Researcher:
Tezelman, Tevfik Serdar

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Tevfik Serdar

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Tezelman

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Tezelman, Tevfik Serdar

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2018 - 201932020 - 20215

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    Should we perform routine prophylactic central neck dissection in patients with thyroid papillary microcarcinoma?
    (Edizioni Luigi Pozzi, 2018) Bilgiç, Cağrı; Karabay, Önder; Ağcaoğlu, Orhan; Şengün, Berke; Özoran, Emre; Taşkın, Orhun Çığ; Dereli, Dilek Yazıcı; Tezelman, Tevfik Serdar; Faculty Member; Undergraduate Student; Faculty Member; Faculty Member; Faculty Member; Faculty Member; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; 175476; N/A; N/A; 166686; 179659; 114860
    PURPOSE: Cervical lymph node (LN) metastases in papillary thyroid cancer (PTC) are common in tumors especially that are larger than 1cm. Ipsilateral central neck dissection (CND) is usually preferred even in the absence of a palpable LN. This study aims to clarify the incidence and predictive factors for occult ipsilateral central LN metastasis in these patients, and the management of patients without clinical evidence of metastasis. METHODS: 204 PTC patients were studied. The patients were divided into two according to the tumor size of <= 5mm or larger. Patient demographics, tumor properties, LN metastasis, preoperative neck ultrasonography findings and surgical outcomes were analyzed. RESULTS: There were 152 patients in study group-1 (nodule > 5 mm) and 52 patients in group-2 (nodule 5 mm). The mean tumor size was 11.9 mm. Overall, preoperative neck ultrasonography showed central neck LN in 25 (12.3%) patients, however, final pathology revealed metastatic LN at central compartment in 59 (28.9%) patients. There were 56 (27.5%) patients with metastasis in group-1 compared to 3 (1.4%) patients in group-2. CONCLUSIONS: Prophylactic CND is advised in PTC for the reduction of recurrence in central compartment. According to our results, in patients with tumors smaller than 5 mm and without evidence of nodal metastasis in preoperative neck ultrasonography, we do not recommend prophylactic CND.
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    Single-incision robotic adrenalectomy (SIRA): the future of adrenal surgery?
    (Ame Publishing Company, 2020) Ağcaoğlu, Orhan; Tezelman, Tevfik Serdar; Karahan, Salih Nafiz; Tüfekçi, Tutku; Faculty Member; Faculty Member; Researcher; Researcher; School of Medicine; School of Medicine; School of Medicine; School of Medicine; 175476; 114860; 337050; 327608
    In compliance with the trend toward less invasive techniques, single incision robotic surgeries have become more common and they have been increasingly used for several surgeries including adrenalectomy. Single incision robotic adrenalectomy (SIRA) aims to combine the merits of robotic surgery with previously defined single incision laparoscopic techniques. It has been shown to be safe and feasible, however, there are only few studies on this new technique. Due to scant data on SIRA in the current literature, it remains to be a current challenge in adrenal surgery. In this review, our goal is to present current literature on SIRA and discuss the data regarding perioperative outcomes, patient selection, learning curve, and its limitations.
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    Comparison of technical details and short-term outcomes of single-incision versus multiport laparoscopic adrenalectomy
    (Lippincott Williams and Wilkins (LWW), 2019) Gurbuz, Bulent; Carilli, Senol; N/A; N/A; N/A; N/A; N/A; Ağcaoğlu, Orhan; Şengün, Berke; Şenol, Kazım; Özoran, Emre; Tezelman, Tevfik Serdar; Faculty Member; Undergraduate Student; Doctor; Teaching Faculty; Faculty Member; School of Medicine; School of Medicine; N/A; School of Medicine; School of Medicine; N/A; N/A; Koç University Hospital; N/A; N/A; 175476; 309087; N/A; 307296; 114860
    To date, the single-incision laparoscopic surgery (SILS) technique has been applied to a wide range of general surgical procedures; however, there are still scant data and debates on adrenal procedures. The aim of this study was to compare surgical outcomes of single-incision versus laparoscopic multiport adrenalectomy. The patients were divided into 2 study groups on the basis of the surgical approach: SILS (group 1) and multiport laparoscopic surgery (group 2). Patient demographics and their perioperative and postoperative results were evaluated retrospectively from the medical records. A total of 80 patients were included in the study. There were 44 patients in group 1 and 36 patients in group 2. The average operative time, estimated blood loss, and tumor size were similar between the study groups. There were no mortalities in both groups and the mean duration of hospital stay was 3 days for both groups. Without using any single-incision access trocars and articulated instrumentation, we achieved the same surgical outcomes in our SILS adrenalectomy series compared with conventional multiport laparoscopy series in terms of postoperative short-term outcomes and cost-effectivity.
