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Article ; Online: Sentinel lymph node biopsy after nipple-sparing mastectomy in early postoperative period: Is it feasible?

Kara, Halil / Arikan, Akif Enes / Dülgeroğlu, Onur / Uras, Cihan

2024 Volume 60, Issue 2, Page(s) 237–241

Abstract: Background: Axillary lymph node status is one of the most important prognostic factors for breast cancer. Sentinel lymph node biopsy (SLNB) after mastectomy is highly controversial. There is not enough data about SLNB in the early period after nipple- ... ...

Abstract	Background: Axillary lymph node status is one of the most important prognostic factors for breast cancer. Sentinel lymph node biopsy (SLNB) after mastectomy is highly controversial. There is not enough data about SLNB in the early period after nipple-sparing mastectomy (NSM). This study investigated the feasibility of SLNB in the early postoperative period of NSM. Materials and methods: Patients who were operated on for breast cancer in Acibadem Maslak Hospital between 2009 and 2018 were searched retrospectively. Results of SLNB as the second session in patients whose final pathology report revealed breast carcinoma after contralateral/bilateral prophylactic mastectomy and mastectomy for benign lesions were evaluated. Results: In the early period (median 14 days) after NSM, SLNB was performed by intradermal radioisotope injection in five patients with occult breast cancer in contralateral/bilateral prophylactic mastectomy and in one patient with preoperatively suspicious mass which yielded breast cancer at final pathology. In five (80%) patients, SLNB was performed, whereas in one patient axillary lymph node dissection (ALND) was performed due to the undetectability of SLN. In one patient, micrometastasis was observed, whereas no metastasis was observed in other patients including the one who underwent ALND. No complication due to SLNB was detected. No recurrence and distant metastasis were detected in a mean follow-up of 42.82 (19-70) months. While SLNB did not change the treatment of patients with contralateral occult carcinoma, other patients had hormonal therapy due to negative SLNB. Conclusion: SLNB in the early postoperative period of NSM can be performed by intradermal radioisotope injection. However, further studies are needed to determine the feasibility of SLNB in the early postoperative period of NSM.
MeSH term(s)	Humans ; Female ; Sentinel Lymph Node Biopsy/methods ; Breast Neoplasms/surgery ; Breast Neoplasms/pathology ; Mastectomy ; Retrospective Studies ; Nipples/surgery ; Nipples/pathology ; Lymphatic Metastasis/pathology ; Lymph Node Excision ; Lymph Nodes/pathology ; Radioisotopes ; Axilla/pathology
Chemical Substances	Radioisotopes
Language	English
Publishing date	2024-03-20
Publishing country	India
Document type	Journal Article
ZDB-ID	410194-7
ISSN	1998-4774 ; 0019-509X
ISSN (online)	1998-4774
ISSN	0019-509X
DOI	10.4103/ijc.IJC_1175_20
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Article ; Online: Impact of preoperative PET/CT for axillary staging in patients with early breast cancer.

Dulgeroglu, Onur / Arikan, Akif Enes / Kara, Halil / Uras, Cihan

Annali italiani di chirurgia

2022 Volume 93, Page(s) 504–509

Abstract: Background: Preoperative evaluation of axillary lymph node status is very important for the choice of primary treatment in breast cancer. This study assessed predictive properties of positron emission tomography-computerized tomography for axillary ... ...

