key: cord-0068081-2nxp92y9 authors: nan title: Ist Turkish International Colorectal Surgery Congress, XVIIIth Turkish Colon and Rectal Surgery Congress date: 2021-10-01 journal: Eur Surg DOI: 10.1007/s10353-021-00737-5 sha: 1fd6bd349aad9cd2492ccb1554af0fda8d6f93f4 doc_id: 68081 cord_uid: 2nxp92y9 nan Case series of affected segment of rectosigmoid resection and reanastomosis in patient with primary and recurrent gynecologic cancers Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey Background: It is aimed to present the results of colorectal resection performed during gynecologic oncologic surgery. Methods: Between January 2018 and May 2021, rectosigmoid colectomy operations were performed on 34 patients, including the covid 19 pandemic period, in the gynecological oncology service of the University of Health Sciences Zeynep Kamil Gynecology and Pediatrics training and research hospital. Results: Of the underwent 34 anastomoses, 27 (79.4 %) were made with primary suture technique and 7 (20.6 %) were end to end anastomosis circular stapler. Intraoperative management included adequate mobilization of the colonic mesentery from the splenic flexura to eliminate tension on the anastomosis, and liberal use of pelvic drains. During the operation, 8 (23.5 %) patients underwent colostomy and 4 (11.8 %) ileostomy. Relaparatomy was required due to anastomotic leakage in 6 (22.2 %) of the anastomoses made with the primary suture technique and in 2 (28.5 %) of the anastomoses made with the end to end anastomosis circular stapler technique. There were no operative mortalities. 4 of the underwent colostomies were closed again at different appropriate time intervals. Conclusions: Rectosigmoid colectomy permitted optimal or curative tumor resection in the majority of these patients, and thus should be performed whenever necessary to rech better oncologic outcome. Keywords: Colostomy, Loop ileostomy Is early onset colorectal cancer related to lymph node metastazis much more? Background: The incidence rate of colorectal cancer is increasing globally in individuals under 50 years of age. EOCRC accounts for approximately 10 % of all colorectal cancers. EOCRC has a certain hereditary predisposition, which has distinct clinico pathological and molecular features compared with traditional CRC. Methods: Between 2010 and 2020, 394 patients who were operated for CRC were included in the study. Patients were divided into 2 groups as EOCRC (<50 years) and AOCRC. Pearson's chi-square test was used to compare categorical variables in independent groups. Logistic regression analysis was performed using the Backward method with the variables whose relationship with the age group was evaluated, with the result of p < 0.100. In Bd3 group, well differentiation rates were significantly lower and moderate differentiation rates were higher than other groups (p = 0.002). Tumor size was significantly bigger and lymphovascular invasion ( LVI) was significantly higher in Bd3 group. Local and distance recurrences were detected in 5 (5.2 %), in 4 (9.8 %), and in 10 (17.9 %) patients of the Bd1, Bd2, and Bd3 groups, respectively (p = 0.03). Five-year overall survival ( OS) and disease-free survival ( DFS) were significantly worse in Bd3 group. Additionally, in the subgroup of patients with Bd3 and LVI, 5-year OS (60 % vs 92 %, p = 0.001) and DFS (56.1 % vs 85.4 %, p = 0.001) were significantly worse than other groups. Conclusions: Tumor budding is a factor that negatively affects prognosis. We think that adjuvant chemotherapy is necessary, especially in pT3/4aN0 colon cancer patients with the presence of Bd3 and LVI together. Keywords: Colon cancer, Tumor budding Factors affecting surgical margin positivity in patients underwent resection for rectosigmoid colon cancer Background: Surgical margin positivity ( SMP) in rectosigmoid colon cancer is a difficult problem to manage and treat. In this study, we examined the factors affecting SMP in patients who underwent surgical resection for rectosigmoid colon cancer. Methods: The patients who were operated for rectosigmoid colon cancer in Van Yuzuncu Yil University Faculty of Medicine Department of General Surgery between 2010 and 2018 were evaluated. The relationship between preoperative, operative and postoperative factors and SMP was evaluated with independent samples T test, Mann Whitney U test and Chi-square test (assuming p< = 0.05 significant). Results: There were 114 patients who met the study criteria. The mean age of the patients was 60.03 ± 14.41 years (25-98), and 61 (53.5 %) patients were female. 7 (6.1 %) patients had SMP. The rate of SMP was higher in patients with younger age (p = 0.022), with more metastatic lymph nodes (p < 0.001), and with a high lymph node ratio (p < 0.001). Conclusions: Young patients and patients with a high number and rate of metastatic lymph nodes have a higher rate of SMP, so these cases are difficult to manage. Adjuvant therapy and re-surgeries may be needed in the treatment of patients with SMP. Keywords: Surgical margin positivity, rectosigmoid colon cancer Endorectal advancement flap for anorectal fistula: a single surgeon experience Al Zahra Hospital Dubai, UAE Background: Anorectal fistulas are challenging to treat. The search for the optimal operation continues. The purpose of this study was to review the results of the endorectal advancement flap. Methods: A retrospective review of a single surgeon experience. Results: 87 patients underwent ERF (Male/Female 42.5 %/57.5 %).Median age was 41 years. Fistula types included low to mid transphincteric 31,high or suprasphincteric 25,horseshoe 10,anoperineal 3, rectovaginal 14, and rectourethral 4.The most common etiology was cryptoglandular disease 87.4 %.34 patients (39.1 %) had prior seton insertion and 18 patients (20.7 %) had prior fistula surgery. 9 patients (10.3 %) had baseline incontinence. Median operative time was 75 minutes. A postoperative complication (anal sepsis) was noted in 4 patients (4.6 %).During a median follow-up of 4 months (range 1-38 months),initial healing was noted in 80 patients (93 %). Recurrence rate was 9.3 % yielding an overall success rate of 83.7 %. There was a non-statistically significance trend for a higher success rate in patients who were non-smokers (92 vs. 73 %, p = 0.065),those with low to mid transsphincteric fistula (87 % vs. 68 %, p = 0.073), and for cryptoglandular type fistula (87 vs. 64 %, p = 0.05) Conclusions: ERF for complex anorectal fistulas is associated with a high healing rate, low complication rate, and infrequent recurrence. Larger studies are needed to further assess the impact of patient related factors and fistula characteristics on long-term success of ERF Keywords: Endorectal advancement flap, Anal fistula Background: Closure of the appendix stump is important for the prevention of serious complications such as sepsis, peritonitis, and postoperative fistula. In our study, we aimed to compare two commonly used surgical techniques for stump closure in LA. Methods: A total of 369 patients who underwent LA with the diagnosis of acute appendicitis in our clinic between January 2011 and January 2020 were analyzed retrospectively. A total of 304 patients who met the inclusion criteria were divided into two groups as intracorporeal ligation and nonabsorbable polymer clips (hem-o-look clips). Patient groups were compared in terms of age, gender, duration of operation, hospital duration, and postoperative 30-day complication rates. Results: Intracorporeal ligation was used in Group 1 (n = 151, 49.67 %), and nonabsorbable polymer