Researcher:
Balık, Emre

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Emre

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Balık

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Balık, Emre

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2014 - 2019272020 - 202333

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    Prognostic significance of metastatic lymph node ratio in patients with pN3 gastric cancer who underwent curative gastrectomy
    (Karger, 2019) Bilici, Ahmet; Şeker, Mesut; Öven, Basak B.; Ölmez, Ömer Fatih; Yıldız, Özcan; Ölmüşçelik, Oktay; Hamdard, Jamshid; Açıkgöz, Özgür; Çakır, Aslı; Öncel, Mustafa; Selçukbiricik, Fatih; Kapran, Yersu; Balık, Emre; Faculty Member; Faculty Member; Faculty Member; School of Medicine; School of Medicine; School of Medicine; 202015; 168101; 18758
    Background: Lymph node involvement is an important prognostic factor in patients with gastric cancer. The aim of this study was to determine the prognostic significance of metastatic lymph node ratio (MLNR) and compare it to the number of lymph node metastasis in pN3 gastric cancer. Methods: We retrospectively analyzed 207 patients with pN3 gastric cancer who had undergone radical gastrectomy. Prognostic factors and MLNR were evaluated by univariate and multivariate analysis. Results: An MLNR of 0.75 was found to be the best cut-off value to determine the prognosis of patients with pN3 gastric cancer (p = 0.001). The MLNR was significantly higher in patients with large-sized and undifferentiated tumors, vascular, lymphatic and perineural invasion, and total gastrectomy. In multivariate analysis, MLNR (p = 0.041), tumor differentiation (p = 0.046), and vascular invasion (p = 0.012) were found to be independent prognos-tic factors for disease-free survival, while both MLNR (p < 0.001) and pN stage (p = 0.002) were independent prognostic indicators, as was tumor size, for overall survival. There was significant difference with respect to the recurrence patterns between MLNR groups. Lymph node and peritoneal recurrences were significantly higher in patients with MLNR > 0.75 compared to the MLNR < 0.75 group (p < 0.05). However, recurrence patterns were similar between pN3a and pN3b. Conclusion: Our results showed that MLNR was a useful indicator to determine the prognosis and recurrence patterns of patients with radically resected gastric cancer. Moreover, MLNR is a beneficial and reliable technique for evaluating lymph node metastasis.
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    Metastasis to lymph nodes around the vascular tie worsens long-term oncological outcomes following complete mesocolic excision and conventional colectomy for right-sided colon cancer
    (Springer-Verlag Italia Srl, 2021) Zenger, Serkan; Aytac, Erman; Gurbuz, Bulent; Ozben, Volkan; Baca, Bilgi; Hamzaoglu, Ismail; Karahasanoglu, Tayfun; N/A; Özoran, Emre; Balık, Emre; Buğra, Dursun; Teaching Faculty; Faculty Member; Faculty Member; School of Medicine; School of Medicine; School of Medicine; 307296; 18758; 1758
    Background Oncologic outcomes after complete mesocolic excision (CME) in colon cancer are under investigation. The aim of our study was to compare CME and conventional colectomy (CC) in terms of pathological and oncological outcomes for right colon cancer and to evaluate the impact of lymph node metastasis around the vascular tie on survival. Methods Consecutive patients with right colon cancer who had CME or CC between January 2011 and August 2018 at two specialized centers in Turkey were included. Statistical analyses were performed with respect to demographic characteristics, operative and pathologic outcomes, harvested and metastatic lymph nodes around the vascular tie (LNVT), recurrences, and survival. Results There were 91 patients in the CME group (58 males, mean age 64 +/- 16 years) and 192 patients in the CC group (96 males, mean age 66 +/- 14 years). The mean number of harvested lymph nodes (CME: 42 +/- 15 vs CC: 34 +/- 13, p = 0.01) and LNVT were higher in the CME group (CME: 3.2 +/- 2.2 vs CC: 2.4 +/- 1.6, p = 0.001). LNVT metastases were 7.7% and 8.3% in the CME and CC groups, respectively (p = 0.85). Three-year overall and disease-free survival rates were 96.4% and 90.9% in the CME group and 90.4% and 87.6% in the CC group in stage I-III patients (p > 0.05). In stage III patients, the 3-year overall survival (92.5% vs 63.5%, p = 0.03) and disease-free survival (85.6% vs 52.1%, p = 0.008) were significantly better in LNVT-negative patients than in LNVT-positive patients. Conclusion LNVT metastasis seems to be the key factor associated with poor disease-free and overall survival in right colon cancer regardless of the radicality of surgery.
