limitations: Of 96 patients, 15.6% (n = 15) harbored LNMs. The median prostate-specific antigen at Ga-PSMA PET/CT was 8.0 ng/ml (interquartile range 5.5-11.7). The majority of patients had intermediate- (52.1%) or high-risk disease (41.7%). Biopsy grade group 4 and 5 was present in 22.9% and 15.6%, respectively. The Ga-PSMA PET/CT scans identified eight of 15 patients (53.3%) as LN-positive (true positive). The calculated per-patient sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of Ga-PSMA PET/CT in the detection of LNM were 53.3%, 98.8%, 88.9%, 92.0%, and 91.7%, respectively. The per-patient sensitivity and specificity in the detection of LNMs larger than 2 mm were 61.5% and 98.8%, respectively. The main limitation is the retrospective design of the study.

Conclusions: Ga-PSMA PET/CT is accurate in lymph node staging and the results support its use for primary staging of prostate cancer.

Patient Summary: We compared prostate-specific membrane antigen (PSMA)-based positron emission tomography (PET)/computed tomography (CT) findings with histopathology results after extended lymph node dissection and showed that it is accurate in detecting lymph node metastases. Our results support the use of PSMA PET/CT for primary staging of prostate cancer.
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http://dx.doi.org/10.1016/j.euf.2021.01.004DOI Listing
March 2021

Feasibility, safety and efficacy of argon beam coagulation in robot-assisted partial nephrectomy for solid renal masses ≤ 7 cm in size.

J Robot Surg 2020 Oct 13. Epub 2020 Oct 13.

Department of Urology, School of Medicine, Koç University, 34010, İstanbul, Turkey.

One of the most important steps of the partial nephrectomy (PN) is hemostatic control of tumor bed which also effects the warm ischemia time (WIT). Argon beam coagulation (ABC) for decades is a well-known method for surface controls during major open surgical sites. This study aimed to compare peri- and postoperative relevant parameters in patients with ABC or internal renorrhaphy (IR) during robot-assisted partial nephrectomy (RAPN). One hundred seventy patients with ≤ 7 cm tumors, who underwent RAPN at our institutions, were included in this retrospective study. Tumor bed was controlled by either IR or by ABC after closing isolated overt collecting system defects. No additional IR was performed in patients with ABC. Estimated blood loss (EBL), WIT, estimated glomerular filtration rate (eGFR) change, on- vs. off-clamp procedure as well as Clavien-Dindo > 2 complications in both groups were compared. Eighty-seven (51.1%) patients had ABC and 83 (48.9%) had IR as their tumor bed control method. Tumor size, side and RENAL nephrometry score in both groups were similar. Mean warm ischemia time (WIT) was 20.8 min in ABC group and 23.8 min in IR group (p = 0.03). In 4-7 cm tumors, WIT was 19.9 min in ABC group while 26.6 min in IR group (p = 0.026). eGFR change from baseline and EBL favored ABC in entire cohort as well as in 4-7 cm tumors with statistical significance. There were more off-clamp procedures with ABC in ≤ 4 cm tumors. No ABC specific complications were observed. Within 2 years of follow-up, no patient developed recurrences. The control of the tumor base with ABC during RAPN shortens the warm ischemia times significantly compared to IR. Besides, ABC had better EBL and GFR changes outcomes. With close monitoring of intra-abdominal pressure and frequent venting, disturbing complications of ABC could completely be avoided. ABC was found to be feasible, safe and effective during RAPN.
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http://dx.doi.org/10.1007/s11701-020-01158-4DOI Listing
October 2020

Corrigendum to "The role of sodium intake in nephrolithiasis: Epidemiology, pathogenesis, and future directions" [Eur J Intern Med 35 (2016) 16-19].

Eur J Intern Med 2017 01 26;37:90. Epub 2016 Nov 26.

Division of Nephrology, Department of Medicine, Koc University School of Medicine, Istanbul, Turkey. Electronic address:

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http://dx.doi.org/10.1016/j.ejim.2016.11.012DOI Listing
January 2017

Gut hormones and gut microbiota: implications for kidney function and hypertension.

J Am Soc Hypertens 2016 12 1;10(12):954-961. Epub 2016 Nov 1.

Division of Nephrology, Department of Medicine, Koc University School of Medicine, Istanbul, Turkey. Electronic address:

Increased blood pressure (BP) and chronic kidney disease are two leading risk factors for cardiovascular disease. Increased sodium intake is one of the most important risk factors for development of hypertension. Recent data have shown that gut influences kidney function and BP by variety of mechanisms. Various hormones and peptides secreted from gut such as gastrin, glucocorticoids, Glucagon-like peptide-1 impact on kidney function and BP especially influencing sodium absorption from gut. These findings stimulate scientist to find new therapeutic options such as tenapanor for treatment of hypertension by blocking sodium absorption from gut. The gastrointestinal tract is also occupied by a huge community of microbes (microbiome) that under normal condition has a symbiotic relationship with the host. Alterations in the structure and function of the gut microbiota have been shown to play a key role in the pathogenesis and complications of numerous diseases including hypertension. Based on these data, in this review, we provide a summary of the available data on the role of gut and gut microbiota in regulation of BP and kidney function.
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http://dx.doi.org/10.1016/j.jash.2016.10.007DOI Listing
December 2016

The role of sodium intake in nephrolithiasis: epidemiology, pathogenesis, and future directions.