clips were used in Group 2 (n = 153, 50.32 %). The operation time and hospital stay were shorter in Group 2 (p˂0.05). Postoperative complications were seen in 15 (4.93 %) patients. Post-operative complications were higher in the group treated with intracorporeal ligation (p < 0.05). Conclusions: As an appendix stump closure technique in the learning curve stage, the application of nonabsorbable polymer clips can be preferred as a method that can reduce the postoperative complication rate and hospital stay. Keywords: Appendicitis, Complication Factors affecting the preference of ostomy in patients who underwent resection for rectosigmoid colon cancer Background: Ostomy is a surgical method used in resection-applied rectosigmoid colon cancer. In this study, we wanted to emphasize in which patients we prefer ostomy in rectosigmoid colon cancer resection. Methods: The patients who were operated for rectosigmoid colon cancer in Van Yuzuncu Yil University Faculty of Medicine Department of General Surgery between 2010 and 2018 were evaluated. In these patients, the preference for ostomy was evaluated with independent samples T test, Mann Whitney U test and Chi-square test (assuming p< = 0.05 significant). Results: There were 114 patients included in the study. The mean age of the patients was 60.03 ± 14.41 (25-98) years, and 61 (53.5 %) patients were female. An ostomy was preferred in 50 (43.9 %) of all patients. Ostomy was preferred in patients who received neoadjuvant therapy (p = 0.003), patients with distal tumor (p < 0.001), patients with extensive reactive lymph node dissection (p = 0.007) and patients with high total lymph node count (p = 0.021). Emergency colon surgery (p = 0.844) and the length of the removed bowel segment (p = 0.957) were not found to be a preference for ostomy. Conclusions: Extensive lymph node dissection, more distal location of the tumor, and neoadjuvant treatment are the factors that affect the choice of ostomy. Keywords: Ostomy, Rectosigmoid colon cancer Impact of positive-to-total lymph node ratio on prognosis in stage 3 colorectal cancer: A multicenter study Background: Colorectal cancer ( CRC) remains a health problem despite advances in diagnostic and treatment methods. This study aimed to determine the impact of positive-tototal lymph node ( LN) ratio (+ LNR) on survival in CRC. Methods: A total of 109 patients who underwent surgery for CRC between 2010 and 2018 were included in the study. Patients with stage 3 CRC were included. Patients age; sex; operation type (emergency or elective); tumor size, grade, and location; TNM stage; vascular and perineural invasions; numbers of LNs examined and negative and positive LNs, + LNR, and administration of postoperative chemotherapy ( CT) were examined. anal incotence was restored in 4 patients after endotonic electrostimulation. Conclusions: We came to the conclusion that our modification of the Wells method is one of the effective methods to be used in the treatment of such patients. Keywords: Prolapse, Rectum Peritoneal Cancer Index -immunoscore in cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) Background: A valid comparison of immun function among different patients, primary pathologies, and tumor burdens requires a reliable assessment of a complex clinical situation. This study aimed to investigate the prognostic impact of combined PCI-Immunoscore in patients treated with CRS/ HIPEC. Methods: 424 patients of the prospectively maintained database were analyzed. Besides clinicopathologic factors, modified Glasgow Prognostic Score (mGPS), CRP-Albumin Ratio ( CAR),Neutrophile-Lymphocyte Ratio ( NLR),thrombocyte count, and Neutrophile-Thrombocyte Ratio ( NTR) were stratified in scoring categories as prognosticators of surgical and oncologic outcomes. Results: The median follow-up was 37.8mos. The overall survival was 51.7 %.The 1,3, and 5-yr survival rates were analyzed as 81.1 %, 58.1 %, and 46.5 %, respectively. The number of resected organs (p = .001; OR:1.94), ICU stay (p = .011; OR:2.11), and the mGPS(1&2) scoring categories were significantly associated with overall morbidity (p = .001; OR:2.52&3.0.7, respectively). Incomplete cytoreduction ( CC-1&2)(p = .001; OR:1.86), PCI (p = .005; OR:1.62), and neoadjuvant chemotherapy (p = .001; OR:2.48) were independent determinants of the recurrent disease. In Cox analysis, anastomotic leak (p = .002; HR:3.26), the completeness of cytoreduction (p = .0014; HR:1.64), the number of organ resection (p = .002; HR:1.83),the lymph node involvement (p = .003; HR:1.76), and all of the combined PCI-CAR-NT(1-3) scoring categories (p = .001; HRs:5.35, 8.7 and 10.15, respectively) were found to be robust prognostic factors for overall survival. Conclusions: Staging the host by combining the PCI with an immunoscore may help to assess/monitor/improve the surgical complications and final oncologic outcomes in these complex cancer patients. The aggregate maximum PCI-Immunoscore tool may be a better prognostic measure for outcome evaluation Keywords: Cytoreductive surgery/ HIPEC, Immunoscore ulum ( MD) in adults is controversial. The aim of this study is to compare the postoperative complications of diverticulectomy in incidental and symptomatic MD. Methods: The adult patients with MD who were surgically treated in our clinic between January 2010 and December 2020 were analyzed retrospectively. Patients were divided into two groups according to having symptomatic and asymptomatic diverticula. Age, gender, preoperative laboratory values, histopathology, hospital duration, and postoperative complications were compared between the groups. Results: A total of 46 patients, symptomatic (Group 1, 78.3 %) and incidental (Group 2, 21.7 %) were included in the study. The number of male patients was higher and the male/female ratio was 30/16. Patients in Group 1 were younger than Group 2 (p < 0.05). MD dimension was longer in Group 1 (p < 0.05). The hospital duration in Group 2 was higher than Group 1 (p > 0.05). All of the postoperative complications were surgical site infections and were more common in Group 1 (p > 0.05). Conclusions: While complications are higher after resection in symptomatic Meckel's diverticulitis, it should be kept in mind that hospital stay may be longer due to primary surgery in incidental Meckel's diverticulitis. Keywords: Diverticulectomy, Complications Correction of the perineal prolapse in the new modification Azerbaijan Medical University, Baku, Azerbaijan Background: Rectal and uterine prolapse is one of the diseases that occur in women after difficult childbirth, heavy physical work, severe weight loss. Methods: The rectal cord apparatus is mobilized without damage to the level of the internal sphincter, the bowel is pulled up and to the right, is brought to a normal position where it will remain in the pelvic cavity, 3 × 5 cm proline mesh is divided into 3 slices up to 1/3 of the length, then 2 slices are fixed to the posterior wall of the rectum mobilized to the inner sphincter with 3-4 sutures at a distance of 1 cm through the muscle layer along the sides, the other 3 slices are sewn in the same way to the cervix uteri or uterus. Results: After 1 year of this operation in 16 patients, no recurrence of uterine, vaginal and rectal prolapse was observed on re-examination, constipation was occurred in 2 patients and treated with conservative treatment. Electrostimulation due to Background: To discuss the clinical application of terminal ileum suspension in laparoscopic radical resection for low rectal cancer. Methods: Between September 2015 to September 