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Publication Metadata only Regional differences in total hospital costs for radical cystectomy in the United States(Elsevier Sci Ltd, 2023) Hoeh, Benedikt; Flammia, Rocco Simone; Hohenhorst, Lukas; Sorce, Gabriele; Chierigo, Francesco; Panunzio, Andrea; Tian, Zhe; Saad, Fred; Gallucci, Michele; Briganti, Alberto; Terrone, Carlo; Shariat, Shahrokh F.; Graefen, Markus; Antonelli, Alessandro; Kluth, Luis A.; Becker, Andreas; Chun, Felix K. H.; Karakiewicz, Pierre I.; Tilki, Derya; School of Medicine; Koç University HospitalObjectives: To test for regional differences in total hospital costs (THC) across the United States in bladder cancer patients treated with open radical cystectomy (ORC) or robotic-assisted radical cystectomy (RARC). Materials: We relied on the National Inpatient Sample (NIS) database (2016-2019) and stratified RC patients according to census region (Midwest, Northeast, South, West). Primary statistical analyses consisted of THC-trend analyses and multivariable log-link linear regression models, after adjustment for hospital clustering (Generalized Estimating Equation function) and discharge disposition weighting. Finally, sensitivity analysis, relying on most favorable patient cohort, was performed. Results: Of 5280 eligible patients, 1441 (27%), 1031 (20%), 1854 (35%) and 954 (18%) underwent RC in the Midwest, Northeast, South and West, respectively. Median THC was 28,915$ and differed significantly between regions (Midwest: 28,105$; Northeast: 28,886$; South: 26,096$; West: 38,809$; p < 0.001). After stratification between ORC and RARC, highest THC was invariably recorded in the West: ORC 36,137$ vs 23,941-28,850$ and RARC 43,119$ vs 28,425-29,952$ (both p < 0.05). In multivariable log-link linear regression models, surgery in the West was independently associated with higher THC: ORC (Exponent beta (Exp(beta]]: 1.39; 95%-CI: 1.32-1.47; p < 0.001) and RARC (Exp(beta]: 1.46; 95%-CI: 1.38-1.55; p < 0.001). Results remained unchanged when analyses were refitted in most favorable patient subgroup. Conclusions: Important regional differences in ORC and RARC THC distinguish the West from other United States regions. The THC discrepancy clearly requires closer examination to identify underlying processes that contribute to inflated costs in the West.Publication Metadata only Anatomical parameters of percutaneous, minimally invasive, direct intralaminar pars screw fixation of spondylolysis(Elsevier Science Inc, 2024) Gudu, Burhan Oral; Aydin, Ahmet Levent; Mercan, Necip Engin; Dilbaz, Suna; Cirak, Musa; N/A; Özer, Ali Fahir; School of Medicine- OBJECTIVE: To investigate the anatomical parameters of the ideal screw trajectory for percutaneous intralaminar screw fixation of a pars defect in lumbar spondylolysis using computed tomography scans. - METHODS: Using advanced radiological software, the ideal intralaminar screw trajectory was determined. The anatomical parameters of this trajectory were analyzed using a total of 80 single-level lumbar tomography scans in patients with spondylolysis at the lumbar 4 vertebrae and lumbar 5 vertebrae levels. The ideal intralaminar screw trajectory started from the inferolateral edge of the lamina and was between the intralaminar region, pars defect, and defective pars neck and pedicle. Along this trajectory, the skin-lamina distance, intralaminar screw length, isthmic lamina length and width, defective pars neck width, lateral entry distance of the screw to the center of the spinous process, and sagittal and coronal screw application angles were analyzed. - RESULTS: When comparing the lumbar 4 vertebrae and lumbar 5 vertebrae parameters, the mean skin-to-lamina distances were 11-9 cm ( P = 0.000), intralaminar screw lengths 3.5-3.6 cm ( P = 0.067), isthmic lamina lengths 22 cm ( P = 0.698), mid-lamina widths 1-1 cm ( P = 0.941), defective pars neck widths 1-1 cm ( P = 0.674), screw lateral entry distances according to the spinous process 1-1.5 cm ( P = 0.000), sagittal screw angles 45 degrees-45 degrees ( P = 0.870), and coronal screw angles 10 degrees-20 degrees ( P = 0.000), respectively. There were no differences based on age and gender ( P < 0.05). - CONCLUSIONS: Percutaneous intralaminar rigid screw fixation of a pars defect in spondylolysis provides minimally