Abstract	Background: Preoperative evaluation of axillary lymph node status is very important for the choice of primary treatment in breast cancer. This study assessed predictive properties of positron emission tomography-computerized tomography for axillary lymph node metastasis. Methods: Patients who were operated between 2014-2019 for early breast cancer and who had preoperative positron emission tomography-computerized tomography images were included. Positron emission tomography-computerized tomography results and histopathologic results were compared retrospectively. Results: Medical records of 223 patients who were operated for early breast cancer and have had positron emission tomography-computerized tomography were evaluated. positron emission tomography-computerized tomography revealed that axillary lymph node status is positive in 97 patients and negative in 126 patients. In histopathological examination, tumor cells were found in 86 patients, of those 27 were negative while 59 were positive in positron emission tomography-computerized tomography. Furthermore, 137 patients were free from tumor cells, in which 99 were negative and 38 were positive in positron emission tomography-computerized tomography. Positive and negative predictive value of positron emission tomography-computerized tomography for metastatic axillary lymph nodes were found 60.8% and 78.5%, respectively. Conclusions: Clinically, positron emission tomography-computerized tomography has low negative predictivity for determination of axilla in early stage or operable breast cancer. Even though it is valuable for the systematic scanning, positron emission tomography-computerized tomography can be overlooked for axillary evolution. Key words: Axilla, Breast Cancer, Cancer Staging, PET-CT.
MeSH term(s)	Axilla/pathology ; Breast Neoplasms/diagnostic imaging ; Breast Neoplasms/surgery ; Female ; Fluorodeoxyglucose F18 ; Humans ; Lymph Nodes/diagnostic imaging ; Lymph Nodes/pathology ; Neoplasm Staging ; Positron Emission Tomography Computed Tomography ; Positron-Emission Tomography/methods ; Radiopharmaceuticals ; Retrospective Studies
Chemical Substances	Radiopharmaceuticals ; Fluorodeoxyglucose F18 (0Z5B2CJX4D)
Language	English
Publishing date	2022-10-17
Publishing country	Italy
Document type	Journal Article
ZDB-ID	418927-9
ISSN	2239-253X ; 0003-469X
ISSN (online)	2239-253X
ISSN	0003-469X
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Article: Transmesocolic approach in laparoscopic complete mesocolic excision for right sided colon cancers.

Çapkınoğlu, Emir / Arıkan, Akif Enes / Dülgeroğlu, Onur / Uras, Cihan

Wideochirurgia i inne techniki maloinwazyjne = Videosurgery and other miniinvasive techniques

2022 Volume 17, Issue 4, Page(s) 699–704

Abstract: Introduction: A mesocolic plane, central vascular ligation (CVL) and proper proximal-distal margins are the essential components of complete mesocolic excision (CME). In the transmesocolic approach, we identify the middle colic vessels and enter the ... ...

Abstract	Introduction: A mesocolic plane, central vascular ligation (CVL) and proper proximal-distal margins are the essential components of complete mesocolic excision (CME). In the transmesocolic approach, we identify the middle colic vessels and enter the lesser sac through the mesocolon for ascending colon and caecum tumors. Aim: To investigate the feasibility and identify the technical details of this technique. Material and methods: The clinical and pathological findings of 26 patients who had undergone laparoscopic right hemicolectomy with CME between 2010 and 2020 were collected retrospectively. All operation videos were recorded and reviewed by the authors with regard to the components of CME. In the transmesocolic approach, dissection starts with identification of the middle colic vessels directly. After division of the middle colic vessels, we enter the omental bursa and dissection continues from superior to inferior direction. Results: There were 26 patients in the study. The mean age was 59.3 ±16.1. There were 15 female and 11 male patients with a mean body mass index of 25.9 ±16.1 kg/m Conclusions: The transmesocolic approach seems to be feasible and safe for CME in right sided colon cancers. However, more prospective randomized studies are needed to use the transmesocolic approach as a standard technique.
Language	English
Publishing date	2022-08-10
Publishing country	Poland
Document type	Journal Article
ZDB-ID	2596147-0
ISSN	2299-0054 ; 1895-4588
ISSN (online)	2299-0054
ISSN	1895-4588
DOI	10.5114/wiitm.2022.118683
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Article: Do prognosis and clinicopathological features differ in young early-stage breast cancer?

