Person: ÖZERKAN, KEMAL
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ÖZERKAN
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KEMAL
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Publication Recurrence of borderline ovarian tumors: Clinical and pathological risk factors(Imr Press, 2021-06-15) Şahin, Hacı Öztürk; Yılmaz, Alpay; Bayrak, Mehmet; Pek, Eren; Özerkan, Kemal; Ozan, Hakan; ÖZERKAN, KEMAL; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Kadın Hastalıkları ve Doğum Anabilim Dalı; K-2269-2016; AAH-9791-2021Objective: The objective of this study was to determine the impact of several clinic pathologic factors on the rate of recurrence of borderline ovarian tumors (BOT). Method: Patients, who were diagnosed in our clinic between October 1996 and April 2016 with a final diagnosis of BOT, were retrospectively investigated. Only patients with a primary diagnosis of BOT were included. A total of 147 patients were diagnosed with BOT and underwent surgical treatment. The pathological reports, medical records and operation notes of the included patients were obtained from the gynecological oncology electronic database system. Results: While 51.7% of all our patients had BOTs of serous histology, 34.6% had mucinous BOTs and 13.6% had sero-mucinous BOTs, and their bilaterality was 11.8%, 2% and 5%, respectively. After treatment, the clinical conditions of 96 patients could be followed and recurrence was observed in six (6.3%) of them. The median follow-up time was 66 months (range: 12-266 months). The median time to recurrence was 46 months (range: 14-10o months). For non-recurrence and recurrence cases, the median age was 42.0 years (range: 17-86) years and 29.oyears (range: 18-3zyears), respectively a statistically significant difference (p = 0.005). Thirteen percent of the patients who underwent conservative surgery had recurrence, whereas no recurrence was observed in patients without conservative surgery (p = 0.009). While no recurrence was observed in patients who were surgically staged as stager, recurrences developed in cases with stage 2 and 3 disease (p= 0.040). In this cohort histologic type, surgical staging, presence of implants, size of the tumor, presence of micropapillary variants, and lymphadenectomy were not associated with recurrence. Conclusion: We found the recurrence of BOT is associated with younger age at diagnosis and conservative surgery. Although we found no statistically significant association of BOT recurrences with surgical staging, among those who were surgically stage recurrences only occured in patients with stage 2 or 3 disease.Publication Clinical significance of risk-reducing salpingo-oophorectomy in patients with BRCA1/2 mutation(Elsevier, 2023-10) Abay, Merve; Özgen, Levent; Yalçın, Yakup; Özerkan, Kemal; ABAY, MERVE; ÖZGEN, LEVENT; YALÇIN, YAKUP; ÖZERKAN, KEMAL; Uludağ Üniversitesi/Tıp Fakültesi/Kadın Hastalıkları ve Doğum Anabilim Dalı; 0000-0003-0070-2646; CAK-3842-2022; JFT-0660-2023; HQP-3191-2023; AAH-9791-2021Objective: Serous tubal intraepithelial carcinoma (STIC) is a precursor lesion which is located in the distal fallopian tube and causes high grade serous ovarian carcinoma (HGSOC). The incidence of STIC for women underwent risk reducing salpingo-oophorectomy for BRCA mutation varies from 0.6 to 7% and its clinical outcomes are still unclear. The aim of this study was to demonstrate the incidence of STIC and HGSOC in BRCA1/2 mutation carriers after risk reducing salpingo-oophorectomy (RRSO) and the clinical outcomes of these patients. Material and methods: We retrospectively reviewed the records of 48 BRCA1 and/or 2 mutation carriers who underwent prophylactic salpingo-oophorectomy with or without hysterectomy at the Department of Obstetrics and Gynecology, Bursa