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    Re: comment on "dealing with the gray zones in the management of gastric cancer: the consensus statement of the İstanbul group" response
    (Aves, 2020) Baca, Bilgi; Hamzaoğlu, İsmail; Karahasanoğlu, Tayfun; Ozben, Volkan; Aytaç, Erman; N/A; N/A; Balık, Emre; Buğra, Dursun; Faculty Member; Faculty Member; School of Medicine; School of Medicine; 18758; 1758
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    Open versus laparoscopic surgery for rectal cancer: single-center results of 587 cases
    (Lippincott Williams & Wilkins, 2016) Keskin, Metin; Akici, Murat; Agcaoglu, Orhan; Yegen, Gulcin; Saglam, Esra; Bulut, Mehmet T.; Buğra, Dursun; Balık, Emre; Faculty Member; Faculty Member; School of Medicine; School of Medicine; 1758; 18758
    Purpose: We aimed to compare the short-term and long-term results of laparoscopic and open rectal resections. Methods: A total of 587 rectal cancer patients were included. The main measures were demographic data, duration of surgery, early postoperative results, pathologic data, and long-term follow-up. Results: There were no significant differences in demographic data, morbidity rate, tumor location, and sphincter-preservation rates between the 2 groups. The duration of surgery (155 vs. 173 min, P < 0.001), time to gas passage, defecation, and solid food intake and length of hospital stay were significantly shorter in the laparoscopic group than the open group (P < 0.05). According to the univariate and multivariate analysis, laparoscopic surgery did not have an effect on local recurrence but had a favorable effect on survival rates. Conclusions: Laparoscopic rectal surgery has advantages over open surgery with respect to short-term and long-term clinical results and when performed in high-volume centers.
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    Robotic complete mesocolic excision for transverse colon cancer can be performed with a morbidity profile similar to that of conventional laparoscopic colectomy
    (Springer, 2020) Özben, Volkan; De Muijnck, Cansu; Zenger, Serkan; Aytac, Erman; Bilgin, İsmail Ahmet; Baca, Bilgi; Hamzaoğlu, İsmail; Karahasanoğlu, Tayfun; N/A; N/A; N/A; N/A; Şengün, Berke; Ağcaoğlu, Orhan; Balık, Emre; Buğra, Dursun; Undergraduate Student; Faculty Member; Faculty Member; Faculty Member; School of Medicine; School of Medicine; School of Medicine; School of Medicine; 309087; 175476; 18758; 1758
    Background: In minimally invasive surgery, complete mesocolic excision (CME) for transverse colon cancer is challenging; thus, non-CME resections are commonly preferred when laparoscopy is used. Robotic technology has been developed to reduce the limitations of laparoscopy. The aim of our study was to evaluate whether robotic CME for transverse colon cancer can be performed with short-term outcomes similar to those of laparoscopic conventional colectomy (CC). Methods: A retrospective review of 118 consecutive patients having robotic CME or laparoscopic CC for transverse colon cancer in two specialized centers between May 2011 and September 2018 was performed. Perioperative 30-day outcomes of the two procedures were compared. Results: There were 38 and 80 patients in the robotic CME group and laparoscopic CC group, respectively. The groups were comparable regarding preoperative characteristics. Intraoperative results were similar, including blood loss (median 50 vs 25 ml), complications (5.3% vs 3.8%), and conversions (none vs 7.5%). The rate of intracorporeal anastomosis was significantly higher (86.8% vs 20.0%), mean operative time was longer (325.0 +/- 123.2 vs 159.3 +/- 56.1 min (p < 0.001), and the mean number of harvested lymph nodes was higher in the robotic CME group (46.1 +/- 22.2 vs 39.1 +/- 17.8, p = 0.047). There were only minor differences in length of hospital stay (7.2 +/- 3.1 vs 7.9 +/- 4.0 days), anastomotic leak (none vs 2.6%), bleeding (none vs 1.3%), surgical site infections (10.5% vs 12.5%), and reoperations (2.6% vs 6.3%). Conclusions: Robotic CME can be performed with a similar morbidity profile as laparoscopic CC for transverse colon cancer along with a higher rate of intracorporeal anastomosis, and higher number of lymph nodes retrieved, but longer operative times.