Arikan, Akif Enes / Kara, Halil / Dülgeroğlu, Onur / Erdoğan, Esin Nur / Capkinoglu, Emir / Uras, Cihan

Frontiers in surgery

2022 Volume 9, Page(s) 900363

Abstract: Background: Breast cancer is the most frequently detected cancer and the leading cause of cancer-related death in women. Although it is mostly seen in older patients, breast cancer affects women aged 24 to >70 years, with poorer prognosis in young ... ...

Abstract	Background: Breast cancer is the most frequently detected cancer and the leading cause of cancer-related death in women. Although it is mostly seen in older patients, breast cancer affects women aged 24 to >70 years, with poorer prognosis in young patients. Young age remains a controversial topic in the literature. This study aimed to identify subtype differences and the effect of age on early-stage breast cancer outcomes. Methods: A total of 300 consecutive patients underwent surgery between 2011 and 2015 for early-stage breast cancer. Of these, 248 were eligible for this study and were divided into three groups: group Y (aged ≤35 years), group M (aged >35 and ≤45 years), and group E (aged >45 years). The clinical and pathological features and data related to recurrence, metastasis, and death were recorded. Results: No statistical differences were found between groups regarding histopathological features except for higher histological grade and Ki-67 levels in group M. Additionally, group Y recorded no progression (recurrence or metastasis) or death. Disease-free survival was 117.8 months (95% CI 111.8-123.8) for group M, which was significantly shorter than that for group E ( Conclusion: A very young age cannot be considered an independent risk factor for poor prognosis. Rather than age, histological grade and Ki-67 index are more important factors in early-stage breast cancer.
Language	English
Publishing date	2022-10-19
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2773823-1
ISSN	2296-875X
ISSN	2296-875X
DOI	10.3389/fsurg.2022.900363
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Article: Has the COVID-19 Pandemic Affected Breast Cancer Stage and Surgical Volume?

Kara, Halil / Arikan, Akif Enes / Dulgeroglu, Onur / Tutar, Burcin / Tokat, Fatma / Uras, Cihan

Frontiers in surgery

2022 Volume 9, Page(s) 811108

Abstract: Background: This study investigates the effects of COVID-19 on the breast cancer stage and the volume of breast cancer surgery in a specialized breast institute.: Methods: Data of 332 patients who were diagnosed and treated for breast cancer between ... ...

Abstract	Background: This study investigates the effects of COVID-19 on the breast cancer stage and the volume of breast cancer surgery in a specialized breast institute. Methods: Data of 332 patients who were diagnosed and treated for breast cancer between December 2019 and November 2020 were evaluated retrospectively according to periods of pandemic. Results: A significant decrease in the number of operations, especially upfront surgeries rather than surgeries after neoadjuvant chemotherapy, was detected in the early period of the COVID-19 pandemic. It was found that patients with complaints were mostly admitted during this period ( Conclusion: Surgical volume is significantly affected in the early period of the COVID-19 pandemic. To overcome overload due to delayed surgeries related to pandemics, some hospitals should be spared for oncological treatments. Following the early period, mostly luminal type, early-stage patients were admitted, probably because of increased self-awareness and short wave duration, but the breast cancer stage was not affected.
Language	English
Publishing date	2022-02-07
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2773823-1
ISSN	2296-875X
ISSN	2296-875X
DOI	10.3389/fsurg.2022.811108
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Article ; Online: Oncologic safety of nipple-sparing mastectomy in patients with short tumor-nipple distance.

Balci, Fatih Levent / Kara, Halil / Dulgeroglu, Onur / Uras, Cihan

The breast journal

2019 Volume 25, Issue 4, Page(s) 612–618

Abstract: Background: There is a tendency to avoid nipple-sparing mastectomy (NSM) when a tumor-nipple distance (TND) is <2 cm due to the risk of occult nipple involvement. The purpose of the study was to determine whether the patients who undergo NSM with ... ...

