Researcher: Bilge, Orhan
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Bilge, Orhan
Bilge, Orhan Ali
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Publication Metadata only Contribution of gallbladder polyp surgery to treatment(Springer, 2017) Carilli, Şenol; Emre, Ali; Kaya, Aziz; Yaltı, Tunc; Kabaoglu, Burcak; N/A; N/A; N/A; N/A; Aliyazıcıoğlu, Tolga; Buğra, Dursun; Bilge, Orhan; Alper, Aydın; Doctor; Faculty Member; Faculty Member; Faculty Member; N/A; School of Medicine; School of Medicine; School of Medicine; Koç University Hospital; N/A; N/A; N/A; N/A; 1758; 176833; 119809Background Surgery is the preferred treatment for gallbladder polyps, not only for relieving the symptoms but also for eliminating the potential risk of malignancy. In our study, we investigated whether patients who had undergone surgery truly had a surgical indication and beyond question required laparoscopic cholecystectomy due to malignancy. Materials and methods 185 patients who were prediagnosed with gallbladder polyps were operated in VKV American Hospital, Istanbul between January 2004 and July 2015. Retrospective data of all patients included patients' age, gender, symptoms, preoperative ultrasonography, pathology reports, radiologic findings regarding the number and size of the polyps, and postoperative follow-up. Results 140 out of 185 patients were symptomatic before surgery. 85 patients (60.7 %) reported that their symptoms persisted after they had undergone surgery. 20 (14.3 %) of the patients with postoperatively persisting symptoms had no polyps in their pathologic examination. Only 35 out of 140 patients (25 %) reported relief of symptoms following surgery. Postoperative pathologic investigation revealed adenocarcinoma in only 1 patient and adenomatous polyps in 2 patients. Conclusion Postoperative pathologic investigations reveal only a very small percentage of premalignant and malignant polyps among patients who have undergone laparoscopic cholecystectomy. This finding clearly points out that we require new methods to differentiate cholesterol polyps from adenomatous polyps. Furthermore, the surgical indication criteria for patients with gall bladder polyps should be updated to prevent futile operations and morbidity.Publication Metadata only Optimizing the personalized care for the management of rectal cancer: a consensus statement(Aves, 2022) Aytaç, Erman; Özer, Leyla; Baca, Bilgi; Uluç, Başak Oyan; Abacioğlu, Mehmet Ufuk; Gönenç, Murat; Aygün, Cem; Yıldız, Mehmet Erdem; Ünal, Kemal; Er, Özlem; Beşe, Nuran; Ceyhan, Güralp Onur; Özbek, Uğur; Tozun, Nurdan; Erdamar, Sibel; Yakıcıer, Cengiz; Saruç, Murat; Özben, Volkan; Esen, Eren; Vardareli, Erkan; Güner, Levent; Hamzaoğlu, İsmail; Karahasanoğlu, Tayfun; N/A; Balık, Emre; Kapran, Yersu; Taşkın, Orhun Çığ; Bölükbaşı, Yasemin; Çil, Barbaros Erhan; Baran, Bülent; Erkol, Burçak; Yaltı, Mehmet Tunç; Attila, Tan; Gürses, Bengi; Bilge, Orhan; Mandel, Nil Molinas; Selek, Uğur; Kayserili, Hülya; Özoran, Emre; Buğra, Dursun; Faculty Member; Faculty Member; Faculty Member; Faculty Member; Faculty Member; Faculty Member; Doctor; Faculty Member; Faculty Member; Faculty Member; Faculty Member; Faculty Member; Faculty Member; Faculty Member; Teaching Faculty; Faculty Member; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; N/A; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; N/A; N/A; N/A; N/A; N/A; N/A; Koç University Hospital; N/A; N/A; N/A; N/A; N/A; N/A; N/A; N/A; N/A; 18758; 168101; 166686; 216814; 169993; 167583; N/A; 221690; 118342; 113169; 176833; 194197; 27211; 7945; 307296; 1758Colorectal cancer is the third most common cancer in Turkey. The current guidelines do not provide sufficient information to cover all aspects of the management of rectal cancer. Although treatment has been standardized in terms of the basic principles of neoadjuvant, surgical, and adjuvant therapy, uncertainties in the management of rectal cancer may lead to significant differences in clinical practice. In order to clarify these uncertainties, a consensus program was constructed with the participation of the physicians from the Acibadem Mehmet Ali Aydınlar and Koc Universities. This program included the physicians from the departments of general surgery, gastroenterology, pathology, radiology, nuclear medicine, medical oncology, radiation oncology, and medical genetics. The gray zones in the management