invasive, low-profile instrumentation. In spondylolysis, a screw length of 3-4 cm and a screw diameter of 45 mm may be sufficient for pars fixation with intralaminar screws.Publication Metadata only Association of TaqI (rs731236) polymorphism of vitamin D receptor gene with lumbar degenerative disc disease(Elsevier Science Inc, 2024) Serifoglu, Luay; Yilmaz, Seda Gulec; Karaaslanli, Abdulmutalip; Etli, Mustafa Umut; Ozdogan, Selcuk; N/A; Düzkalır, Ali Haluk; N/A; Koç University Hospital- BACKGROUND: Lumbar degenerative disc disease (LDDD) significantly contributes to low back pain, with a complicated etiology involving genetic and environmental facts. The aim of study was to investigate the association between the Taq I (rs731236) polymorphism of the vitamin D receptor ( VDR ) gene with LDDD. - METHODS: In total, 248 patients with symptomatic LDDD and 146 control subjects were examined. The evaluation of clinical features of patients with LDDD comprised radiodiagnostic magnetic resonance imaging, neurologic examinations, pain scores including the visual analog scale (VAS), and disability investigation with Oswestry Disability Index (ODI). Genotyping of the VDR gene polymorphism was conducted using polymerase chain reaction ebased methods.- RESULTS: Individuals of the LDDD group who were VDR TaqI AA genotype carriers were significantly greater than the other group ( P = 0.014), whereas those with GG genotype were significantly lower ( P = 0.028) in the patient group. In addition, VAS and ODI scores were significantly lower in the GG genotype carrier group, whereas AA genotype carriers had the greatest scores ( P = 0.004). Carrying the G allele decreased the risk of LDDD 1.7 times ( P = 0.014) and carrying the A allele enhanced the risk 1.8 times ( P = 0.028). Moreover, G-allele carriers had significantly lower VAS ( P = 0.002) and ODI scores ( P < 0.0001). - CONCLUSIONS: VDR Taq I (rs731236) GG genotype and G allele have protective potential, whereas the AA genotype and A allele are risk factors for LDDD. The findings reveal a statistically significant association of the Taq I (rs731236) polymorphism of VDR gene polymorphism with LDDD. This result highlights the potential role of genetic factors in developing LDDD and suggests avenues for future research in genetic screening and personalized treatment strategies.Publication Metadata only The relationship between inflammatory processes and apoptosis in lumbar disc degeneration(Elsevier Inc., 2024) Cetintas, Semih Can; Akyol, Sibel; Alizada, Orkhan; Tahmazoglu, Burak; Hanci, Murat; Isler, Cihan; N/A; Akgün, Mehmet Yiğit; N/A; Koç University HospitalObjective: Degenerative Disc Disease (DDD) is a common health problem in the population. There are recent studies focusing on relationship between DDD and immunological factors. However, there is still a lack of data on the role of apoptosis in DDD pathophysiology. Therefore, we aimed to investigate the relationship between Modic-type changes and the apoptosis in DDD. Materials and Methods: Ninety adult male patients who presented with low back and/or radicular pain and were operated on due to lumbar disc herniation were included. Three groups were formed based on Modic type degeneration observed on magnetic resonance imaging. Specific parameters involved in the intrinsic and extrinsic pathways of apoptosis were assessed in excised disc materials using the enzyme-linked immunosorbent assay method. Results: All three groups formed according to Modic degeneration types were homogenous in all variances. Cytochrome-C was significantly decreased only in the Modic type-3 group, whereas Tumor Necrosis Factor-Related Apoptosis-Inducing Ligand Receptor-1, B-Cell Lymphoma-2 (Bcl-2) Homologous Antagonist Killer-1, Direct Inhibitor of Apoptosis-Binding Protein with Low Pi, and Bcl-2 Associated X Apoptosis Regulator levels were significantly different in both Modic type-2 and -3 groups. However, BH3 interacting domain death agonist and Bcl-2 levels were similar across all groups. Conclusions: In conclusion, this study suggests that Direct Inhibitor of Apoptosis-Binding Protein with Low Pi, cytochrome - c, Bcl-2 Associated X Apoptosis Regulator, Bcl-2 Homologous Antagonist Killer-1, and Tumor Necrosis Factor-Related Apoptosis-Inducing Ligand Receptor-1proteins play important roles in the development