2017, forty patients with low-rectal cancer were randomly assigned to control group receiving laparoscopic radical proctectomy with total mesorectal excision TME combined with the terminal ileal loop ostomy n = 20 and test group receiving laparoscopic radical proctectomy with TME combined with terminal ileum suspension n = 20). The first exhaust time postoperative hospital stay postoperative discomforts and complications were recorded. Results: There were statistical differences between the two groups at the first exhaust time post-operation diarrhea, colostomy bleeding and the rate of colostomy back operation P < 0.05. Compared to the control group, there were no statistical differences at the rate of anastomotic fistula and postoperative hospital stay P > 0.05. Conclusions: Terminal ileum suspension could achieve the clinical effect of the ileostomy and significantly decrease postoperation complications. It does not affect the patient's postoperative recovery and reduces the pain and financial burden of patients. Keywords: Terminal ileum suspension, Low-rectal cancer The incidence and mortality rates of earlyonset colorectal cancer ( EO-CRC) are increasing, while with few studies focused on the disease. This study aims to assess clinicopathological characteristics and prognosis of EO-CRC patients in China. Methods: In this retrospective study, patients are less than 40-year-old, having undergone resection in Cancer Hospital, Chinese Academy of Medical Sciences from January 2017 to December 2018 were enrolled. The clinicopathological characteristics and prognosis between non-neoadjuvant and neoadjuvant groups were analysed. Results: This study collected 211 EO-CRC patients, with 152 in non-neoadjuvant group and 59 in neoadjuvant group. The deficient mismatch repair rate was 15.15 %. In neoadjuvant group, pathologic complete response rate was 11.86 % and vascular tumour thrombus was less frequently identified (P = 0.002). There were no significant differences between the 3-year recurrence-free survival ( RFS) and overall survival ( OS) rates ( RFS:76.32 % vs 64.41 %, p = 0.09; OS: 88.16 % vs 83.05 %, P = 0.4). Advanced N, M stages, perineural invasion were associated with poor prognostic of RFS, advanced T, N stages, and tumour deposits with poor prognostic of OS. Conclusions: Advanced N stage is the important factor of poor prognosis in RFS and OS of EO-CRC patients with the rates of 3-year RFS and OS reaching 70 % and 85 %. Keywords: Early-onset colorectal cancer, Clinicopathological characteristics Background: The ileum has unique functions such as enzymatic digestion of nutrients, absorption of vitamin B12, fats and bile salts, and immunologic functions. This study aimed to determine the prognostic role of ileal resection on surgical and oncological results of cytoreductive surgery ( CRS) and hyperthermic intraperitoneal chemotherapy ( HIPEC). Methods: Prospectively maintained database of 661 patients of whom 348(52.3 %) had ileal resection were analyzed. Besides clinicopathological variables, peritoneal cancer index ( PCI), completeness of cytoreduction ( CC-0, CC-1 and-2), (neo) adjuvant-chemotherapy, operative time, usage of albumin, erythrocyte suspension ( ES), and fresh frozen plasma ( FFP) were evaluated. Results: Median follow-up period was 35.26 months. The 3-and 5-year survival rates were significantly lower in ileal resection group (41.3 % and 28.0 % vs. 57.5 % and 36.3 %; p = .001). High PCI score (p<.001), more CC-1 or CC-2 cytoreductions (p<.001), high number of resected organs (> = 5 organs) (p = .000), more splenectomy (p = .001), the prolonged operative time (p<.001), increased morbidity (p<.001), more neoadjuvant chemotherapy (p = .004), the presence of ostomy (p<.001), and development of infection (p<.001), more intra-operative ES(p<.001), albumin (p<.001), and FFP(p<.001), and more postoperative ES(p<.001) usage were found in ileal resection group. PCI score (p = .000), the number of resected organs (p = .000), splenectomy (p = .045), neoadjuvant-chemotherapy (p = .004) and morbidity (p = .020) were independent prognostic factors. Conclusion: The loss of ileal functions have potential prognostic role on increased post-operative complications and worsened overall survival in patients with PMs. Keywords: Cytoreductive surgery/ HIPEC, Ileum Background: Sphincteroplasty is important in the management of anal sphincter injury. We aimed to evaluate overlapping and direct apposition sphincteroplasty techniques for the anal sphincter repair. Methods: Thirty-six patients who underwent sphincteroplasty due to anal sphincter injury between 2011 and 2021 were analyzed retrospectively. Age, gender, etiologic factors, degree of laceration, repair technique, postoperative complication, time between injury and repair, length of hospital stay, followup time, and postoperative Cleveland Clinical Incontinence Score ( CCIS) were evaluated. The outcomes of overlapping and apposition sphincteroplasty techniques were compared. Results: 31 were female, 5 were male, and the mean age was 31.5 ± 6.7 years. The etiologic factors were obstetric trauma in 25 patients, perianal intervention in 7 patients, and trauma in 4 patients. The overlapping technique was applied to 14 patients and the apposition technique was applied to 22 patients. Postoperative mean CCIS of all cases was 5.5 ± 2.6. The mean CCIS of overlapping sphincteroplasty was significantly lower than apposition repair (p:0.006).It was observed that the CCIS level decreased as the time between sphincter injury and repair decreased (p < 0.001; r:0.625). Conclusions: It is important to repair anal sphincter injury as early as possible. Overlapping and direct apposition are safe methods, and the quality of life is higher in overlapping sphincteroplasty. Keywords: Anal sphincter injury, Sphincteroplasty Background: Endometriosis is defined as the presence of endometrial-like tissue outside the uterus. The reported incidence in pre-menopausal women varies between 8 and 15 %. Gastrointestinal ( GI) involvement is reported in up to 3.8-37 % of women diagnosed with endometriosis. In this study, we aim to present our experience in this rare disease. Methods: Chart review was performed by using the keyword"endometriosis", 27 females were identified. Patient demographics, details of surgical treatment for invasive intestinal endometriosis ( IIE), the number of pregnancies, delivery type, use of fertility treatment modalities were documented. In total, 15 patients with IIE were included while 12 patients were excluded from the study. Results: Median age was 36 (26−68). Of the 15 patients,13 were admitted in emergency setting. Only 5 patients had a previous diagnosis of endometriosis. The most common indication for surgery was intestinal obstruction (66.7 %), and the most common affected location was terminal ileum (46.7 %).Stoma was created in 8 patients and 6 of them were reversed during the follow-up. Morbidity rate was 13.3 % and mortality rate was 6.7 %. Conclusions: IIE is a rare disease that may mimic other GI diseases, such as inflammatory bowel disease and malignancies. In young women with cyclic intestinal obstruction symptoms, IIE should be kept in mind in differential diagnosis. Keywords: Endometriosis, Intestinal obstruction Colonoscopy findings in patients whose fecal occult blood tests were positive while colorectal cancer screening Gökmen Güzel* General Surgery Department of Antalya Serik State Hospital, Antalya, Turkey Background: According to the colorectal cancer ( CRC) screening programme in our country, citizens