Researcher:
Kartal, Kinyas

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Doctor

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Kinyas

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Kartal

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Kartal, Kinyas

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2019 - 201932020 - 20222

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    Colostomy reversal after a Hartmann's procedure effects of experience on mortality and morbidity
    (Edizioni Luigi Pozzi, 2019) Çıtgez, Bülent; Köksal, Mustafa Hakan; Besler, Evren; Akgün, İsmail Ethem; Mihmanli, Mehmet; N/A; Kartal, Kinyas; Doctor; N/A; Koç University Hospital; N/A
    Aim: Hartmann's procedure (HP) is mostly lifesaving procedure especially for obstructive colorectal carcinomas, but remains bothersome requiring staged operation and subsequent reversal colostomy. We aimed to investigate risk factors for unfavorable surgical outcome after Hartmann's reversal. MATERIALS and METHODS: Between September 2003 and September 2014, all patients who underwent colostomy reversal surgery after HP were enrolled into the study. Retrospective data collection included demographics (age, gender, body mass index (BMI), ASA scores) primary pathologies, interval period, surgeon who performed procedure [general surgeon (GS)/colorectal specialty (CRS)], postoperative complications and hospital stay. RESULTS: There were 72 patients (49M/23F) with a median age of 64 (range: 29-83) years. The median BMI was 24 (21-44). Most of the patients (82%) had ASA score 3-4. Colorectal cancer was the primary diagnosis in 79% while others included diverticular perforation, volvulus, trauma and Crohn disease. Hartmann's procedure was performed as an emergency in three-fifths of patients. Median interval period between index surgery and reversal colostomy was 7 (1-24) months. The morbidity and mortality rates for colostomy reversal surgery were 34% and 8.3%, respectively. The most common postoperative complication was surgical site infection (22%) followed by anastomotic leak 5%. Mortality and morbidity rates were significantly higher in patients with higher BMI (p=0.031), higher ASA scores (p=0.028) and patients who underwent procedure not by a CRS. CONCLUSION: Reversal colostomy procedure resulted in significant morbidity and mortality, particularly in those with high BMI and ASA scores. Efforts to improve risk management and specialization in colorectal surgery may help to improve the outcome in reversal colostomy after Hartmann's procedure.
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    Atypical ductal hyperplasia in men with gynecomastia: what is their breast cancer risk?
    (Springer, 2019) Coopey, Suzanne B.; Li, Clara; Yala, Adam; Barzilay, Regina; Faulkner, Heather R.; King, Tari A.; Acevedo, Francisco; Garber, Judy E.; Guidi, Anthony J.; Hughes, Kevin S.; N/A; Kartal, Kinyas; Doctor; N/A; Koç University Hospital; N/A
    Purpose Atypical ductal hyperplasia (ADH) significantly increases the risk of breast cancer in women. However, little is known about the implications of ADH in men.Methods Review of 932 males with breast pathology was performed to identify cases of ADH. Patients were excluded if ADH was upgraded to cancer on excision, or if they had contralateral breast cancer. Cases were reviewed to determine whether any male with ADH developed breast cancer.ResultsNineteen males were diagnosed with ADH from June 2003 to September 2018. All had gynecomastia. Surgical procedure was mastectomy in 8 patients and excision/reduction in 11. One patient had their nipple areola complex removed, and 1 required a free nipple graft. Median patient age at ADH diagnosis was 25years (range 18-72years). of the 14 patients with bilateral gynecomastia, 10 had bilateral ADH and 4 had unilateral. Five cases of ADH were described as severe, bordering on ductal carcinoma in situ. No patient reported a family history of breast cancer. No patient took tamoxifen. At a mean follow-up of 75months (range 4-185months), no patient developed breast cancer.Conclusion Our study is the first to provide follow-up information for males with ADH. With 6years of mean follow-up, no male in our series has developed breast cancer. This suggests that either ADH in men does not pose the same risk as ADH in women or that surgical excision of symptomatic gynecomastia in men effectively reduces the risk of breast cancer.
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    Familial pancreatic cancer: who should be considered for genetic testing?
    (Springer, 2022) Guan, Zoe; Tang, Rong; Griffin, Molly; Wang, Yan; Braun, Danielle; Klein, Alison P.; Hughes, Kevin S.; N/A; Kartal, Kinyas; Doctor; N/A; Koç University Hospital; N/A