and progression of DDD and are correlated with Modic types. Further studies are needed to explore the potential therapeutic role of inhibiting these apoptotic proteins in DDD. © 2024 Elsevier Inc.Publication Metadata only Differences in other-cause mortality in metastatic renal cell carcinoma according to partial vs. radical nephrectomy and age: a propensity score matched study(Elsevier Sci Ltd, 2024) Siech, Carolin; Incesu, Reha-Baris; Morra, Simone; Scheipner, Lukas; Baudo, Andrea; Jannello, Letizia Maria Ippolita; de Angelis, Mario; Goyal, Jordan A.; Tian, Zhe; Saad, Fred; Shariat, Shahrokh F.; Longo, Nicola; Carmignani, Luca; de Cobelli, Ottavio; Ahyai, Sascha; Briganti, Alberto; Mandel, Philipp; Kluth, Luis A.; Chun, Felix K. H.; Karakiewicz, Pierre I.; N/A; Tilki, Derya; School of Medicine; Koç University HospitalIntroduction: It is unknown whether the benefit from partial nephrectomy regarding lower other-cause mortality is applicable to older patients with metastatic renal cell carcinoma. Materials and methods: Using Surveillance Epidemiology and End Results database, patients with metastatic renal cell carcinoma, undergoing partial or radical nephrectomy, were stratified according to age (<60, 60-69, and >= 70 years). After propensity score matching, Kaplan-Meier survival analyses and multivariable Cox regression models were used. Results: Of 2,390 patients with metastatic renal cell carcinoma, 885 (37%) were aged <60 years, and 90 (10%) underwent partial nephrectomy; 824 (34%) were aged 60-69 years, and 61 (7%) underwent partial nephrectomy; and 681 (29%) were aged >= 70 years, and 64 (9%) underwent partial nephrectomy. After propensity score matching, in patients aged <60 years, partial nephrectomy was associated with lower other-cause mortality (hazard ratio 0.22; p = 0.02); in patients aged 60-69 years, partial nephrectomy was associated with lower othercause mortality (hazard ratio 0.38; p = 0.03); but not in patients aged >= 70 years. Discussion: In metastatic renal cell carcinoma, partial nephrectomy is associated with lower other-cause mortality in patients aged <60 years and in patients aged 60-69 years, but not in patients aged >= 70 years. In consequence, consideration of partial nephrectomy might be of great value in younger metastatic renal cell carcinoma patients.Publication Metadata only Surgically treated pelvic liposarcoma and leiomyosarcoma: the effect of tumor size on cancer-specific survival(Elsevier Ltd, 2024) Baudo, Andrea; Piccinelli, Mattia Luca; Incesu, Reha-Baris; Morra, Simone; Scheipner, Lukas; Barletta, Francesco; Tappero, Stefano; Garcia, Cristina Cano; Assad, Anis; Tian, Zhe; Acquati, Pietro; de Cobelli, Ottavio; Longo, Nicola; Briganti, Alberto; Terrone, Carlo; Chun, Felix K.H.; Ahyai, Sascha; Saad, Fred; Shariat, Shahrokh F.; Carmignani, Luca; Karakiewicz, Pierre I.; N/A; Tilki, Derya; School of Medicine; Koç University HospitalIntroduction: In soft tissue pelvic liposarcoma and leiomyosarcoma, it is unknown whether a specific tumor size cut-off may help to better predict prognosis, defined as cancer-specific survival (CSS). We tested whether different tumor size cut-offs, could improve CSS prediction. Materials and methods: Surgically treated non-metastatic soft tissue pelvic sarcoma patients were identified (Surveillance, Epidemiology, and End Results 2004–2019). Kaplan-Meier plots, univariable and multivariable Cox-regression models and receiver operating characteristic-derived area under the curve (AUC) estimates were used. Results: Overall, 672 (65 %) liposarcoma (median tumor size 11 cm, interquartile range [IQR] 7–16) and 367 (35 %) leiomyosarcoma (median tumor size 8 cm, IQR 5–12) patients were identified. The p-value derived ideal tumor size cut-off was 17.1 cm, in liposarcoma and 7.0 cm, in leiomyosarcoma. In liposarcoma, according to p-value derived cut-off, five-year CSS rates were 92 vs 83 % (≤17.1 vs > 17.1 cm). This cut-off represented an independent predictor of CSS and improved prognostic ability from 83.8 to 86.8 % (Δ = 3 %). Similarly, among previously established cut-offs (5 vs 10 vs 15 cm), also 15 cm represented an independent predictor of CSS and improved prognostic ability from 83.8 to 87.0 % (Δ = 3.2 %). In leiomyosarcoma, according to p-value derived cut-off, five-year CSS rates were 86 vs 55 % (≤7.0 