between the ages of 50 and 70 should have a fecal occult blood test ( FOBT) in every 2 years time and colonoscopy should be performed when FOBT was positive. We aimed to evaluate the effectiveness of the program by examining the results of the patients referred to us during the last 1 year. Methods: Demographics, colonoscopy findings, pathology results and treatment methods of 73 consecutive patients with positive FOBT who were sent to our Endoscopy Unit for advanced examination were analysed retrospectively. Results: 38 (52 %) patients were female and 35 (48 %) were male; the median age was 60(50-79). A malignant mass (adenocarcinoma) in 4 (5.5 %) patients and polyps in 28 (38.4 %; precancerous adenomatous polyps in 22 patients whereas hyperplastic polyps in 9) patients were detected. Malignancies were Background: Specimen removal from the natural orifice after laparoscopic surgery is increasingly preferred. In this study, we aimed to share the results of cases with sigmoid volvulus who underwent laparoscopic surgery and transanal specimen extraction. Methods: Patients who underwent elective laparoscopic sigmoid colon resection and transanal specimen extraction for the diagnosis of sigmoid volvulus were retrospectively analyzed. The patients were evaluated in terms of age, gender, comorbidity, operation time, surgical difficulties, length of hospital stay, and complications. Results: Eight patients underwent laparoscopic sigmoid resection and transanal specimen extraction. All patients were male and the median age was 68 (28-86). There were 5 patients with comorbidity. The median operative time was 195 minutes (180-360). Anastomotic leakage occurred in 1 patient. The median hospital stay was 5.5 days (3-21). Conclusions: Transanal specimen extraction after laparoscopic resection is a feasible and safe method since there is no occupying mass such as tumor or diverticula in sigmoid volvulus. This approach may reduce wound complications and provide a short hospitalization. Keywords: Sigmoid volvulus, Natural orifice Background: In the current study, we investigated the role of the Human MutL homolog 1 (MLH1) gene-93 G>A promoter polymorphism in the occurrence and development of colorectal cancer ( CRC). Methods: DNA isolation was performed from blood samples taken from 134 patients and 137 controls by salting method. Genotyping was performed on agarose gel using polymerase chain reaction-restriction fragment length polymorphism ( PCR-RFLP) methods. Results: There were no correlations observed between the subject groups both for genotype and allele frequencies (P > 0.05). Moreover, there were no statistically differences between heterozygote GA and mutant genotype AA and clinic ated with ARM OS included age, gender, tumor stage, and lactate dehydrogenase ( LDH) level. These factors were analyzed using multivariable logistic regression. The OS was analyzed by Kaplan-Meier. The different treatment method was analyzed by Cox proportional hazard model. Results: A total of 80 patients were assessed in this study. The OS analysis results showed that one-year, two-year, threeyear, and five-year OS were 70.0 %, 32.5 %, 21.2 % and 2.5 %, respectively. Log-rank test analysis showed that low LDH level (< 248 U/ L, P = 0.032), receiving surgery (P < 0.001), stage I (P = 0.019), T1 stage (P = 0.006) and M0 stage (P = 0.011) had better OS in all patients. However, better OS was associated in patients who only received surgery ( HR = 2.828; 95 % CI: 1.360-5.920, P = 0.006) from Cox regression analysis. Conclusions: Surgical treatment is a promising way to improve OS in patients with ARM. Keywords: Melanoma, Anorectum Background: Objective Obesity is known to be a preoperative risk factor for rectal cancer surgery. This study aimed to investigate the influence of obesity on the surgical outcomes of laparoscopic surgery for rectal cancer. Methods: The clinical data of 356 patients with rectal cancer from Jan 2012 to Dec 2015 were analyzed retrospectively. Perioperative outcomes were compared between 48 patients with a BMI (body mass index) > = 30 kg/m2 [obese group ] and 308 patients with a BMI<30 kg/m2 [non-obese group] who underwent laparoscopic surgery. Results: Operation times were significantly longer for the obese group than for the non-obese group (125.2 ± 30.5 min vs. 180.5 ± 58.2 min, P = 0.021). There were no statistically significant differences between two groups in terms of intraoperative blood loss, the number of retrieved lymph nodes, postoperative recovery and postoperative complications (P>0.05). During the follow-up period, the overall survival rates were not significantly different between the two groups [66.7 % (32/48) vs 67.2 % (207/308), P = 0.787]. The differences in recurrence and metastasis between the two groups were not statistically significant. Conclusions: Our analysis revealed that laparoscopic surgery can be safely performed in patients with BMI> = 30. The procedure was considered to be difficult but sufficiently feasible. Keywords: Rectal cancer, Obese, Body mass index, Laparoscopy, Treatment outcome study was aimed to compare of surgical and oncological results of rectal cancer patients over 65( GI) and under/equal to 65( GII) years of age. Methods: The prospectively maintained database of 991 patients were analyzed. All conventional clinicopathologic features, operative findings, and oncologic outcomes were compared in between GI and GII patients. Results: 57.2 % of the patients were over 65 years old. Tumors in GI(57.2 %) were located at 55 % in proximal rectum, 28.2 % in mid-rectum, and 16.7 % in distal rectum, whileas 50.7 %, 26.4 %, and 22.8 % in GII(42.8 %), respectively. 76 % and 81 % of GI and GII patients had received neo-chemo/radiotherapy. There was at least one co-morbidity in both groups ( GI: 91.5 % and GII: 86.8 %). Perioperative mortality rates and length of hospital stays ( LoH) were similar in both groups (mortality: 2.6 %; LoH:13 days, ranging 3 to 54). All the pathological stages were well-matched in adult and geriatric patients. There were no significant differences between groups in terms of local and/ or distant recurrence and disease-free survival. Conclusions: Multidisciplinary management of geriatric rectal cancer can be performed effectively with good oncologic outcomes in experienced colorectal units. Keywords Background: Studies on short-course preoperative radiotherapy in combination with total mesorectal excision for rectal cancer reported improved local control without clear survival benefits. The optimal fractionation and interval between radiotherapy and surgery are still under debate. We, therefore, aimed to report 10-year results of a randomized clinical trial ( RCT, NCT01444495) comparing different time intervals between irradiation and surgery for rectal cancer. Methods: Patients with rectal cancer were randomly assigned to short-course preoperative radiotherapy (5 × 5 Gy) followed by surgery 7-10 days or 4-5 weeks after the end of irradiation. The primary endpoint was the local recurrence rate at 5 years. The secondary endpoints included overall survival, disease-free survival, systemic recurrence rate, and downstaging. Results: A total of 154 patients were randomly assigned to short (n = 77) or long interval (n = 77) surgery. The cumulative incidence of local recurrence at 10 years was 1.5 % and 12.7 % in the short and long-interval groups, respectively (p = 0.037). Accordingly, the incidence of systemic relapse was 16.9 % versus 9.9 % (p = 0.230). There were no differences in the overall 10-year survival between patients