Abstract	Background: There is a tendency to avoid nipple-sparing mastectomy (NSM) when a tumor-nipple distance (TND) is <2 cm due to the risk of occult nipple involvement. The purpose of the study was to determine whether the patients who undergo NSM with immediate reconstruction are oncologically safe when TND is <2 cm. Methods: Patients who underwent NSM followed by immediate reconstruction for breast cancer were retrospectively analyzed. Patients who are negative for nipple-base in either frozen-section or paraffin histopathology were included. MRI was used to obtain TNDs to compare local-recurrence-free and disease-free survival in group I (TND <2 cm) and group II (TND ≥2 cm). Disease-free survival rates were determined to assess the outcome. Results: Of the 214 cases with malignancy on MRI, 21 cases diagnosed with pure ductal carcinoma in situ were excluded. Among the 193 NSM cases diagnosed with invasive cancer, TND was <2.0 cm in 59 (30.56%) cases and ≥2.0 cm in 134 (69.43%) cases. No significant differences were found between groups in regards to ER, PR, HER2-neu status, and nodal involvement (P = 0.34, P = 0.41, P = 0.54, and P = 0.12 respectively). In a median follow-up time of 62 months (range; 13-114), patients in group I had four local recurrences, whereas group II was found to have five local and three distant metastases. No significant differences were observed between groups concerning disease-free survival (10-year DFS 93.2% vs 96.3%; P = 0.368 respectively). Conclusions: Patients who have invasive cancer diagnosis with a TND <2 cm are eligible to undergo therapeutic NSM with immediate reconstruction.
MeSH term(s)	Adult ; Breast Neoplasms/diagnostic imaging ; Breast Neoplasms/mortality ; Breast Neoplasms/pathology ; Breast Neoplasms/surgery ; Carcinoma, Ductal, Breast/diagnostic imaging ; Carcinoma, Ductal, Breast/mortality ; Carcinoma, Ductal, Breast/pathology ; Carcinoma, Ductal, Breast/surgery ; Carcinoma, Intraductal, Noninfiltrating/diagnostic imaging ; Carcinoma, Intraductal, Noninfiltrating/mortality ; Carcinoma, Intraductal, Noninfiltrating/pathology ; Carcinoma, Intraductal, Noninfiltrating/surgery ; Disease-Free Survival ; Female ; Humans ; Magnetic Resonance Imaging ; Mammaplasty ; Mastectomy/adverse effects ; Mastectomy/methods ; Middle Aged ; Neoplasm Recurrence, Local/pathology ; Nipples/anatomy & histology ; Nipples/surgery ; Organ Sparing Treatments ; Postoperative Complications/etiology ; Prophylactic Mastectomy/methods ; Survival Rate
Language	English
Publishing date	2019-05-13
Publishing country	United States
Document type	Journal Article
ZDB-ID	1289960-4
ISSN	1524-4741 ; 1075-122X
ISSN (online)	1524-4741
ISSN	1075-122X
DOI	10.1111/tbj.13289
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Article: Robotic nipple sparing mastectomy through a single incision: Advantages of starting with posterior dissection.

Uras, Cihan / Enes Arıkan, Akif / Kara, Halil / Dülgeroğlu, Onur / Avşar, Yakup

Turkish journal of surgery

2020 Volume 36, Issue 3, Page(s) 303–309

Abstract: Objectives: Loss of breast, which is an important body marking of women, causes a huge decrease in quality of life (QoL) after treatment. In order to overcome this morbidity and increase QoL, nipple sparing mastectomy (NSM) has been developed. Even ... ...