Uludag University between January 2000 and January 2022. Inclusion criteria: BRCA 1 and/or 2 mutation carriers diagnosed by genetic testing, asymptomatic patients with no abnormal findings on pelvic examination. Exclusion criteria: patients with no abnormal findings on pelvic examination and a presence of a personal history of ovarian, fallopian tube or peritoneal cancer. Results: A total of 48 BRCA 1 and/or 2 mutation carriers underwent RRSO. STIC was diagnosed in 1 (2,0%) patient and restaging surgery was not performed. Primary peritoneal carcinoma (PPC) did not develop during the 20 months follow-up period. One (2.0%) patient was diagnosed with occult ovarian cancer. Restaging surgery was performed and chemotherapy treatments were given after surgery. A pelvic recurrence developed 25 months after the occult cancer diagnosis in the follow up period. One (2.0%) patient with normal histopathological findings after RRSO was diagnosed with peritoneal cancer 57 months after the operation. Conclusion: The risk of PPC continues after RRSO. Therefore, close follow-up procedure is very important for early diagnosis and effective treatment of patients with PPC after RRSO.Publication Mesh complications on youtube(Elsevier, 2020-09-01) Orhan, Adnan; ORHAN, ADNAN; Göktürk, Gözde Güner; Özerkan, Kemal; ÖZERKAN, KEMAL; Kasapoglu, Işıl; KASAPOĞLU, IŞIL; Aslan, Kiper; ASLAN, MÜNİR KİPER; Uncu, Gurkan; UNCU, GÜRKAN; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Kadın Hastalıkları ve Doğum Anabilim Dalı.; 0000-0002-7558-8166; 0000-0002-9277-7735; K-2269-2016; AAH-9791-2021; AER-7173-2022; AAH-9694-2021; AAT-3479-2021; V-5292-2019Objective: There has been a heated discussion about mesh materials in urogynecology in recent years. The role of social media in this discussion is critical. This study aims to make a systematic analysis of videos uploaded to YouTube about mesh complications in urogynecology.Study Design: YouTube was searched using specific terms about mesh materials. The primary outcome was the relationship between the video characteristics-which were publisher identity, attitude, the main focus of the video country, and year- and the mesh debate in urogynecology.Results: We analyzed 1128 YouTube videos about mesh complications. There was no distinction between stress urinary incontinence and pelvic organ prolapse when referring to the mesh material in 79 % of the videos. 35.2 % of the videos were in the News group, 31.2 % were in the Patients group, 19.6 % were in the Doctors group, and 14.0 % were in the Lawyers group. Videos in the News (75.7 %), Patients (92.6 %), and Lawyers (99.4 %) groups mostly had a negative attitude, while videos in the Doctors (48.9 %) group mostly had an informative attitude. News (43.2 %) and Patients (51.2 %) group videos were predominantly from the United Kingdom. However, Lawyers (81.0 %) and Doctors (44.3 %) videos were predominantly from the USA. In the last three years, the news and patients videos have increased by an average of 40 % each year.Conclusion: YouTube has influenced the mesh dilemma with a negative attitude. As long as social media is at the center of this discussion, a healthy outcome cannot be achieved.Publication The comparison of outcomes between the "skeleton uterus technique" and conventional techniques in laparoscopic hysterectomies(Wolters Kluwer Medknow Publications, 2019-04-01) Orhan, Adnan; ORHAN, ADNAN; Kasapoğlu, Işıl; KASAPOĞLU, IŞIL; Ocakoğlu, Gökhan; OCAKOĞLU, GÖKHAN; Yürük, Oğuzhan; YÜRÜK, OĞUZHAN; Uncu, Gürkan; UNCU, GÜRKAN; Özerkan, Kemal; ÖZERKAN, KEMAL; Bursa Uludağ Üniversitesi/Tıp Fakültesi; 0000-0002-7558-8166; 0000-0002-1114-6051; V-5292-2019; K-2269-2016; AAT-3479-2021; AAH-9791-2021; AAI-4169-2021; AAH-5180-2021; HLG-6346-2023Aim: The aim of