subject to short and longinterval surgery (58 % vs 61 %, p = 0.754). Conclusions: Short-course radiotherapy with delayed surgery demonstrated an increased risk of local relapse over a 10-year follow-up. Keywords: Rectal cancer, Preoperative short-course radiotherapy pathological parameters; tumor stage, tumor grade, age, sex, smoking status and alcohol consuming (P > 0.05). In contrast, the promotor hMLH1 -93G>A polymorphism was significantly associated ( OR = 0.56; 95 % CI = 0.35-0.91; P = 0.018) with a reduced risk of CRC in the recessive model ( GG+GA vs AA). Conclusion: Our findings indicated that the genetic variant of hMLH1-93 G/A may not be associated with the risk of CRC, however, the recessive model was associated with a reduced risk of disease. Further studies with a large sample size can be performed to understand the prognostic role of hMLH1 gene polymorphisms in CRC. Keywords Background: Fournier's gangrene ( FG) is a fatal disease that is characterized with the necrotizing soft tissue infection ( NSTI) of perianal, perineal, and genital region. Factors affecting the prognosis of FG were well described, but little data exist about the impact of treating center. In this study, we aimed to present the largest single center data, and the impact of center affect in FG. Methods: Data of the patients who underwent surgical debridement for FG between January 1996 and May 2021 were collected from the prospectively maintained departmental database. In total,235 patients included in the study. Patients were classified into two groups based on the year of admission:Before 2010 and After 2010. Patient demographics, duration of symptoms, presence of DM,etiology of NSTI, UFGSI score, need of mechanical ventilation, and length of hospital ( LHS) were recorded. Results: Results: Median age was 58(22-88) and 32.8 % were females. Median UFGSI score was 9(1-30).Overall mortality rate was 23.4 %.Of the 235 patients,101 were admitted before 2010.Patients in the After 2010 group were older (p = 0.008),had longer LHS(p = 0.047),increased need for mechanical ventilation (p = 0.023),higher UFGSI score (p = 0.023),more frequent anorectal origin (p = 0.0005).However, mortality rates were comparable between the two groups (19.8 % vs.26.12 %,p = 0.25). Conclusions: Our department managed more complicated FG patients in the second period of this study with comparable mortality rate. This finding may be result of the increasing experience of our center. Keywords: Fournier's gangrene Comparison of oncologic outcomes in geriatric patients with rectal cancer Dokuz Eylul University Hospital, Department of Surgery, Colorectal&Pelvic Surgery Unite, Izmir, Turkey Background: The morbi-mortality and oncologic outcomes can be worsened in geriatric rectal cancer patients due to fraility, co-morbidities, sarcopenia, (neo-) adjuvant therapy. This to those with incomplete occlusion and those with no suspicion of strangulation. Success, mortality and morbidity were compared in the treatment groups. Results: Conservative treatment and early surgical treatment was performed in 284 cases and in 96 cases, respectively. Successful results were obtained in 73.6 % of the cases with conservative treatment. The success rates were 85 % and 46.5 % in incomplete and complete occlusion patients, respectively. Late surgical treatment was performed in 75 patients with unsuccessful results. Conclusions: The majority of ASBO patients can be cured with conservative treatment. Late surgical treatment in patients for whom conservative treatment fails does not increase mortality and morbidity. Keywords: Adhesion, Obstruction Completely diverted tube ileostomy versus conventional loop ileostomy Marmara University, Faculty of Medicine, Department of General Surgery, Istanbul, Turkey Background: Diverting ileostomies are performed to prevent morbidity andmortality caused by anastomotic leakage. However, many complications may develop due to loop ileostomy and its reversal. We aimed to compare the results of completely diverted tube ileostomy and loop ileostomy. Methods: The study was designed prospectively and operations were performed by the same surgeon at a single center. Completely diverted tube ileostomy was performed in 20 consecutive patients and loop ileostomy was performed in the next 20 consecutive patients who needed diverting stoma. The primary outcome of the study was to compare the overall complication rates. Length of hospital stay, cost-effectivity, achieving complete diversion and length of time with a stoma were evaluated as secondary outcomes. Results: There were no significant differences between the demographic characteristics. Complete diversion was achieved in both groups. Overall complications were significantly higher in the loop ileostomy group [p = 0.002]. Median time with a stoma was statistically higher in the loop ileostomy group [p < 0.001]. Conclusion: Completely diverted tube ileostomy is superior to loop ileostomy for reasons such as lack of need for reversal surgery, fewer complications, and provides a significant cost advantage. Keywords: Tube ileostomy, Loop ileostomy Background: Low anterior Resection Syndrome ( LARS), which consists of symptoms such as incontinence, urgency, diarrhea, and increased frequency of defecation, has been increasingly seen in patients undergoing low anterior resection. In this study, risk factors that may affect the development of LARS in patients who underwent laparoscopic resection for rectal cancer were investigated. Methods: Patients who completed the LARS score questionnaire were classified into 2 groups based on having major LARS or not (Group 1:No LARS or minor LARS; Group 2:Major LARS). Age, gender, BMI, tumor localization, distance from the anastomosis to the anal verge, lymph node positivity, neoadjuvant and adjuvant treatment status, and protective stoma status were recorded. The mean follow-up time of the patients was 23 (min-max;18-25) months. Results: Among the 50 patients, 21 (42 %) were classified into the major LARS group. There was no significant difference between the groups in terms of age, gender, BMI, harvested lymph nodes. The distance from the anastomosis line to the anal verge, receiving neoadjuvant radiotherapy and having protective stoma were significantly associated with major LARS. Conclusion: The incidence of major LARS after laparoscopic low anterior resection is relatively high. Neoadjuvant radiotherapy, distance from the anal verge, and diverting stoma are major risk factors. Keywords: LARS, SKOR Selection treatment method in adhesive small bowel obstruction evaluation of 380 cases Background: Today, 70 % of mechanical bowel obstructions are caused by adhesive small bowel obstruction ( ASBO). Despite those who recommend the surgical method in the treatment of this problem, it is reported that good results can be obtained with the conservative method. In this study, the efficacy of surgical and conservative treatment methods in ASBO was reviewed. Methods: The data of 380 patients with previous abdominal surgery and bowel obstruction findings were evaluated. Emergency surgery was performed in patients with suspected strangulation and in patients with complete occlusion findings at the first admission examination. Conservative treatment was begin the length of the intraperitoneal rectum (R) to the length of distance between promontorium and peritoneal reflection (PRx). The primary outcome was to evaluate whether the ratio of R/ PRx is higher in patients with rectal prolapse compared to the control group. Results: The length of the sigmoid