of rectal cancer were determined by reviewing the evidence-based data and current guidelines before the meeting. Topics to be discussed consisted of diagnosis, staging, surgical treatment for the primary disease, use of neoadjuvant and adjuvant treatment, management of recurrent disease, screening, follow-up, and genetic counseling. All those topics were discussed under supervision of a presenter and a chair with active participation of related physicians. The consensus text was structured by centralizing the decisions based on the existing data.Publication Metadata only Risk factors for delayed gastric emptying after pancreaticoduodenectomy(Lippincott Williams & Wilkins, 2022) Bilgiç, Çağrı; Sobutay, Erman; N/A; Bilge, Orhan; Faculty Member; School of Medicine; 176833Objectives: Delayed gastric emptying (DGE) is a complication that affects the length of hospitalization and associated cost after pancreaticoduodenectomy (PD). The reported risk factors for DGE were controversial. This study aimed to identify risk factors for the development of DGE after PD. Methods: The patients who underwent PD between October 2010 and October 2020 were retrospectively examined. Multivariate analysis was performed to predict the variables causing DGE. Results: In total, 225 patients underwent PD. The pylorus preserving PD was applied to 151 patients (67%), whereas standard PD to 74 (33%). The DGE was detected in 26 patients (11.5%). The majority of cases were classified as grade A (57.7%), whereas 3 8.4% as grade B and 3.9% as grade C. In the multivariate analysis, diabetes mellitus (odds ratio [OR], 3.48; 95% confidence interval [CI], 1.45-8.34; P = 0.05), the preoperative biliary stent (OR, 2.5; 95% CI, 1.04-5.99; P = 0.039), and the pylorus resection (OR, 3.05; 95% CI, 1.28-7.25; P= 0.012) were independently associated with DGE. Conclusions: We demonstrated that implementation of the preoperative stent, pylorus resection, and diabetes mellitus are independent risk factors for DGE. Pylorus preservation should remain the standard of care in PD.Publication Metadata only Laparoscopic assisted pancreaticoduodenectomy in periampullary tumors(Dokuz Eylül Üniversitesi Tıp Fakültesi, 2021) Zenger, Serkan; Can, Uğur; Gürbüz, Bülent; Bilgiç, Çağrı; Sobutay, Erman; N/A; Bilge, Orhan; Faculty Member; School of Medicine; 176833Objective: In line with the developments in technology, the number of minimally invasive procedures in pancreatic surgery is increasing gradually in order to reduce the morbidity rates. We aimed to present the results of the patients who underwent laparoscopic assisted pancreaticoduodenectomy for periampullary tumors in our clinic. Materials and Methods: Data of the patients who underwent laparoscopic assisted pancreaticoduodenectomy for periampullary tumor between April 2014 and August 2020 were retrospectively analyzed. Demographic and clinical characteristics, surgical outcomes, postoperative results and pathological data of the patients were presented. Results: of the 30 patients, 12 (40%) were female, 18 (60%) were male, and the mean age was 64±14. Laparoscopy was converted to open technique in five (13.3%) patients. The mean operative time was 378 ± 72 minutes and the mean length of hospital stay was 10 ± 4 days. In postoperative period, seven (23.3%) patients had minor complications and four (13.3%) patients had major complications. Major complications were grade B pancreatic fistula in three patients and intraabdominal abscess in one patient. Pathological diagnosis of patients were adenocarcinoma in 20 (66.7%) patients, intrapapillary mucinous neoplasm in 6 (20%) patients, solid pseudopapillary neoplasm in 2 (6.6%) patients, neuroendocrine tumor in 1 (3.3%) patient and gastrointestinal stromal tumor in 1 (3.3%) patient. The mean number of harvested lymph nodes was 16.5 ± 8.2. Conclusion: Laparoscopic assisted pancreaticoduodenectomy is a feasible method due to the advantages of minimally invasive procedures such as reducing local complications, morbidity, and length of hospital stay. However, we believe that laparoscopic assisted pancreaticoduodenectomy should be performed by teams experienced in laparoscopy in selected patients. / Amaç: Teknolojideki gelişmeler doğrultusunda, morbidite oranlarını azaltmak amacıyla pankreas cerrahisinde de minimal invaziv girişimlerin sayısı giderek artmaktadır. Bu çalışmada, kliniğimizde periampuller