this study is to compare demographic characteristics, operative data, and complication rates of women who underwent total laparoscopic hysterectomy by the skeleton uterus technique (Skeleton-TLH) with those of women who underwent TLH by the standard technique (Standard-TLH) in a university teaching and research hospital.Materials and Methods: This retrospective study included 932 laparoscopic hysterectomies in a university teaching and research hospital between January 1, 2013 and December 31, 2017. Clinical characteristics, operative outcomes, and complications were recorded and compared for the two techniques.Results: In total, 932 laparoscopic hysterectomies were performed, 454 by Skeleton-TLH and 478 by Standard-TLH. The general demographic characteristics of the patients were similar; only gravida and parity were statistically significantly different between the groups (P < 0.001). Based on the primary outcomes (the operative data), total anesthesia time and main operation time were similar in the two groups. Estimated blood loss was statistically significantly lower in the Skeleton-TLH group than in the Standard-TLH group. Hospital stay was longer for the Skeleton-TLH group, and specimen weight was heavier. The secondary outcome was the complication rate. There were no differences between the Skeleton-TLH and Standard-TLH groups in the rates of all minor and major complications.Conclusion: TLH with the skeleton uterus technique is feasible and safe, especially for advanced pelvic surgeons. This technique not only provides retroperitoneal access to the pelvic spaces and good anatomical visibility; but it also delivers a safer laparoscopic hysterectomy by clamping the uterine arteries and monitoring the ureter throughout the operation.Publication Laparoscopic sacral colpopexy with polyester fiber suture: Ozerkan modification(Springer London, 2020-08-01) Özerkan, Kemal; Orhan, Adnan; Kasapoğlu, Işıl; Ata, Barış; Uncu, Gürkan; ÖZERKAN, KEMAL; ORHAN, ADNAN; KASAPOĞLU, IŞIL; UNCU, GÜRKAN; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Kadın Hastalıkları ve Doğum Anabilim Dalı.; 0000-0002-7558-8166; AAH-9791-2021; K-2269-2016; AAT-3479-2021; V-5292-2019Introduction and hypothesis Mesh-related problems are significant complications of laparoscopic sacral colpopexy. The conventional technique precludes performing laparoscopic sacral colpopexy without using a mesh. We describe the Ozerkan modification for laparoscopic sacral colpopexy using a polyester fiber suture instead of a standard mesh and report 1-year objective and subjective outcomes. Methods Women diagnosed with stage >= 2 vaginal vault prolapse were prospectively recruited for the Ozerkan modification between 2015 and 2017. The primary outcome was the anatomic success of the repair, defined by objective parameters using the pelvic organ prolapse quantification system (stage 0 or 1). Secondary outcomes were subjective outcomes assessed with the quality of life scores. Results Twenty-two women underwent the Ozerkan modified laparoscopic sacrocolpopexy. Mean operation time was 85.6 min. Mean estimated blood loss was 71 ml. One patient was lost during the clinical follow-up in the outpatient clinic up to 1 year. Nineteen of 21 patients had stage 0 or 1 prolapse at the end of 1 year. Two patients were not satisfied with their pelvic floor after 1 year. Both the objective and subjective cure rates were 90.4%. There were no bladder or bowel complications during the peri- or postoperative period. Conclusions The new modification of laparoscopic sacral colpopexy seems a feasible and safe option to avoid mesh complications in the treatment of vaginal vault prolapse.Publication The ki-67 index and neutrophile-lymphocyte ratio are prognostic factors in patients with low-risk