Eur J Intern Med 2016 Nov 19;35:16-19. Epub 2016 Jul 19.

Division of Nephrology, Department of Medicine, Koc University School of Medicine, Istanbul, Turkey. Electronic address:

The prevalence of nephrolithiasis has doubled over the last decade and the incidence in females now approaches that of males. Since dietary salt is lithogenic, a purported mechanism common to both genders is excess dietary sodium intake vis-a-vis processed and fast foods. Nephrolithiasis has far-reaching societal implications such as impact on gross domestic product due to days lost from work (stone disease commonly affects working adults), population-wide carcinogenic diagnostic and interventional radiation exposure (kidney stone disease is typically imaged with computed tomographic imaging and treated under imaging guidance and follow-up), and rising healthcare costs (surgical treatment will be indicated for a number of these patients). Therefore, primary prevention of kidney stone disease via dietary intervention is a low-cost public health initiative with massive societal implications. This primer aims to establish baseline epidemiologic and pathophysiologic principles to guide clinicians in sodium-directed primary prevention of kidney stone disease.
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http://dx.doi.org/10.1016/j.ejim.2016.07.001DOI Listing
November 2016

Endostatin in chronic kidney disease: Associations with inflammation, vascular abnormalities, cardiovascular events and survival.

Eur J Intern Med 2016 Sep 7;33:81-7. Epub 2016 Jul 7.

Department of Nephrology, Gülhane School of Medicine, Ankara, Turkey.

Background And Aims: Endostatin, generated from collagen XVIII, and endorepellin, possess dual activity as modifiers of both angiogenesis and endothelial cell autophagy. Plasma endostatin levels are elevated in a large number of diseases, and may reflect endothelial cell dysfunction. Few data on endostatins are available for patients with chronic kidney disease (CKD). We tested whether serum endostatin values are predictive for all-cause mortality and cardiovascular events (CVEs) in a CKD population.

Materials And Method: A total of 519 CKD pre-dialysis patients were included. Baseline plasma endostatin levels were measured in all patients. All included patients were followed-up (time-to-event analysis) until occurrence of death, fatal or nonfatal CVEs. Fatal and nonfatal CVE including death, stroke, and myocardial infarction were recorded prospectively

Results: The mean age of the patients was 52.2±12.3years. There were 241 (46.4%) males, 111 (21.4%) had diabetes, 229 (44.1%) were smokers and 103 (19.8%) had a previous CVE. After a median follow-up of 46months, 46 patients died and 172 had a new CVE. In the univariable Cox survival analysis, higher endostatin levels were associated with a higher risk for both outcomes. However, after adjusting for traditional (age, gender, smoking status, diabetes, systolic blood pressure, HDL and total cholesterol) and renal-specific (eGFR, proteinuria and hsCRP) risk factors, endostatin levels remained associated only with the CVE outcome (HR=1.88, 95% CI 1.37-2.41 for a 1 SD increase in log endostatin values).

Conclusion: Endostatin levels are independently associated with incident CVE in CKD patients, but show limited prediction abilities for all-cause mortality and CVE above traditional and renal-specific risk factors.
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http://dx.doi.org/10.1016/j.ejim.2016.06.033DOI Listing
September 2016

Novel Masters of Erythropoiesis: Hypoxia Inducible Factors and Recent Advances in Anemia of Renal Disease.

Blood Purif 2016 18;42(2):160-7. Epub 2016 Jun 18.

Division of Nephrology, Department of Medicine, Sakarya University Training and Research Hospital, Sakarya, Turkey.

Anemia seen in patients with chronic kidney disease is a particular form of 'anemia of chronic disease'. Although multifactorial in origin, erythropoiesis-stimulating agents (ESAs) and adjuvant iron therapy represent the primary treatment for anemia in chronic kidney disease. Subsequent clinical observations revealed that these ESA hyporesponsive patients often had increased systemic inflammation as a consequence of their comorbidities. Use of high ESA doses to overcome this ESA hyporesponsiveness posed some concerns regarding associated adverse events of therapy and increased mortality in this special patient population. Recognizing the pivotal roles of hypoxia inducible factors (HIFs) in orchestrating elements of erythropoiesis opened new avenues in the management of renal anemia. Several phase 1 and 2 studies confirmed the results of early experimental studies supporting the beneficial role of augmenting HIFs for erythropoiesis. In this review, we describe the physiologic functions of HIF in erythropoiesis with special emphasis on interactions with iron and hepcidin metabolism and inflammation.
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http://dx.doi.org/10.1159/000446273DOI Listing
February 2017