bölge tümörlerinde laparoskopi yardımlı pankreatikoduodenektomi uyguladığımız hastaların sonuçlarını paylaşmayı amaçladık. Gereç ve Yöntem: Nisan 2014 ile Ağustos 2020 yılları arasında periampuller bölge tümörü nedeniyle laparoskopi yardımlı pankreatikoduodenektomi uygulanan hastaların demografik ve klinik özellikleri, ameliyat verileri, postoperatif sonuçları ve patolojik verileri retrospektif olarak incelendi. Bulgular: Çalışmaya dâhil edilen 30 hastanın 12’si (%40) kadın, 18’i (%60) erkek, ortalama yaşları 64 ± 14 idi. Beş (%13,3) hastada açık yönteme geçildi. Ortalama ameliyat süresi 378 ± 72 dakika ve ortalama hastanede kalış süresi ise 10 ± 4 gündü. Postoperatif dönemde, 7 (%23,3) hastada minor komplikasyon, 4 (%13,3) hastada ise major komplikasyon saptandı. Major komplikasyonlar; 3 hastada grade B pankreatik fistül ve 1 hastada ise karın içi apse idi. Hastaların patolojik tanıları; 20’sinde (%66,7) adenokarsinom, 6’sında (%20) intrapapiller müsinöz neoplazm, 2’sinde (%6,6) solid psödopapiller neoplazm, 1’inde (%3,3) nöroendokrin tümör ve 1’inde (%3,3) ise gastrointestinal stromal tümör idi. Ortalama çıkarılan lenf nodu sayısı 16,5 ± 8,2 idi. Sonuç: Laparoskopi yardımlı pankreatikoduodenektomi, lokal komplikasyonları ve morbiditeyi azaltması, hastanede kalış süresini kısaltması gibi minimal invaziv girişimlerin sağladığı avantajlar nedeniyle uygulanabilir bir yöntemdir. Ancak laparoskopi yardımlı pankreatikoduodenektomi için, uygun hasta seçimi ile birlikte bu işlemin laparoskopi konusunda tecrübeli ekipler tarafından uygulanması gerektiği kanaatindeyiz.Publication Metadata only Outcomes of first-line long-acting octreotide treatment in non-functional, advanced gastroenteropancreatic neuroendocrine tumors(Zerbinis Medical Publ, 2015) Saglam, Sezer; Hacisahinogullari, Hulya; Ozturk, Nakiye; Kapran, Yersu; Gulluoglu, Mine; Turkmen, Cuneyt; Adalet, Isik; Balci, Numan Cem; N/A; Bilge, Orhan; Faculty Member; School of Medicine; 176833Purpose: Benefits of somatostatin analogues have been mostly studied in mixed samples of patients including both functional and non-functional neuroendocrine tumors. This study aimed to examine the response of patients with non-functional metastatic or inoperable gastroenteropancreatic neuroendocrine tumors (GEP-NETs) that received first-line treatment with the somatostatin analogue octreotide LAR. Methods: The medical records of 23 patients with locally inoperable or metastatic non-functional neuroendocrine tumors who received octreotide LAR (long acting release) treatment were retrospectively reviewed for clinical data and disease course. All patients had received first-line octreotide MR 30 mg for 4 weeks. Progression free survival (PFS) and overall survival (OS) were the primary and secondary endpoints, respectively. Results: All patients were followed for a median of 47 months. Mean PFS and OS were 25.0 +/- 3.4 months (95% Cl: 18.4-31.5) and 71.3 +/- 9.5 months (95% Cl: 52.7-89.9), respectively, with an estimated 5-year OS of 58%. Patients with <= 25% of hepatic tumor load had better PFS when compared to patients with >25% hepatic tumor load (32.2 +/- 6.2 vs 19.4 +/- 2.7 months, p=0.043). During treatment, the following adverse events developed: skin reaction (N=1, 4.3%), cholestasis (N=1, 4.3%), grade 1 diarrhea (N=1, 4.3%), and newly onset diabetes (N=3; 13.0%). Conclusion: Octreotide LAR seems to be an effective treatment option with acceptable tolerability for patients with well-differentiated non-functional GEP-NETs. Survival benefits warrant further testing in future large-scale prospective trials.Publication Open Access Management of nodal disease in advanced-stage ovarian cancer: porta hepatis, celiac, pelvic and paraaortic lymphadenectomy(MRE PRESS, 2022) Taşkıran, Çağatay; Giray, Burak; Vatansever, Doğan; Bilge, Orhan; Faculty Member; Faculty Member; Faculty Member; Faculty Member; School of Medicine; Koç University Hospital; 134190; N/A; 193687; 176833Maximal cytoreduction is considered the most important prognostic factor for ovarian cancer survival. Most ovarian cancer patients are diagnosed at an advanced stage, and more than half of them have upper abdominal involvement. Upper abdominal regions alongside the pelvis should be evaluated systematically as a routine procedure during cytoreductive surgery. Therefore, aggressive procedures are adopted during cytoreductive surgery, including