vs > 7.0 cm). This cut-off represented an independent predictor of CSS and improved prognostic ability from 68.6 to 76.5 % (Δ = 7.9 %). Conclusions: In liposarcoma, the p-value derived tumor size cut-off was 17.1 cm vs 7.0 cm, in leiomyosarcoma. In both histologic subtypes, these cut-offs exhibited the optimal statistical characteristics (univariable, multivariable and AUC analyses). In liposarcoma, the 15 cm cut-off represented a valuable alternative. © 2024 Elsevier LtdPublication Metadata only Expansion of the subcutaneous compartment by umbilicus resection for intrathecal pump placement: the "Karagoz-Hacivat technique"(Lippincott Williams and Wilkins, 2024) Isler C.; Cerci HM; Aydin YS; Toklu S; Hanci MM; Bağhaki, Semih; ; ; Koç University HospitalBACKGROUND AND OBJECTIVES:Intrathecal baclofen (ITB) for severe spasticity can encounter complications such as wound dehiscence and ulcers because of elevated intracompartmental pressure within the abdominal subcutaneous and subfascial pocket housing the pump. We propose an innovative technique to manage ITB wound ulcers.METHODS:Resecting the umbilicus create a more spacious and less tension-prone pocket for the ITB pump.RESULTS:Between 2015 and 2023, we implanted ITB pumps in 65 patients. Among them, 5 patients presented with skin ulcer or dehiscence underwent surgery using the novel technique. Postoperative follow-up revealed successful wound healing, with no further wound-related complications.CONCLUSION:The proposed technique provides effective and practical solution to wound and skin complications related to ITB pump. Moreover, it may serve as a viable preemptive strategy during the initial implantation of the ITB pump in selected patients.Publication Metadata only Total vNOTES hysterectomy versus conventional total laparoscopic hysterectomy in virgin transgender men(Taylor and Francis Ltd, 2024) Elci, Erkan; Elci, Gulhan; Dönmez, Emin Erhan; School of MedicineBackground and Aim: Comparison of the applicability, safety, and surgical outcomes of total vaginal NOTES hysterectomy (TVNH) using natural orifice transluminal endoscopic surgery, which is considered a natural orifice surgery for hysterectomy with bilateral salpingo-oophorectomy (HBSO) in virgin transgender men, with conventional total laparoscopic hysterectomy (TLH). Material and Methods: A retrospective cohort study was conducted between 2019 and 2021. The results of transgender male individuals who underwent HBSO operations using TVNH (n = 21) were compared with those who underwent operations using TLH (n = 62). Results: TVNH was performed in 21 individuals, while TLH was performed in 62 individuals. Patients in the TVNH approach group had a longer operation duration than those in the TLH group (p = .001). Patients in the TVNH group experienced less pain at two hours (5 +/- 1.56), six hours (4 +/- 1.57), 12 h (2 +/- 0.91), and 24 h (1 +/- 0.62) postoperatively (p = .001). The postoperative hospitalization duration was shorter in the TVNH group (1.6 +/- 1.01) than in the TLH group (2.9 +/- 0.5) (p = .001). Conclusions: For the HBSO operation of female-to-male transgender individuals, TVNH, which is completely endoscopically performed, can be preferred and safely conducted as an alternative surgical method to conventional laparoscopy.Publication Metadata only Identifying low cancer-specific mortality risk lymph node-positive radical prostatectomy patients(Wiley, 2024) Barletta, Francesco; Tappero, Stefano; Morra, Simone; Incesu, Reha-Baris; Garcia, Cristina Cano; Piccinelli, Mattia L.; Scheipner, Lukas; Tian, Zhe; Gandaglia, Giorgio; Stabile, Armando; Mazzone, Elio; Terrone, Carlo; Longo, Nicola; Chun, Felix K. H.; de Cobelli, Ottavio; Ahyai, Sascha; Saad, Fred; Shariat, Shahrokh F.; Montorsi, Francesco; Briganti, Alberto; Karakiewicz, Pierre I.; Tilki, Derya; School of MedicineObjectives: To identify low cancer-specific mortality (CSM) risk lymph node-positive (pN1) radical prostatectomy (RP) patients. Methods: Within Surveillance, Epidemiology and End Results database (2010-2015) pN1 RP patients were identified. Kaplan-Meier plots and multivariable Cox-regression (MCR) models were used. Pathological characteristics were used to identify patients at lowest CSM risk. Results: Overall, 2197 pN1 RP patients were identified. Overall, 5-year cancer-specific survival (CSS) rate was 93.3%. In MCR models ISUP GG1-2 (hazard ratio [HR]: 0.12, p < 0.001), GG3 (HR: 0.14, p < 0.001), GG4 (HR: 0.35, p = 0.002), pT2 (HR: 0.27, p = 0.012), pT3a (HR: 0.28, p = 0.003), pT3b (HR: 0.39, p = 0.009), and 1-2 positive lymph nodes (HR: 0.64, p = 0.04) independently predicted lower CSM. Pathological characteristics subgroups with the most protective hazard ratios were used to identify low-risk (ISUP GG1-3 and pT2-3a and 1-2 positive lymph nodes) patients versus others (ISUP GG4-5 or pT3b-4 or >= 3 positive lymph nodes). In Kaplan-Meier analyses, 5-year CSS rates were 99.3% for low-risk (n = 480, 21.8%) versus 91.8% (p < 0.001) for others (n = 1717, 78.2%). Conclusions: Lymph node-positive RP patients exhibit variable CSS rates. Within this heterogeneous group, those at very low risk of CSM may be identified based on pathological characteristics, namely ISUP GG1-3, pT2-3a, and 1-2 positive lymph nodes. Such stratification scheme might be of value for individual patients counseling, as well as in design of clinical trials.Publication Metadata only Repeat stereotactic radiosurgery for persistent cerebral arteriovenous malformations in pediatric patients(American Association of Neurological Surgeons, 2024) Garcia, Gracie; Mantziaris, Georgios; Pikis, Stylianos; Dumot, Chloe; Lunsford, L. Dade; Niranjan, Ajay; Wei, Zhishuo; Srinivasan, Priyanka; Tang, Lilly W.; Liscak, Roman; May, Jaromir; Lee, Cheng-Chia; Yang, Huai-Che; Nabeel, Ahmed M.; Reda, Wael A.; Tawadros, Sameh R.; Karim, Khaled Abdel; El-Shehaby, Amr M.N.; Eldin, Reem Emad; Elazzazi, Ahmed Hesham; Moreno, Nuria Martínez; Álvarez, Roberto Martínez; Padmanaban, Varun; Jareczek, Francis J.; McInerney, James; Cockroft, Kevin M.; Alzate, Juan Diego; Kondziolka, Douglas; Tripathi, Manjul; Sheehan, Jason P.; Peker, Selçuk; Samancı, Mustafa Yavuz; School of MedicineOBJECTIVE The purpose of this study was to describe the long-term outcomes and associated risks related to repeat stereotactic radiosurgery (SRS) for persistent arteriovenous malformations (AVMs) in pediatric patients. METHODS Under the auspices of the International Radiosurgery Research Foundation, this retrospective multicenter study analyzed pediatric patients who underwent repeat, single-session SRS between 1987 and 2022. The primary outcome variable was a favorable outcome, defined as nidus obliteration without hemorrhage or neurological deterioration. Secondary outcomes included rates and probabilities of hemorrhage, radiation-induced changes (RICs), and cyst or tumor formation. RESULTS The cohort included 83 pediatric patients. The median patient age was 11 years at initial SRS and 15 years at repeat SRS. Fifty-seven children (68.7%) were managed exclusively using SRS, and 42 (50.6%) experienced hemorrhage prior to SRS. Median AVM diameter and volume were substantially different between the first (25 mm and 4.5 cm3, respectively) and second (16.5 mm and 1.6 cm3, respectively) SRS, while prescription dose and isodose line remained similar. At the 5-year follow-up evaluation from the second SRS, nidus obliteration was achieved in 42 patients (50.6%), with favorable outcome in 37 (44.6%). The median time to nidus obliteration and hemorrhage was 35.5 and 38.5 months, respectively. The yearly cumulative probability of favorable outcome increased from 2.5% (95% CI 0.5%–7.8%) at 1 year to 44% (95% CI 32%–55%) at 5 years. The probability of achieving obliteration followed a similar pattern and reached 51% (95% CI 38%–62%) at 5 years. The 5-year risk of hemorrhage during the latency period after the second SRS reached 8% (95% CI 3.2%–16%). Radiographically, 25 children (30.1%) had RICs, but only 5 (6%) were symptomatic. Delayed cyst formation occurred in 7.2% of patients, with a median onset of 47 months. No radiation-induced neoplasia was observed. CONCLUSIONS The study results showed nidus obliteration in most pediatric patients who underwent repeat SRS for persistent AVMs. The risks of symptomatic RICs and latency period hemorrhage were quite low. These findings suggest that repeat radiosurgery should be considered when treating pediatric patients with residual AVM after prior SRS. Further study is needed to define the role of repeat SRS more fully in this population. © 2024 American Association of Neurological Surgeons. All rights reserved.