Abstract	Objectives: Loss of breast, which is an important body marking of women, causes a huge decrease in quality of life (QoL) after treatment. In order to overcome this morbidity and increase QoL, nipple sparing mastectomy (NSM) has been developed. Even though the demand for better cosmetic results has yielded endoscopic nipple sparing mastectomy, limitations like unsuitable optical window and limited manual control of rigid-tip instruments, and struggling to keep dissection space have led robotic nipple sparing mastectomy (rNSM) to be developed. Material and methods: Records of three patients who underwent to rNSM for invasive breast carcinoma with DaVinci Xi (Intuitive Surgical, Sunnyvale, CA) in affiliated hospitals of xxxxx xxxxx xxx xxxx University, Research Institute of xxxxx in 2018 were investigated retrospectively. In all breasts (n=4), dissection was started from the posterior side of breast. Results: In the unit, 738 breast cancer patients underwent surgery between 2018 and 2019 with an NSM ratio of 31.4% (n=232). Of these patients, three underwent rNSM with DaVinci Xi robotic system. The operation was performed on the left breast in one patient, right in one, and bilateral in one patient. Only in patient #2, who was a neoadjuvant chemotherapy recipient, seroma was observed six weeks after surgery (3 weeks after removal of drains) and spontaneously resolved in 4 weeks. No other complication was seen in all patients. In the follow-up period of median 21 months, no loco-regional recurrence or distant metastasis was seen. Conclusion: A single incision robotic mastectomy can be performed easily and safely when the dissection starts from the pre-pectoral plane rather than the subcutaneous plane.
Language	English
Publishing date	2020-09-28
Publishing country	Turkey
Document type	Journal Article
ISSN	2564-6850
ISSN	2564-6850
DOI	10.47717/turkjsurg.2020.4771
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Article ; Online: Management of Occult Contralateral Inguinal Hernia: Diagnosis and Treatment With Laparoscopic Totally Extra Peritoneal Repair.

Kara, Halil / Arikan, Akif E / Dülgeroğlu, Onur / Moldur, Derya E / Uras, Cihan

Surgical laparoscopy, endoscopy & percutaneous techniques

2020 Volume 30, Issue 3, Page(s) 245–248

Abstract: Background: Up to 33% risk of occult contralateral inguinal hernia has been reported. This study aims to evaluate diagnostic and treatment modalities in the case of occult contralateral hernia and the role of ultrasonography (USG).: Materials and ... ...

Abstract	Background: Up to 33% risk of occult contralateral inguinal hernia has been reported. This study aims to evaluate diagnostic and treatment modalities in the case of occult contralateral hernia and the role of ultrasonography (USG). Materials and methods: Patients who had undergone inguinal hernia repair between 2009 and 2018 were studied retrospectively. The detection rate of occult inguinal hernia by USG and results of laparoscopic totally extra peritoneal repair (TEP) were evaluated. Results: Of 295 patients, USG was performed to the contralateral site in 80 with clinically unilateral hernia and occult hernia was detected in 44 (55%). Bilateral TEP was performed for these patients. There was no recurrence and no significant complication. Conclusions: As it is noninvasive, easily accessible and has high sensitivity, USG is recommended in diagnosis. In the case of occult contralateral inguinal hernia, bilateral TEP is considered as a safe procedure. Thus, the need for a second operation and related complications can be prevented. We recommend routine USG to detect whether contralateral occult inguinal hernia is present.
MeSH term(s)	Adolescent ; Adult ; Aged ; Female ; Hernia, Inguinal/diagnosis ; Hernia, Inguinal/surgery ; Herniorrhaphy ; Humans ; Laparoscopy ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Ultrasonography ; Young Adult
Language	English
Publishing date	2020-02-25
Publishing country	United States
Document type	Journal Article
ZDB-ID	1475108-2
ISSN	1534-4908 ; 1530-4515 ; 1051-7200
ISSN (online)	1534-4908
ISSN	1530-4515 ; 1051-7200
DOI	10.1097/SLE.0000000000000765
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Article: Local steroid injection in severe idiopathic granulomatous mastitis as a new first-line treatment modality with promising therapeutic efficacy.

Cabioglu, Neslihan / Uras, Cihan / Mutlu, Halime / Sezgin, Derya / Emiroglu, Selman / Dulgeroglu, Onur / Yilmaz, Ravza / Tukenmez, Mustafa / Arikan, Akif Enes / Kara, Halil / Muslumanoglu, Mahmut

Frontiers in medicine

2023 Volume 10, Page(s) 1251851

Abstract: Background: Intralesional steroid injection has recently evolved as a novel treatment modality for localized idiopathic granulomatous mastitis (= IGM). We aimed to explore the therapeutic efficacy of local steroid injections (LSI) in patients with ... ...