    Background Determining how many female patients who underwent breast imaging meet the eligibility criteria for genetic testing for familial pancreatic cancer (FPC). Methods A total of 42,904 patients seen at the Newton-Wellesley Hospital between 2007 and 2009 were retrospectively reviewed. The first four categories were based on pancreatic cancer-associated syndromes: (1) hereditary breast and ovarian cancer (HBOC), (2) Lynch syndrome (LS), (3) familial atypical multiple mole melanoma (FAMMM), and (4) family history of FPC (FH-FPC). PancPRO (5) and MelaPRO (6) categories were based on risk scores from Mendelian risk prediction tool. Results Exactly 4445 of 42,904 patients were found to be in at least one of the six risk categories. About 5.7% of patients were classified as being at high risk for HBOC, 2.3% as being at high risk for LS, 0.1% as being at high risk for FAMMM, 0.1% as being at high risk for FH-FPC, 2.7% as being at high risk based on PancPRO, and 0.2% as being at high risk based on MelaPRO. Conclusion About 10.4% of the female patients were classified as being at high risk for FPC. This finding emphasizes the importance of applying criteria to the general population, in order to ensure that individuals with high risk are identified early.
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    PublicationOpen Access
    Intraoperative neuromonitoring in thyroid surgery: an efficient tool to avoid bilateral vocal cord palsy
    (Sage, 2020) Aygün, Nurcihan; Celayir, Mustafa Fevzi; Besler, Evren; Çitgez, Bülent; İşgör, Adnan; Uludaǧ, Mehmet; Kartal, Kinyas; Doctor; School of Medicine
    Objectives: this study aimed to analyze the effects of intraoperative neuromonitoring (IONM) on the prevalence of vocal cord palsy (VCP) in thyroid surgery. Methods: data from 493 patients (839 nerves at risk [NAR]) who underwent thyroid surgery between July 2014 and May 2016 were retrospectively evaluated. The patients were divided into 2 groups: Group 1 (G1) consisted of patients who underwent surgery without IONM, whereas group 2 (G2) consisted of patients who underwent surgery with IONM. The surgical techniques were identical, and experienced surgeons performed the procedures in both groups. Intraoperative neuromonitoring was performed in compliance with the International Neural Monitoring Guidelines. Results: in total, 211 patients (170 female, 41 male) with 360 NAR were included in G1, and 282 patients (220 female, 62 male) with 479 NAR were included in G2. The number of VCP per NAR in G1 and G2 was 33 (9.2%) and 27 (5.6%), respectively (P =.005). The number of transient VCP per NAR in G1 and G2 was 27 (7.5%) and 23 (4.8%; P =.230), respectively. The number of permanent VCP per NAR in G1 and G2 was 6 (1.7%) and 4 (0.8%; P =.341), respectively. Bilateral VCP was detected in 4 (2.7%) patients in G1, whereas there was no patient with bilateral VCP in G2 (P =.033). Conclusions: intraoperative neuromonitoring may decrease the incidence of total VCP and prevent the development of bilateral VCP, which has unfavorable results for both patients and health-care professionals.
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    PublicationOpen Access
    Clinicopathologic differences between micropapillary and papillary thyroid carcinoma
    (Kare Yayıncılık, 2019) Aygün, Nurcihan; Uludağ, Mehmet; Kartal, Kinyas; Doctor; Koç University Hospital
    Objectives: the aim of this study is observing the clinicopathologic features of thyroid papillary microcarcinomas (PTMs) and comparing these features with papillary thyroid carcinoma (PTC). Methods: a total of 86 surgically treated patients suffering from PTC were evaluated retrospectively. Group 1 (G1) included patients with a tumor <1 cm, while Group 2 (G2) included patients with a tumor >1 cm. The two groups were compared in terms of the preoperative thyroid-stimulating hormone (TSH) level, anti-thyroid peroxidase antibody (anti-TPO) and antithyroglobulin antibody (TgAb) values, multicentricity, the lymphovascular invasion rate, the presence of extrathyroidal extension, and central and/or lateral lymph node metastasis. Results: there was no statistically significant difference observed between the groups in terms of the preoperative TSH level, anti-TPO, and TgAb values. The rate of multicentricity of the tumor in G2 was 66%, while it was 36% in G1 (p<0.001). The lymphovascular invasion rate in G1 was 14.2%, while it was 61% in G2 (p<0.001). The extrathyroidal extension rate of the tumor cells in G1 was 21.4%, while it was 63.6% in G2 (p<0.001). The central lymph node metastasis rate in G2 was 38.6%, while it was 4.8% in G1 (p<0.001). The lateral lymph node metastasis rate in G2 was 20.5%, while it was 0% in G1 (p<0.001). Conclusion: PTMs are generally associated with good prognostic factors with high survival rates. However, the risk factors such as multifocality, extrathyroidal extension, and lymphovascular invasion increasing the recurrence risk are not rare in PTM. Thus, the patients having these histopathological features of the tumor should be followed more carefully.