upper abdominal regions, to achieve maximal cytoreduction. It should include the exploration of porta hepatis and celiac lymph nodes. The feasibility of metastatic disease resection at the porta hepatis and celiac lymph nodes has been demonstrated in many studies with acceptable morbidity. Furthermore, ovarian cancer often leads to retroperitoneal lymph nodes metastases in patients with advanced stages of the disease. Data from the literature showed that more than half of the advanced-stage ovarian cancer patients had lymph node involvement. In this manuscript, we reviewed the current literature and aimed to investigate the impact on survival of surgical resection of porta hepatis, celiac regions, and pelvic/paraaortic lymph nodes in patients with advanced-stage ovarian cancer. Resection of metastatic disease at the porta hepatis/celiac lymph nodes to achieve maximal cytoreduction is feasible but with a relatively high rate of morbidity and mortality. Randomized controlled trials indicate that in the absence of suspicious lymph nodes, both during surgery and at imaging, systematic lymphadenectomy seems to provide no survival benefit.Publication Open Access Effects of the largest metastatic lymph node size on the outcomes of patients who underwent pancreaticoduodenectomy for pancreatic ductal adenocarcinoma(Kare Yayıncılık, 2022) Bilgiç, Çağrı; Bozkurt, Emre; Tüfekçi, Tutku; Sucu, Serkan; Özoran, Emre; Özata, İbrahim Halil; Kaya, Mesut; Tellioğlu, Gürkan; Bilge, Orhan; Researcher; Researcher; Teaching Faculty; Teaching Faculty; Faculty Member; Faculty Member; School of Medicine; Koç University Hospital; N/A; N/A; N/A; 307296; N/A; N/A; N/A; 176833Objectives: prognostic importance of metastatic lymph nodes in pancreatic cancer is always garnered attention due to dismal prognosis, with some quantitative factors drawing attention for significantly predicting outcomes. Size is one of the easy approach morphological characteristics of the lymph node, and data for effect of largest metastatic lymph node (LMLN) size on survival outcomes are lacking in pancreatic cancer. We aim to evaluate the effect of LMLN size on the prognosis of patients with pancreatic ductal adenocarcinoma (PDAC). Methods: this retrospective study evaluates the effect of LMLN size on survival outcomes by grouping the patients who were surgically treated for PDAC, according to their lymph node stage and calculated cutoff value for LMLN size, between February 2015 and May 2020. Results: in the study cohort of 131 patients, the mean age was 63.9 +/- 10.8 years and 77 patients were female. Ninety-nine of the pa-tients had pN1, 32 had pN2 stage disease. The optimal cutoff point of LMLN size for predicting the prognosis was calculated as 7.5 mm (sensitivity = 81% and specificity = 81%). 34 (34.3%) of pN1 and 7 (21.9%) of pN2-staged patients had lymph node smaller than 7.5 mm. Three-year survival was significantly longer for patients whose LMLN size was <7.5 mm (56.2-18.2%, p<0.001). Whereas, the patients with LMLN size <7.5 mm had statistically significant longer median survival rate in the subgroup of patients with pN1 lymph node stage, no significant difference in median survival rates was observed between subgroups of pN2 patients (p=0.237). Conclusion: the present study demonstrated that the LMLN size was one of the potential predictors of survival in patients with PDAC.Publication Open Access Surgical site infections after pancreaticoduodenectomy: preoperative biliary system interventions and antimicrobial prophylaxis(Elsevier, 2020) Bilgiç, Ç.; Keske, Ş.; Sobutay, E.; Can, U.; Zenger, S.; Gürbüz, B.; Ergönül, Önder; Bilge, Orhan; Faculty Member; Faculty Member; School of Medicine; 110398; 176833Background: The rate of surgical site infection (SSI) after pancreaticoduodenectomy (PD) is high and insertion of preoperative bile duct catheterization (PBDC) predispose a high risk of SSI with multidrug resistant (MDR) microorganisms. Aim: To describe the effects of PBDC and the prophylaxis in development of SSI. Methods: We conducted a retrospective study between January 01, 2010 and December 2018 including the patients with PD and total pancreatectomy. Findings: In total 214 consecutive patients were included. The PBDC was inserted to 63 (29%) patients. The rate of intraoperative bile fluid culture positivity was higher among the patients with PBDC (84% vs. 17% respectively, p < 