Abstract	Background: Intralesional steroid injection has recently evolved as a novel treatment modality for localized idiopathic granulomatous mastitis (= IGM). We aimed to explore the therapeutic efficacy of local steroid injections (LSI) in patients with severe IGM. Methods: Fifty-one patients diagnosed with severe IGM were included in the study and treated with either local steroid injection (LSI) alone ( Results: Patients with LSI alone required more LSI applications than those in the combined LSI with OST group (LSI: 5 ± 2.9; vs. LSI/OST: 3.5 ± 2.5; Conclusion: Local steroid injection could be considered as the first-line treatment in patients with severe IGM until a therapeutic response has been obtained either as the sole treatment modality or combined with oral steroids. Compared with systemic oral steroid therapy, local steroid administration can be considered a new treatment modality with fewer side effects.
Language	English
Publishing date	2023-10-04
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2775999-4
ISSN	2296-858X
ISSN	2296-858X
DOI	10.3389/fmed.2023.1251851
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Article: Detachment and embolization of totally implantable central venous access devices: diagnosis and management.

Kara, Halil / Arikan, Akif Enes / Dulgeroglu, Onur / Uras, Cihan / Icten, Gul Esen / Tutar, Burcin / Parlakkilic, Ulku Tuba / Sonmez, Ozlem

Acta chirurgica Belgica

2021 Volume 122, Issue 4, Page(s) 240–247

Abstract: Background: Detachment and embolization (DE) is a rare complication of totally implantable central venous access devices (TIVADs). This study aimed to analyze clinical findings, etiology, and treatment options in DE of TIVADs.: Methods: Patients who ... ...

Abstract	Background: Detachment and embolization (DE) is a rare complication of totally implantable central venous access devices (TIVADs). This study aimed to analyze clinical findings, etiology, and treatment options in DE of TIVADs. Methods: Patients who experienced DE between 2010-2019 were included. Indications, implantation techniques, time to diagnosis, patient complaints, diagnostic methods, rupture site, location of embolization, treatment methods, and chest X-rays prior to detachment were analyzed retrospectively. Results: DE of TIVAD was detected in 12(1.2%) patients. Eleven patients had breast cancer and one had colon cancer. Mean age at implantation was 45.3 ± 9.6(31-61.3) years. Seven (58%) patients were asymptomatic, four (33.3%) had TIVAD malfunction, and one (8.3%) had pain and swelling at port site after injection. Mean time from implantation to diagnosis was 1149.92(16-2795) days. The etiologies comprised Pinch-off Syndrome (POS) in eight (66%) patients, detachment directly adjacent to the lock mechanism in three (25%) patients, and probable iatrogenic injury during explantation in one (9%) patient. The most common site of embolism was the superior vena cava (25%). While the embolized fragment was removed percutaneously in 11 patients, medical follow-up was treatment choice for one patient. Conclusions: DE is a rare complication with an incidence rate of 1.2% in this study. Since most patients were asymptomatic, chest radiography plays an important role in diagnosis. The most common cause was POS, and it can be prevented by inserting the catheter from lateral third of the clavicle during subclavian vein catheterization. The first-choice treatment was percutaneous femoral retrieval. However, if not technically possible, alternative treatment options are thoracotomy or follow-up with anticoagulant therapy.
MeSH term(s)	Catheterization, Central Venous/adverse effects ; Catheters, Indwelling/adverse effects ; Device Removal ; Humans ; Retrospective Studies ; Syndrome ; Vena Cava, Superior
Language	English
Publishing date	2021-03-09
Publishing country	England
Document type	Journal Article
ZDB-ID	210274-2
ISSN	0001-5458
ISSN	0001-5458
DOI	10.1080/00015458.2021.1896829
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