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    Tumor border pattern and size help predict lymph node status in papillary microcarcinoma: a clinicopathologic study
    (Elsevier, 2020) Peker, Önder; Terzioğlu, Tarık; Taşkın, Orhun Çığ; Armutlu, Ayşe; Ağcaoğlu, Orhan; Demirkol, Mehmet Onur; Tezelman, Tevfik Serdar; Kapran, Yersu; Faculty Member; Teaching Faculty; Faculty Member; Faculty Member; Faculty Member; Faculty Member; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; Koç University Hospital; 166686; 133567; 175476; 196946; 114860; 168101
    Objective: Lymph node metastasis occurs in a subset of papillary microcarcinoma patients. We aimed to analyze the differences between metastatic and non-metastatic papillary microcarcinomas in order to identify a high-risk subgroup that is likely to require more aggressive treatment. Materials and methods: 126 thyroidectomies with lymph node dissections (central +/- lateral), diagnosed as papillary microcarcinoma, were reviewed. Results: Mean age of 126 patients (F/M = 3.3) was 42 years. Mean size of the largest tumor was 7 mm. Classical was the most frequently (89%) encountered subtype. Multiple histologic subtypes co-occurred in 19%. Lymphovascular invasion was present in 16% (n = 20). 55 (44%) and 71 (56%) cases were unifocal and multifocal, respectively. 90 cases (71%) were non-encapsulated with overall infiltrative tumor borders, whereas in 36 cases (29%), the tumor had a well-defined capsule. Among those, 23 (64%) had tumor capsule invasion. 47 (37%) cases had metastasis in lymph nodes. In univariate analysis, metastasis was associated with tumor size of > 5 mm (p = 0.02), tumor burden of > 5 mm (p = 0.03), lymphovascular invasion (p = 0.02) and non-encapsulation (p = 0.01). No associations were found regarding sex, age, histologic subtype, lymphocytic thyroiditis, tumor capsule invasion (in capsulated tumors), laterality and multifocality (p > 0.05). In multivariate analysis, lymphovascular invasion (p = 0.01, OR = 3.97, 95% CI 1.35-11.67), tumor size > 0.5 cm (p = 0.031, OR = 2.92, 95% CI 1.10-7.71) and non-encapsulation (p = 0.033, OR = 2.85, 95% CI 1.08-7.51) were independent risk factors. Conclusion: Size (largest tumor or sum of all foci) of > 5 mm, non-encapsulation and lymphovascular invasion were independent predictors of LNM in PMs. Unifocal tumors metastasize the same as multifocal tumors, suggestive of the contribution of other factors. Patients with sporadically resected microcarcinomas should be carefully followed-up, especially those that harbor risk factors in histology.
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    Surgical approaches for papillary microcarcinomas: Turkey's perspective
    (Aves, 2018) Makay, Özer; Ozdemir, Murat; Şenyürek, Yasemin Giles; Tunca, Fatih; Duren, Mete; Uludağ, Mehmet; Hacıyanlı, Mehmet; İçözz, Göokhan; İşgör, Adnan; Özbaş, Serdar; Özcan, Zehra; N/A; Tezelman, Tevfik Serdar; Faculty Member; School of Medicine; 114860
    Objectives: The incidence of papillary microcarcinomas, which are defined as thyroid cancers of <10mm in size, has been increasing in the last decade. Herein, we present internet-based questionnaire results performed by the Turkish Association of Endocrine Surgery with the aim to evaluate the perspective of the management of papillary microcarcinomas in Turkey. Material and Methods: The user-friendly questionnaire consisted of 13 questions in total. These questions mainly addressed the surgical management of nodules and cancer of <1 cm in size. Patient management before, during, and after surgical intervention was also included; additionally, the "active surveillance approach" was questioned. Results: There were 420 responders in total who were of multidisciplinary origin (endocrinologists, surgeons, nuclear medicine specialists, pathologists, and oncologists). Total thyroidectomy was the predominant treatment approach (65%) for the classical type of microcarcinoma limited in one lobe, whereas in cases of microcarcinomas incidentally diagnosed during hemithyroidectomy, complementary surgery approach was advised by 40% of the responders. The responders found capsule invasion (86%) and patient based management (94%) of high importance. The percentage of the responders who recommended radioactive iodine ablation in incidental cancers having no aggressive criteria was 51%. The survey participants that were against routine central dissection in these cases accounted for 73% of the responders. The recommendation of active surveillance (follow-up without any interventional therapy) was limited with 9% responders. Conclusion: The results of the questionnaire demonstrated that there have been various choices in Turkey for the surgical treatment of the papillary microcarcinomas.
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    PublicationOpen Access
    The use of focused, radioguided parathyroidectomy in geriatric patients with a history of thyroid surgery
    (Hellenic Society of Nuclear Medicine, 2020) Falay, Fikri Okan; Ağcaoğlu, Orhan; Karahan, Salih Nafiz; Deniz, Sinan; Gökler, Ozan; Aydemir, Yeliz; Taşkın, Orhun Çığ; Tezelman, Tevfik Serdar; Demirkol, Mehmet Onur; Teaching Faculty; Faculty Member; Researcher; Doctor; Teaching Faculty; Faculty Member; Faculty Member; Faculty Member; School of Medicine; Koç University Hospital; 246484; 175476; N/A; N/A; 311179; N/A; 166686; N/A; 196946