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    Totally robotic versus totally laparoscopic surgery for rectal cancer
    (LIPPINCOTT WILLIAMS & WILKINS, 2018) Esen, Eren; Aytaç, Erman; Zenger, Serkan; Baca, Bilgi; Hamzaoğlu, İsmail; Karahasanoğlu, Tayfun; Ağcaoğlu, Orhan; Balık, Emre; Buğra, Dursun; Faculty Member; Faculty Member; Faculty Member; School of Medicine; School of Medicine; School of Medicine; 175476; 18758; 1758
    In this study, perioperative and short-term postoperative results of totally robotic versus totally laparoscopic rectal resections for cancer were investigated in a comparative manner by considering risk factors including obesity, male sex, and neoadjuvant treatment. In addition to overall comparison, the impact of sex, obesity (body mass index >= 30 kg/m(2)), and neoadjuvant treatment was assessed in patients who had a total mesorectal excision (TME). Operative time was longer in the robotic group (P<0.001). In obese patients who underwent TME, the mean length of hospital stay was shorter (7 +/- 2 vs. 9 +/- 4 d, P=0.01), and the mean number of retrieved lymph nodes was higher (30 +/- 19 vs. 23 +/- 10, P=0.02) in the robotic group. Totally robotic and totally laparoscopic surgery appears to be providing similar outcomes in patients undergoing rectal resections for cancer. Selective use of a robot may have a role for improving postoperative outcomes in some challenging cases including obese patients undergoing TME.
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    How can optimal cytoreduction rates increased over ninety percent with a minimal usage of neoadjuvant chemotherapy ?
    (Lippincott Williams and Wilkins (LWW), 2016) Onan, Anıl; Karataş, Funda; Bostancı, Esra; Kerem, Mustafa; Arvas, Macit; Güner, Haldun; Taşkıran, Çağatay; Mısırlıoğlu, Selim; Yıldız, Şule; Balık, Emre; Alper, Aydın; Faculty Member; Faculty Member; Faculty Member; Faculty Member; Faculty Member; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; 134190; N/A; 134205; 18758; 119809
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    Comparative study between ghost ileostomy and defunctioning ileostomy in terms of morbidity and cost-effectiveness in low anterior resection for rectal cancer
    (Springer, 2021) Zenger, Serkan; Gurbuz, Bulent; Can, Ugur; N/A; N/A; N/A; Balık, Emre; Yaltı, Mehmet Tunç; Buğra, Dursun; Faculty Member; Faculty Member; Faculty Member; School of Medicine; School of Medicine; School of Medicine; 18758; 221690; 1758
    Purpose The aim of this study was to compare ghost ileostomy (GI) and defunctioning ileostomy (DI) in patients who underwent low anterior resection (LAR) for rectal cancer in terms of postoperative morbidity, rehospitalization rates, and total costs. Methods Patients with an anastomosis level between 5 and 10 cm from the anal verge after LAR were analyzed retrospectively. Clinical characteristics, operative outcomes, postoperative morbidity, rehospitalization rates, and total costs were compared. Results A total of 123 patients were enrolled as follows: 42 patients in the GI group and 81 patients in the DI group. Anastomotic leakage (AL) was identified in three patients who underwent GI, and in all of them, GI was easily converted to DI. There were 96.3% of the patients with DI rehospitalized at least one time because of surgery-related and/or stoma-related complications or stoma closure. When we did not take into account the patients who were rehospitalized for stoma closure, the rates of rehospitalization were 4.7% and 22.2% in the GI and DI groups, respectively (P= 0.01). The mean total costs calculated by removing additional surgical procedures and adding all of the rehospitalization costs were 25,767 USD and 41,875 USD in the GI and DI groups, respectively (P= 0.0001). Conclusion GI may be a safe and cost-effective method in patients who underwent LAR with low or medium risk factors for AL. It is possible to avoid unnecessary ileostomy and reduce unwanted outcomes due to it, such as postoperative complications, rehospitalizations, and increased total costs by performing GI.