endometrial cancer(Mre Press, 2021-04-21) Çubukcu, Erdem; Şahin, Ahmet Bilgehan; Atalay, Fatma Öz; Ocak, Birol; Özşen, Mine; Abakay, Candan Demiröz; Özerkan, Kemal; Hasanzade, Ulviyya; Mesahorlı, Merve; Deligönül, Adem; Ozan, Hakan; Evrensel, Türkkan; ÇUBUKÇU, ERDEM; ŞAHİN, AHMET BİLGEHAN; ÖZ ATALAY, FATMA; OCAK, BİROL; ÖZŞEN, MİNE; DEMİRÖZ ABAKAY, CANDAN; ÖZERKAN, KEMAL; HASANZADE, ULVIYYA; Mesahorlı, Merve; DELİGÖNÜL, ADEM; OZAN, HAKAN; EVRENSEL, TÜRKKAN; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Tıbbi Onkoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Patoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Radyasyon Onkolojisi Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Jinekolojik Onkoloji Anabilim Dalı.; 0000-0002-7846-0870; 0000-0001-7537-1699; 0000-0002-5771-7649; 0000-0001-5380-5898; AAH-9791-2021; K-2269-2016; AAM-4927-2020; ETP-1691-2022; JHC-4482-2023; HHA-1866-2022; AAI-1609-2021; AAH-3855-2021; EXU-7466-2022; FNB-4540-2022; ESM-4544-2022; DKZ-4159-2022; EXJ-0967-2022Objective: To investigate the prognostic factors comparing clinical, histopathological, and laboratory parameters in low-risk endometrial cancer (EC). Methods: In the present single-center study, multivariate Cox regression analysis was performed on retrospective clinical and laboratory data and histopathological features obtained from the re-evaluation of 253 patients with low-risk EC. Receiver operating characteristic curves (ROC) were plotted for neutrophile-lymphocyte ratio (NLR), platelet-lymphocyte ratio, lymphocyte-monocyte ratio and Ki-67 index for recurrence. Kaplan-Meier analysis was employed for survival rates. Results: The median age was 58.5 years (32.0-75.4). Most of the patients were obese and post-menopausal. In nearly half of the patients, lymphadenectomy was performed in addition to hysterectomy and oophorectomy. The median tumor size was 30 mm (range 2-80), and the median Ki-67 index was 25 (1-90). According to the ROC curve analysis, the cut-off values for the Ki-67 index, NLR, PLR, and LMR were determined as >= 22, >= 1.98, >= 115.3, and >= 4.71, respectively. The log-rank test revealed that the patients with a Ki67 index lower than 22% and NLR lower than 1.98 had statistically longer recurrence-free survival (RFS) (p = 0.002 for Ki-67 index and p = 0.004 for NLR). The multivariate analysis revealed that the Ki-67 index and NLR were statistically significant factors for RFS (p = 0.012 and p = 0.029, respectively). Conclusion: The present study highlights the prognostic implications of both the Ki-67 index and NLR in lowrisk EC.Publication Is fibroid location associated with hemorrhage and complication rates following laparoscopic myomectomy?(Springer, 2020-05-26) Aslan, Kiper; Orhan, Adnan; Türkgeldi, Engin; Süer, Ebru; Düzok, Nergis; Özerkan, Kemal; Ata, Barış; Uncu, Gürkan; ASLAN, MÜNİR KİPER; ORHAN, ADNAN; SÜER, EBRU; DÜZOK, NERGİS; ÖZERKAN, KEMAL; UNCU, GÜRKAN; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Kadın Hastalıkları ve Doğum Anabilim Dalı.; 0000-0002-9277-7735; 0000-0002-7558-8166; 0000-0002-5008-3292; K-2269-2016; AAH-9716-2021; AAT-3479-2021; AAH-9791-2021; AER-7173-2022; AAU-2710-2020; AAH-9694-2021; V-5292-2019Objective To determine whether hemorrhage and complication rates vary according to the location of the dominant fibroid following laparoscopic myomectomy. Background Laparoscopic myomectomy is associated with less postoperative pain, analgesic requirement, shorter hospitalization period, and less febrile complications when compared to conventional laparotomy. Despite the advantages, complications like hemorrhage, blood transfusion, bowel and urinary tract injury, and conversion to laparotomy may be seen in laparoscopic myomectomy. We do not know whether the fibroid location