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Öğe Clinical outcomes of uterine carcinosarcoma results of 94 patients(Lippincott Williams & Wilkins, 2015) Gökçe, Zeynep Kestel; Turan, Taner; Karalok, Alper; Tasçı, Tolga; Üreyen, Işın; Özkaya, Enis; Köse, Mehmet Faruk; Tulunay, GökhanObjective: We aimed to determine the clinicopathologic features and identify prognostic factors of patients with uterine carcinosarcoma. Materials and Methods: A total of 94 patients with uterine carcinosarcoma who were diagnosed between January 1993 and October 2013 were included. Staging surgery consisted of total abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymphadenectomy, peritoneal cytology, and omentectomy. Staging is undertaken according to the 2009 International Federation of Gynecology and Obstetrics staging system. Kaplan-Meier survival analysis was used to determine the effects of variables on disease-free survival (DFS) and overall survival (OS). Results: Seventy-nine patients underwent staging surgery and none of them had residual tumor after surgery. Three-year DFS and 3-year OS were 42.7% and 59.2%, respectively. In the univariate analysis, stage, presence of para-aortic metastatic lymph nodes, uterine serosal spread, positive peritoneal cytology, and extrapelvic metastases were associated with 3-year DFS and stage, presence of para-aortic metastatic lymph nodes, uterine serosal spread, positive peritoneal cytology, adnexal involvement, and extrapelvic metastases were associated with 3-year OS. Seventy-four patients received adjuvant therapy. Adjuvant therapy did not reduce recurrence or improve survival. Any of the chemotherapy regimens was not superior to the others. In the multivariate analysis, only age was an independent prognostic factor for 3-year DFS and no parameter was statistically significant for 3-year OS. Conclusions: Age was an independent prognostic factor for 3-year DFS. Older age was associated with poor survival. Extrauterine spread was associated with survival. The aims of surgery should be both staging and providing tumoral debulking. Prospective randomized trials are needed to better define the necessity and modality of the administered adjuvant therapy.Öğe Early and late complications after inguinofemoral lymphadenectomy for vulvar cancer(Asian Pacific Organization for Cancer Prevention, 2015) Cırık Akda?, Derya; Karalök, Alper; Üreyen, Işın; Taşçı, Tolga; Kalyoncu, Rukiye; Türkmen, Osman; Köse, Mehmet Faruk; Tulunay, Gökhan; Turan, TanerBackground: We aimed to determine the frequency of early and late complications following groin surgery for vulvar cancer and analyze possible risk factors. Materials and Methods: This retrospective cohort study included 99 women who underwent for vulvar cancer. The early (?1 month) complications were wound infection, breakdown and lymphocyst and late (>1 month) complications were lower limb lymphedema, incontinence and erysipelas. The risk factors for developing each of the complications were analyzed with regression analysis. Results: In the entire cohort, 29 (29.3%) women experienced early and 12 (12.1%) had late complications. Wound complications including infection and breakdown were the leading early complications (23.2%). In the multivariate analysis, both obesity (body mass index ?30 kg/m2 ) and advanced age (?65 years) were found as independent predictive factors for early complications. Obese women of advanced age had 6.32 times more risk of experiencing any of the early complications, when compared to non-obese and young women (55.6% vs 8.7%). The most common late complication was lower limb lymphedema (10.1%) that was more frequently seen in young women. However, neither age nor lymph node count were significantly associated with the occurrence of lower limb lymphedema. Conclusions: More than 40% of the women suffered from postoperative complications after inguinofemoral lymphadenectomy in the current study. While advanced age and obesity were the significant predictors for any of the early complications, there was no identified risk factor for lower limb lymphedema.Öğe Is neurosurgery with adjuvant radiotherapy an effective treatment modality in isolated brain involvement from endometrial cancer? From case report to analysis(Lippincott Williams & Wilkins, 2017) Kimyon, Günsu; Turan, Taner; Başaran, Derman; Türkmen, Osman; Karalok, Alper; Tasçı, Tolga; Tulunay, Gökhan; Köse, Mehmet FarukAim: The aim of this study was to evaluate the treatment options and post-brain involvement survival (PBIS) of patients with isolated brain involvement from endometrial cancer (EC). Materials and Methods: The literature electronic search was conducted from 1972 to May 2016 to identify articles about isolated (without extracranial metastases) brain involvement from EC at recurrence and the initial diagnosis. Forty-eight articles were found. After comprehensive evaluation of case series and case reports, the study included 49 cases. Results: The median age