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    The role of protective ileostomy and the validity of bowel resection as a part of cytoreductive surgery for advanced stage epithelial ovarian cancer
    (Lippincott Williams and Wilkins (LWW), 2016) Onan, Anıl; Karataş, Funda; Güler, İsmail; Bostancı, Esra; Bedirli, Abdülkadir; Kerem, Mustafa; Arvas, Macit; Güner, Haldun; N/A; Mısırlıoğlu, Selim; Taşkıran, Çağatay; Yıldız, Şule; Balık, Emre; 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; 134190; 134205; 18758
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    Impact of prolonged neoadjuvant treatment-surgery interval on histopathologic and operative outcomes in patients undergoing total mesorectal excision for locally advanced rectal cancer
    (Lippincott Williams and Wilkins (LWW), 2020) Akbaba, Ata C.; Aytac, Erman; Yozgatlı, Tahir K.; Bengür, Fuat B.; Esen, Eren; Bilgin, İsmail A.; Şahin, Bilgehan; Atalar, Banu; Erdamar, Sibel; Özben, Volkan; Baca, Bilgi; Hamzaoğlu, İsmail; Karahasanoğlu, Tayfun; Zenger, Serkan; Buğra, Dursun; Sezen, Duygu; Kapran, Yersu; Balık, Emre; Buğra, Dursun; Faculty Member; Faculty Member; Faculty Member; Faculty Member; Faculty Member; School of Medicine; School of Medicine; School of Medicine; School of Medicine; American Hospital; 170535; 168101; 18758; 1758
    Background: This study primarily aimed to assess the impact of prolonged neoadjuvant treatment-surgery interval (PNSI) on histopathologic and postoperative outcomes. Impacts of the mode of neoadjuvant treatment (NT) and surgery on the outcomes were also evaluated in the same patient population. Patients and Methods: Between February 2011 and December 2017, patients who underwent NT and total mesorectal excision for locally advanced rectal cancer were included. PNSI was defined as >4 and >8 weeks after short-course and long-course NT modalities, respectively. Results: A total of 44 (27%) patients received short-course NT (standard interval: n=28; PNSI: n=16) and 122 (73%) patients received long-course NT (standard interval: n=39; PNSI: n=83). Postoperative morbidity was similar between the standard interval and PNSI in patients undergoing short-course [n=3 (11%) vs. n=3 (19%), P=0.455] and long-course [n=6 (15%) vs. n=16 (19%), P=0.602] NT. PNSI was associated with increased complete pathologic response in patients receiving short-course NT [0 vs. n=5 (31%), P=0.002]. Compared with short-course NT, long-course NT was superior in terms of tumor response based on the Mandard [Mandard 1 to 2: n=6 (21%) vs. 6 (38%), P=0.012] and the College of American Pathologists (CAP) [CAP 0 to 1: n=13 (46%) vs. n=8 (50%), P=0.009] scores. Postoperative morbidity was similar after open, laparoscopic, and robotic total mesorectal excision [n=1 (14.2%) vs. n=21 (21%) vs. n=6 (12.5%), P=0.455] irrespective of the interval time to surgery and the type of NT. Conclusions: PNSI can be considered in patients undergoing short-course NT due to its potential oncological benefits. The mode of surgery performed at tertiary centers has no impact on postoperative morbidity after both NT modalities.