affects these complications. Materials and methods Women, who underwent laparoscopic myomectomy at two different tertiary academic hospitals, were analyzed retrospectively. Only women with at least one intramural fibroid (Monroe type 3, 4, or 5) were included. Patients were categorized according to localization of the dominant fibroid, i.e., anterior uterine wall, posterior uterine wall, and fundus. Change in hemoglobin levels before and after surgery and complication rates were compared across categories. Results Two hundred nineteen women with a mean age of 35.7 +/- 6 years were included. There were 81 women with fundal fibroid, 56 with anterior wall, and 72 with posterior wall fibroid. The other ten women with intraligamentary and isthmic fibroid were excluded. The mean fibroid diameter was 6.7 +/- 2.6, 6.6 +/- 2.3, and 6.7 +/- 2.3 cm in the fundal, anterior, and posterior groups, respectively (p = 0.9). The median (25th-75th percentile) changes in hemoglobin levels were 1.5 (0.8-2.2), 1.3 (0.6-2.1), and 1.3 (0.9-2) g/dl in fundal, anterior, and posterior wall groups, respectively (p = 0.55). There were 5 (6.2%), 5 (8.9%), and 2 (2.8%) complications in fundal, anterior, and posterior wall groups, respectively (p = 0.33). Conclusion The incidence of hemorrhage or complication does not seem to vary depending on the fibroid location. However, the sample size was limited; observed values suggest that fibroid location does not affect hemorrhage and complication rates.Publication A meshless practical laparoscopic sacrohysteropexy modification and long-term outcomes(Elsevier, 2020-11-01) Orhan, Adnan; Özerkan, Kemal; Kasapoglu,Işıl; Ocakoğlu, Gökhan; Aslan, Kiper; Uncu, Gürkan; ORHAN, ADNAN; ÖZERKAN, KEMAL; KASAPOĞLU, IŞIL; OCAKOĞLU, GÖKHAN; ASLAN, MÜNİR KİPER; UNCU, GÜRKAN; Uludağ Üniversitesi/ Tıp Fakültesi/Doğum ve Jinekoloji Bölümü/Ürojinekol ve Minimal İnvas Jinekol Ünitesi; Uludağ Üniversitesi/Sağlık Bilimleri Enstitüsü/Biyoistatistik Anabilim Dalı; 0000-0002-7558-8166; 0000-0002-1114-6051; 0000-0002-9277-7735; V-5292-2019; AER-7173-2022; AAH-9694-2021; AAT-3479-2021; AAH-9791-2021; AAH-5180-2021; K-2269-2016Study Objective: To describe a new modification of laparoscopic sacrohysteropexy without using a mesh and report the 3-year outcomes.Design: A prospective cohort study.Setting: Minimally Invasive Gynecology Unit, Bursa Uludag University Hospital, Turkey.Patients: Women who were diagnosed with >= stage 2 uterine prolapse.Interventions: A laparoscopic sacrohysteropexy modification using a polyester fiber suture instead of a standard polypropylene mesh.Measurements and Main Results: The primary outcome was the anatomic success of the repair, with success defined as objective parameters using the pelvic organ prolapse quantification system. The secondary outcomes were subjective outcomes, which were assessed using the quality-of-life scales. Forty-seven women who underwent the procedure were followed up for a minimum of 3 years. Forty-four of the 47 patients had stage 0 or 1 prolapse at the end of the second year, according to the primary outcomes. The anatomic success rate was 93.6%. In the secondary outcomes, 2 patients were not satisfied with their pelvic floor after the second year. The subjective cure rate was 95.7%. There was a statistically significant improvement in both pelvic organ prolapse quantification and quality-of-life scores in the third postoperative year. The mean operating time was 84.6 minutes, and the mean estimated blood loss was 21.3 mL. There were no bladder or bowel complications in the perioperative or postoperative period.Conclusion: Laparoscopic sacrohysteropexy can be performed safely with this meshless modification in uterine prolapse as an alternative. (c) 2020 AAGL. All rights reserved.