    Objective: geriatric patients are often reluctant to undergo parathyroid surgery under general anesthesia because of the major comorbidities. The use of minimally invasive techniques for parathyroid lesions under local anesthesia have been published. Radioguided lesion localization has been known to decrease operative time and reduce the occurrence of positive margins in breast cancer surgery. We hypothesize that it could also be effectively used in focused parathyroid surgery in geriatric patients with in history of thyroid surgery. Materials and methods: our study group consists of geriatric patients with a history of thyroid surgery who underwent focused parathyroid surgery between February 2017 and October 2019. Group-1 included 18 patients who had parathyroidectomy under radioguidance. Group-2, 22 patients who had surgery without it. Patient demographics, operative time, number of frozen sections and length of hospital stay were analyzed. Results: analyzed data were similar between groups. The mean age of the patients was 72.56±12.65 years (range: 65-88). The operative times for group-1 and group-2, were 65.42±7.78 and 74.63±15.98 minutes, respectively (P=0.002). All patients were discharged uneventfully on postoperative day-2. Conclusion: radioguidance parathyroidectomy positively affected the operative time and also decreased the need for additional frozen section.
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    PublicationOpen Access
    Single-incision robotic adrenalectomy (SIRA): the future of adrenal surgery?
    (AME Publishing Company, 2020) Ağcaoğlu, Orhan; Karahan, Salih Nafiz; Tüfekçi, Tutku; Tezelman, Tevfik Serdar; Faculty Member; Researcher; Researcher; School of Medicine; 175476; N/A; N/A; N/A
    In compliance with the trend toward less invasive techniques, single incision robotic surgeries have become more common and they have been increasingly used for several surgeries including adrenalectomy. Single incision robotic adrenalectomy (SIRA) aims to combine the merits of robotic surgery with previously defined single incision laparoscopic techniques. It has been shown to be safe and feasible, however, there are only few studies on this new technique. Due to scant data on SIRA in the current literature, it remains to be a current challenge in adrenal surgery. In this review, our goal is to present current literature on SIRA and discuss the data regarding perioperative outcomes, patient selection, learning curve, and its limitations.
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    PublicationOpen Access
    Management of endocrine surgical disorders during COVID-19 pandemic: expert opinion for non-surgical options
    (Springer, 2021) Sezer, A.; Makay, O.; Erdoğan, M. F.; Bayram, F.; Güldiken, S.; Raffaelli, M.; Sönmez, Y. A.; Lee, Y.-S.; Vamvakidis, K.; Mihai, R.; Duh, Q.-Y.; Akıncı, B.; Almquist, M.; Barczynski, M.; Bayraktaroğlu, T.; Berber, E.; Bukey, Y.; Çakmak, G. K.; Cantürk, N. Z.; Cantürk, Z.; Çelik, M.; Çelik O.; Ceyhan, B. O.; Cherenko, S.; Clerici, T.; Coombes, D. S.; Demircan, O.; Dionigi, G.; Emre, A. U.; Erbil, Y.; Filiz, A. I.; Gozu, H. I.; Gürdal, S. O.; Gürleyik, G.; Hacıyanlı, M.; Kebudi, A.; Kim, S.; Koutelidakis, G.; Kuru, B.; Mert, M.; Oruk, G. G.; Özbaş, S.; Palazzo, F.; Pandev, R.; Riss, P.; Sabuncu, T.; Şahin, I.; Sakman, G.; Saygılı, F.; Şenyürek, Y. G.; Sleptsov, I.; Van Slycke, S.; Teksöz, S.; Terzioğlu, T.; Tunca, F.; Uğurlu, M. U.; Uludağ, M.; Villar-del-Moral, J.; Vriens, M.; Ağcaoğlu, Orhan; Alagöl, Faruk; Deyneli, Oğuzhan; Dereli, Dilek Yazıcı; Tezelman, Tevfik Serdar; Faculty Member; Faculty Member; Faculty Member; School of Medicine; 175476; N/A; 171914; 179659; N/A
    Purpose: the COVID-19 pandemic brought unprecedented conditions for overall health care systems by restricting resources for non-COVID-19 patients. As the burden of the disease escalates, routine elective surgeries are being cancelled. The aim of this paper was to provide a guideline for management of endocrine surgical disorders during a pandemic. Methods: we used Delphi method with a nine-scale Likert scale on two rounds of voting involving 64 experienced eminent surgeons and endocrinologists who had the necessary experience to provide insight on endocrine disorder management. All voting was done by email using a standard questionnaire. Results: overall, 37 recommendations were voted on. In two rounds, all recommendations reached an agreement and were either endorsed or rejected. Endorsed statements include dietary change in primary hyperparathyroidism, Cinacalcet treatment in secondary hyperparathyroidism, alpha-blocker administration for pheochromocytoma, methimazole ± β-blocker combination for Graves’ disease, and follow-up for fine-needle aspiration results of thyroid nodules indicated as Bethesda 3–4 cytological results and papillary microcarcinoma. Conclusion: this survey summarizes expert opinion for the management of endocrine surgical conditions during unprecedented times when access to surgical treatment is severely disrupted. The statements are not applicable in circumstances in which surgical treatment is possible.