colon and the length of distance between promontorium and peritoneal reflection (PRx) were not significantly different between the two groups. However, the length of the intraperitoneal rectum was significantly higher in the prolapse group. Furthermore, the median R/PRx ratio in the prolapse group was significantly higher than in the control group. Conclusions: This study showed that intraperitoneal rectum in patients with rectal prolapse is significantly more redundant than the normal population. This result could be considered reasonable evidence for the role of rectal redundancy on rectal prolapse pathophysiology. Keywords: rectal prolapse pathophysiology, redundancy Is routine COVID-19 PCR testing necessary prior to colonoscopic interventions? Istanbul Medeniyet University Goztepe City Hospital, Department of General Surgery, Istanbul, Turkey The aim of the present study was to evaluate the effectiveness of routine nose/throat polymerize chain reaction ( PCR) swab testing for coronavirus disease 2019 ( COVID-19) prior to colonoscopic interventions. Methods: Two peaks of COVID-19 were announced in Turkey during 2020. Infectious parameters of the patients who underwent colonoscopy during these two peaks were recorded and analyzed. p < 0.05 was accepted as statistically significant. Results: The first peak group consisted of 199 (39.0 %) patients while 311 (61.0 %) patients were in the second peak group. Preinterventional PCR testing was performed in none of the patients in the first peak group while all patients underwent PCR testing prior to colonoscopy in the second peak group. During the postinterventional 14-days-follow-up period, PCR testing was indicated and performed in 4 patients (2.0 %) in the first peak group and 37 (11.9 %) patients in the second peak group due to COVID-like symptoms. Postinterventionally, none of the patients in the first peak group had positive PCR results (0.0 %), whereas 5 (1.6 %) patients were diagnosed with COVID-19 in the second peak group (p = 0.162; p > 0.05). Conclusions: Routine preinterventional PCR testing did not affect COVID-19 infection rates measured during the 14-dayfollow-up period after colonoscopic interventions. Keywords: COVID-19, Colonoscopy Neoadjuvant monotherapy of PD-1 monoclonal antibody in five cases of dMMR/MSI-H colorectal cancer Background: Although it is an effective modality, anal biofeedback is no common used in fecal incontinece patients due to the lack of availability, the need of more than one session with trained personnel and high cost. In this study, we aimed to evaluate the success achieved by self-administered home biofeedback treatment. Methods: Patients with fecal incontinece at single center were included in this prospective study. These patients were trained on the application of biofeedback therapy using a novel biofeedback device. Treatment was recommended twice a day for 3 months. The Wexner score, Fecal Incontinence Severity Index ( FISI) and the Fecal Incontinence Quality of Life Scale ( FIQOL) were compared before and after the treatment. Results: Home biofeedback treatment was applied to 22 patients. The median age was 57 (17-69) years old. A very significant decreases were observed in the Wexner scores (p < 0.001) and the median value of the FISI (p < 0.001) after the biofeedback treatment. Furthermore, a very significant increase in the quality of life was found at the end of the treatment (p < 0.001). Conclusion: Home biofeedback is an effective treatment for fecal incontinence. It can be preferred to standard biofeedback therapies because of its simplicity, easy-to-understand and cheapness. Keywords: Fecal incontinence, Home biofeedback A novel circTDRD3-HIF1α-positive feedback loop promotes the proliferation and metastasis of colorectal cancer Background: circRNAs and Tumor hypoxia are thought to play a key role in tumor progression and malignancy, respectively. Nevertheless, the biological effects and mechanisms of specific circRNAs exposed to hypoxia microenvironment in colorectal cancer ( CRC) still remains elusive. Methods: qRT-PCR was used to determine the expression level of circTDRD3 in CRC tissues and cell lines. Subsequently, functional experiments in vitro and in vivo were performed to explore functional effects on tumor growth and metastasis in CRC. Mechanistically, luciferase reporter assay, FISH, RIP assays, CHIP assays were performed to confirm the interaction among circTDRD3, miR-1231 and HIF-1α. Results: CircTDRD3 was upregulated evidently in both CRC tissues and cell lines. Overexpression of circTDRD3 facilitated the proliferation, migration and metastasis of CRC cell lines in vitro and in vivo. Mechanistically, circTDRD3 was shown to regulate the expression of HIF1α by sponging miR-1231 to promote EMT in CRC cells, meanwhile HIF1α could bind to the TDRD3 Background: In performing the taTME procedure, it was found that the clinical anatomy encountered at different sites of dissection of the intestinal wall differed, resulting in differences in the difficulty of the procedure. Methods: Anatomical study of 22 adult male pelvic specimens without obvious lesions using fine dissection and simulated taTME. Results: Determine the anatomical levels and signs of the transanal approach into the anterior rectal space, propose the concept of the lower boundary plane of the anterior rectal space, and determine the differences in the anatomical structures of different subdivisions. Conclusions: In taTME, the anterior rectal surgery area is divided into two zones, upper and lower, with the lower border Methods: A total of 141 patients with resectable rectal cancer were included. Lymph node yield was compared in patients with short and long time intervals between radiotherapy and surgery. Survival curves were compared between patients with different ypN and lymph node ratio ( LNR) categories. Univariate and multivariate analyzes were performed to identify independent prognostic factors for overall survival and disease-free survival. Results: Data were available for a median follow-up of 11.6 years. Higher difference in overall survival at 10 years was observed in patients with LNR < = 0.41 and >0.41 when compared to ypN categories. Separate prognostic factor analyzes were performed for the whole population and for subgroups who had <12 and > = 12 lymph nodes retrieved. LNR was identified as an independent prognostic factor for overall survival in multivariate analyses for all patients and those with less than 12 retrieved lymph nodes. Conclusions: LNR better discriminates patients in terms of overall survival than ypN categories. Keywords: Rectal cancer, Lymph node ratio Background: A growing body of research has revealed that lncRNAs participate in regulating genomic instability. Methods: We obtained RNA expression profiles, somatic mutation profiles and clinical information of colorectal cancer ( CRC) from TCGA project. We divided the cohort into two groups based on mutation frequency and identified genomic instability-related lncRNAs ( GI-lncRNAs) using R software. We further analyzed the function of GI-lncRNAs and established a prognostic model through Cox regression. Using the prognostic model, we divided the cohort into high and low risk groups, and further verified the prognostic differences between the two groups as well as the predictive power of GI-lncRNAs in CRC. Results: We identified a total of 143 GI-lncRNAs that differentially expressed between higher and lower mutation frequency group. According to KEGG pathway and GO analyses, a series of cancer-associated terms were enriched. We