0.001). The SSI was detected in 52 patients (24%). In multivariate analysis, the rate of SSI was found to be higher among the patients with PBDC (OR: 2.33, 95% Cl: 1.14–4.76, p = 0.02). As the etiologic agents of SSI, Pseudomonas spp. and MDR pathogens were mainly detected in PBDC group. The resistance to ampicillin-sulbactam was significantly higher in the PBDC group (87.5% vs. 25%, p = 0.012). The similar bacterial species both in bile fluid and the surgical site were detected in 11 (21%) patients with SSI. Among 8 patients (15%), antimicrobial susceptibility was the same. Only in five out of 52 (10%) patients, the SSI pathogens was susceptible to the agent that was used for surgical prophylaxis. Conclusion: Unnecessary catheterizations should be avoided. By considering the increasing prevalence of resistant bacteria as the cause of SSI, the clinicians should closely follow-up their patients for choosing the proper antimicrobials.Publication Open Access Intraductal papillary mucinous neoplasm of the pancreas associated with neuroendocrine tumor: a case report(Elsevier, 2017) Vural, M.; Yilmaz, S.; Goksel, S.; N/A; N/A; Gürses, Bengi; Böge, Medine; Bilge, Orhan; Faculty Member; Faculty Member; School of Medicine; N/A; N/A; 176833Introduction: Intraductal papillary mucinous neoplasm is an uncommon cystic tumor of pancreas that can be associated with ductal adenocarcinoma. Coexistence of pancreatic IPMN and neuroendocrine tumor is very rare. Here, we report the imaging features of mixed type intraductal papillary mucinous neoplasia of the pancreas with high grade dysplasia together with neuroendocrine carcinoma and perform review of the literature. Presentation: A 68-year old patient has been evaluated for possible IPMN that was suspected during ultrasound. MRI revealed main and side branch duct dilatations. At the head, a contrast enhancing nodular lesion was identified. Due to the presence of high risk stigmata according to guidelines, surgery was performed. Histopathological examination revealed an unusual association, including mixed type IPMN and neuroendocrine carcinoma. Discussion: The concomitant occurrence of pancreatic IPMN and neuroendocrine tumor has been reported in case studies and brief reviews. Yet, the imaging findings and underlying molecular mechanisms of this entity has not been fully understood. In addition to this unusual association, pancreatic intraepithelial neoplasia was also detected in the present case. Although majority of neuroendocrine tumor associated ipmns were reported to be having low grade dysplasia, our patient had high grade dysplasia. Further studies and reviews with larger groups are needed to establish imaging features and underlying molecular mechanisms of this rare association. Conclusion: Although the major concern during work-up of IPMN is presence of associated pancreatic ductal adenocarcinoma, the possibility of neuroendocrine tumor, in the presence of a hypervascular solid foci on imaging studies should be kept in mind.Publication Open Access 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(Wiley, 2021) Cesur, Ezgi; Kırış, Talat; Giray, Burak; Kulle, Cemil Burak; Azamat, İbrahim Fethi; Ağcaoğlu, Orhan; Dilege, Ece; Erkan, Murat Mert; Balık, Emre; Bilge, Orhan; Buğra, Dursun; Vatansever, Doğan; Taşkıran, Çağatay; Erus, Suat; Yavuz, Ömer; Tanju, Serhan; Dilege, Şükrü; Tarım, Kayhan; Kiremit, Murat Can; Kılıç, Mert; Canda, Abdullah Erdem; Kordan, Yakup; Akyoldaş, Göktuğ; Solaroğlu, İhsan; Sasani, Mehdi; Gökler, Ozan; Ünsaler, Selin; Altuntaş, Muzaffer Ozan; Hafız, Ayşenur Meriç; Şimşek, Sezai Aykın; Deveci, Mehmet Ali; Korkmaz, Murat; Çakar, Nahit; Ergönül, Önder; Faculty Member; Faculty Member; Faculty Member; Faculty Member; Faculty Member; Faculty Member; Faculty Member; Faculty Member; Faculty Member; Teaching Faculty; Faculty Member; Researcher; Faculty Member; Faculty Member; Faculty Member; Faculty Member; Faculty Member; Faculty Member; Teaching Faculty; Teaching Faculty; Teaching Faculty; Faculty Member; Faculty Member; Doctor; Faculty Member; Faculty Member; School of Medicine; Koç University Hospital; N/A; N/A; 175476; 218050; 214689; 18758; 176833; 1758; 193687; 134190; 175565; N/A; 214690; 122573; 327605; N/A; N/A; 116202; 157552; N/A; 102059; N/A; 311179; 167909; 169795; 53676; N/A; 206311; N/A; 198906; 110398Background: 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.