of the patients at initial diagnosis was 57 years (range, 40-77 years). Poor differentiation was determined in 36 (73.5%) patients. Thirty-five (71.4%) patients had a single brain lesion. Lesion was found in the supratentorial part of the brain in 33 (67.3%) patients. Median PBIS for all cohorts was 13 months (range, 0.25-118 months) with 2-year PBIS of 52% and 5-year PBIS of 37%. Age, tumor type, grade, disease-free interval, diagnosis time of brain lesion, localization, and number of brain lesionwere not predictive of PBIS. Two-year PBIS was 77% in patients who underwent surgical resection and radiotherapy, whereas it was 19% in the surgical resection-only group, and 20% in the primary radiotherapyYonly group (Ps = 0.003 and 0.001, respectively). Chemotherapy was not associated with improved PBIS. Conclusions: Although neuroinvasion from EC appearsmostly with a disseminated disease, there is a considerable amount of patients with isolated brain involvement who would have a higher chance of curability. Surgery with radiotherapy is the rational current management option, and this improves the survival for isolated brain involvement from EC.Öğe Performing gynecologic cancer surgery during the COVID-19 pandemic in Turkey: A multicenter retrospective observational study(Wiley, 2020) Dursun, Polat; Dervişoğlu, Haluk; Daggez, Mine; Turan, Taner; Kılıç, Fatih; Moraloğlu Tekin, Özlem; Üreyen, Işın; Toptaş, Tayfun; Demirayak, Gökhan; Önder, Ayşe Büşra; Çelik, Çetin; Bayramoğlu, Denizhan; Güzel, Ahmet Barış; Arıöz, Dağıstan Tolga; Bilir, Filiz; Özdemir, İsa Aykut; Taşçı, Tolga; Karalök, Alper; Karateke, AteşObjective To report the perioperative outcomes of 200 patients with gynecologic cancer who underwent surgery during the Novel Coronavirus Disease (COVID-19) pandemic and the safety of surgical approach. Methods Data of patients operated between March 10 and May 20, 2020, were collected retrospectively. Data were statistically analyzed using IBM Statistical Package for the Social Sciences (SPSS) Statistics for Windows v. SP21.0. Results Data of 200 patients were included. Their mean age was 56 years. Of the patients, 54% (n=108), 27.5% (n=55), 12.5% (n=25), and 2% (n=4) were diagnosed as having endometrial, ovarian, cervical, and vulvar cancer, respectively. Of them, 98% underwent non-emergent surgery. A minimally invasive surgical approach was used in 18%. Stage 1 cancer was found in 68% of patients. Surgeons reported COVID-related changes in 10% of the cases. The rate of postoperative complications was 12%. Only two patients had cough and suspected pneumonic lesions on thoracic computed tomography postoperatively, but neither was positive for COVID-19 on polymerase chain reaction testing. Conclusion Based on the present findings, it is thought that gynecologic cancer surgery should continue during the COVID-19 pandemic while adhering to the measures. Postponement or non-surgical management should only be considered in patients with documented infection. Gynecologic cancer surgery should continue during the COVID-19 pandemic while adhering to measures. Only 1% of patients developed COVID-19-related symptoms during the postoperative follow-up period.Öğe The impact of tumor and lymph node characteristics on disease free survival in squamous cell vulvar cancer(2016) Akdağ Cırık, Derya; Karalok, Alper; Üreyen, Işın; Türkmen, Osman; Taşcı, Tolga; Narin, Mehmet Ali; Köse, Mehmet Faruk; Boran, Nurettin; Turan, Taner; Tulunay, GökhanWe aimed to determine the prognostic significance of tumor and lymph node (LN) characteristics on disease free survival (DFS) in patients who underwent surgery for squamous cell vulvar carcinoma. A total of 94 patients who underwent vulvar surgery and groin dissection were included. The impact of clinicopathologic variables such as age, body mass index, tumor size, tumor depth, total and metastatic lymph node number on DFS were assessed. The estimates of survival were determined with Kaplan-Meier and log rank analysis. In the univariate analysis; age, body mass index, tumor size, tumor location, total LN number, metastatic LN number and adjuvant therapy did not have impact on DFS. The median number of removed LNs was 21. Although removal of higher number of lymph nodes did not improved the DFS, patients who had <= 3 metastatic LNs had better 2-year DFS rate compared to those with >3 metastatic LNs (71.8% vs 40.0%; p= 0.042, respectively). In the multivariate analysis, both the depth of tumor invasion and LN involvement were the independent predictors of DFS. Additionally, in stage III disease, patients receiving adjuvant therapy had significantly less locoregional recurrence compared to those who did not receive. The presence of LN metastasis and increased tumor depth (> 3 mm) are poor prognostic factors for DFS in squamous cell vulvar cancer. Although the number of lymph nodes removed was not correlated with DFS, patients who had <= 3 metastatic LNs had better DFS compared to those with > 3 LNs.