further constructed a prognostic model that including 5 GI-lncRNAs ( PTPRD-AS1, AC009237.14, LINC00543, AP003555.1 and AL109615.3). We validated that the expression of the 5 GI-lncRNAs were associated with prognosis and mutation of critical genes. Conclusions: The present research further confirmed the vital function of GI-lncRNAs in genomic instability and the 5 GI-lncRNAs are potential biomarkers and needed to be studied in depth. Keywords: Genomic instability, Long noncoding RNAs Western countries. Computed tomography ( CT) is very important in diagnosis. Clinically, it is difficult to distinguish cecal diverticulitis from acute appendicitis. In our study, we aimed to present our patients diagnosed with solitary cecal diverticulitis. Methods: The records of 18 patients diagnosed with solitary cecum diverticulitis by examination and CT were analyzed from 152 patients admitted to our hospital with quadrant pain and hospitalized with the diagnosis of diverticulitis between 2015-2021.The patients' dermographic characteristics, comorbidities, Hinchey classification, applied treatments, and follow-up were recorded. Results: 11 of the patients were female and 7 were male, with a mean age of 50.4 years (range:22-83 years). Our incidence of cecal diverticulitis was 11.8 %. 83.3 % of the patients were Hinchey 1a and 16.7 % were Hinchey 3.All patients were diagnosed with CT.Surgery was performed in 22 % of the patients, while 78 % were treated conservatively (Table) . Conclusions: Cecal diverticulum accounts for 3.6 % of colonic diverticulum in Western countries. Clinically, it is difficult to distinguish cecal diverticulitis from acute appendicitis. Computed tomography ( CT) is very important in diagnosis. Keywords: Cecal diverticulitis, Lower quadrant pain Single-Port port laparoscopic Hartmann's procedure reversal: First results General Surgery, School of Medicine, Marmara University, Istanbul, Turkey Background: Single port laparoscopic surgery provides better cosmetic results and postoperative recovery. We aimed to evaluate the feasibility and safety of single-port laparoscopic reversal of Hartmann's procedure ( SPL-HR) through the colostomy site. Methods: Five patients who underwent SPL-HR were evaluated. A peristomal incision was made, and the colostomy completely detached from the abdominal wall. The anvil of the circular stapler was inserted in the proximal colon and pushed back to the cavity. The single-port device was inserted through the stoma incision. Conventional laparoscopic instruments were used. The rectal stump and descending colon were mobilized. Splenic flexure mobilization was performed selectively if necessary. End-to-end anastomosis was performed using the circular stapler. Demographics features, details of initial Hartmann's procedure, operative parameters, and perioperative complications were recorded. Results: We successfully performed SPL-HR in all patients. No additional trocars or conversion to open surgery were required. The median operative time was 100 min (range 50-100 min). Postoperative intra-abdominal abscess occurred in 1 patient. The median length of hospital stay was 5 days (range 3-9 days). There was no readmission after the discharge of patients Conclusions: In our experience, SPL-HR is a feasible and safe surgical technique. Keywords: Single-port laparoscopy, Hartmann's reversal of the pre-rectal space (distance from the dentate line intestinal wall is about 4 cm), and different approaches (normal circumferential and lateral approaches) can be taken to enter the pre-rectal space in order to reduce the occurrence of surgical complications. Keywords: Pre-rectal space, Rectal cancer, Transanal total mesorectal excision, Anatomy Can Lymphocyte/ C-Reactive Protein Ratio Predict Morbidity in Surgery for Complicated Sigmoid Diverticulitis? University of Health Sciences Turkey, Tepecik Education and Research Hospital, Department of General Surgery, Izmir, Turkey Background: Many different markers are used as predictors of morbidity and mortality that may develop after major abdominal surgery. The aim of this study is to evaluate the prognostic effect of LCR on morbidity in surgery for complicated diverticulitis. Materials-Methods: Patients who were operated on for complicated sigmoid colon diverticulitis between January 2015 and January 2020 were retrospectively analyzed. Patients aged >18 years with diverticulitis stage Hinchey 3 and 4 according to computed tomography or operative findings were included in the study. The patients were divided into two groups as those with postoperative complications (Group 1) and those without complications (Group 2). Demographic characteristics and inflammatory parameters of the patients were compared. Results: We retrospectively analyzed 61 patients who underwent surgical resection for complicated sigmoid diverticulitis. Eighteen (29.5 %) female and 36 (59.5 %) male patients who met the criteria were included in the study. LCR was found to have an effect on the development of postoperative morbidity in complicated diverticulitis (p < 0.05). Conclusion: We think that LCR can be used as a useful marker to identify those at high postoperative risk in patients undergoing surgery for complicated diverticulitis. This simple applicable laboratory parameter can guide surgeons in these patients. Keywords: Diverticulitis, Morbidity Background: Fournier's gangrene, a potentially fatal disease characterized by necrotizing fasciitis of the perineal and genital region, is a surgical emergency requiring aggressive surgical debridement and antibiotics. In this study, stoma indications and its effect on surgical outcome in patients with Fournier's gangrene were evaluated in the light of literature data. Methods: Our study is a retrospective study that included 120 patients diagnosed with Fournier's gangrene in our center between 2009 and 2019. Patients were grouped as with and without stoma, and demographic data, comorbidities, clinical characteristics, laboratory data, and postoperative follow-up data of the patients were analyzed between groups. Results: The median age of the patients was 58.05 (47-67)/ year, and 89 (74.2 %) were male. No statistically significant difference was found between the groups in terms of gender, diabetes mellitus status, presence of other comorbidities, white blood cell value, C-reactive protein value, creatinine value, glucose value, number of debridements, graft requirement and hospital stay. A statistically significant difference was found in age, hemoglobin value and mortality. Conclusions: In our study, it was found that the stoma group was older, had a lower hemoglobin value, and had a higher mortality. Keywords: Fournier's gangrene, Stoma Background: Traumatic anal sphincter injuries result in incontinence and impair quality of life. We analyzed our cases in which we applied early repair to sphincter injuries caused by obstetric and non-obstetric (penetrating/blunt) etiologies. Methods: The data of 19 patients with traumatic anal sphincter injury who were treated in our clinic between January 2015 and June 2021 were analyzed. Demographic characteristics of the patients, type of injury, time of first attempt, type of repair and long-term results were examined. Results: Of 19 patients, 13 (68.4 %) were female and 6 (31.6 %) were male, with a mean age of 37.4 (19-79). Twelve (63.2 %) of all injuries were due to normal delivery and others due to non-obstetric reasons. Primary sphincter repair was performed on average 12.6 (1-120) hours after injury due to loss of sphincter tone in all patients on rectal digital examination. Jorge-Wexner incontinence score was used in the follow-up of the cases, and the mean score was 2.37 (0-15) in the 1st month after the operation. Permanent complete incontinence was only present in one patient in the non-obstetric group. Conclusions: Satisfactory results in terms of quality of life have been obtained with primary sphincteroplasty performed in the early post-traumatic period. Keywords: Anal sphincter injury, Sphincteroplasty Background: With the increasing incidence of mediumlow rectal cancer, laparoscopy has become the main surgical method. Studies suggested that obese people with deep, narrow pelvises may make surgery more difficult. This paper mainly discusses the relationship between the pelvic factors and the difficulty of laparoscopic middle-low rectal resection. Methods: In this study, clinical data were collected from 80 patients with medium-low rectal cancer who underwent laparoscopic rectal resection between January 2018 and February 2019. 25 pelvic factors were measured on CT images. The operative time, blood loss, conversion to open procedure, use of transanal dissection, postoperative hospital stay and postoperative complications were taken as the criteria of surgical difficulty. Univariate analysis and multivariate analysis were used to analyze the influencing factors of pelvic size and related clinical data on surgical difficulty. Results: Univariate analysis and multivariate analysis suggest that interspinous diameter, anteroposterior diameter of inlet, length of pubic symphysis and distance from sacral prom-Methods: 31 patients with ASA score of III who underwent emergency colorectal resection in our center between 2013 and 2018 were included in the study. Patients were grouped as with and without Clavien-Dindo 3a complication and preoperative CT images were evaluated. Results: Of the 31 patients included in the study, 23 (74.19 %) were male and the median age was 66 (56-77)/year. In the analysis performed between the groups, no statistically significant difference was found between age, gender, left psoas area, total muscle area and visceral fat area. There was a statistically significant difference in the right psoas area and subcutaneous fat area criteria. Conclusions: In our study, it was determined that the right psoas muscle area was less and the subcutaneous fat area was more in patients with ASA score of III, who underwent emergency colorectal resection, and who developed complications above Clavien-Dindo 3a. Keywords: Colorectal surgery, Sarcopenia Results: The average age of included 40 FAP patients is 46,5.%52,5 of the patients were male and the %47, 5 were female. All IPAA patients performed temporary loop ileostomy. Conclusions: In all subscales of SF-36,the IRA group was significantly higher than IPAA group. In the comparison between sex groups themselves;all subscales of IRA were significantly higher in both groups IRA versus IPAA.İn various studies;while no significant difference was found between the two groups when compared with SF-36 but a significant difference was found when compared with EORTC QLQ-CR38.We think that this difference is due to many reasons, from the usage limits of SF-36 to social differences. Keywords: Familial Adenomatosus Polyposis, Quality of life Background: With the development and more widespread use of endoscopy devices, gastrointestinal malignancies, including early-stage cancers and precancerous lesions, are detected more frequently. In this study, our endoscopic submucosal dissection ( ESD) results of gastrointestinal lesions are presented in the light of current literature. The study includes patients who were evaluated in the surgical endoscopy unit of our hospital and underwent ESD between 2018-2021 July. In our study, the demographic data of the patients, the duration of surgery, complications, histopathological results and the results of patients who required resection according to histopathological examination were evaluated. Results: In our study, ESD was performed in 58 patients (30 males, 28 females, mean age 63 ± 10/years), including 24 rectal, 2 rectosigmoid, 34 colonic lesions. Histopathological examination revealed 23 lesions as malignant and 37 lesions as benign. Poor prognostic criteria were found in the histopathological examination of 6 patients, and oncological resection was performed in five patients and follow-up in one patient. After oncological resection, residual tumor was detected in 2 patients and lymph node positivity was detected in 1 patient. Conclusions: Emerging endoluminal surgery with the ESD technique is included in surgical guidelines for the treatment of early stage gastrointestinal tract malignancies. Keywords: Endoscopic surgery, ESD The effect of sarcopenia on surgical outcomes in patients with ASA score III and undergoing emergency colorectal surgery; single center experience Background: Sarcopenia is closely associated with decreased muscle mass and it is possible to measure skeletal muscle volume with computed tomography. In this study, we aimed to evaluate the effect of sarcopenia on surgical results in patients with an ASA score of III who underwent emergency colorectal resection, in the light of literature data. Results: Seven prognostic factors, including depth of tumor invasion, number of regional lymph node metastases, distant metastasis, preoperative CEA level and BRCA2, KRAS and SMAD4 mutation status were included in the prognostic model construction. After verification we found that the model has better performance to predict prognosis than traditional TNM staging. Conclusions: We used seven prognostic indicators to construct a Nomogram model for the prognosis of colorectal cancer that demonstrates better prediction performance than traditional TNM staging. Keywords: NGS, Nomogram Background: The COVID-19 pandemic has affected all aspects of clinical care, including diagnosis and treatment of colorectal cancers ( CRC).During the initial peak of the pandemic, elective patient care was restricted in addition to the government-imposed lockdown, resulting in a decrease in number of colonoscopies being performed and patients admitted for treatment. In this study, we aimed to investigate whether the pandemic has affected presentation characteristics and outcomes of CRCs in this period. Methods: This is a single-center, retrospective study, based on all CRCs that underwent surgical resection in a tertiary-center. Patients were divided into two groups:before and after 15 months of identification of"patient-zero"in Turkey (18/03/2020).Patient demographics, initial presentation characteristics, clinical outcomes and pathological cancer stages were compared. Results: Overall,215 patients underwent resection for CRCs during 30-month period ( COVID:107,pre-COVID:108).Patient characteristics, tumor location and clinical-staging were comparable between two groups. During COVID period, number of obstructive CRCs (p < 0.01) and emergency presentations (p < 0.01) increased significantly compared to the pre-COVID period. But there were no differences between 30-day morbidity, mortality, and pathological outcomes (p > 0.05). Conclusion: Although the results of our study indicate a significant increase in emergency presentation and decrease in elective-admissions of CRCs during the pandemic, patients treated in COVID-period were not in a significant disadvantage in terms post-operative outcomes. Further efforts should be made to decrease risks related to emergency presentation of CRCs for future adverse-events. Keywords: COVID-19, Bowel obstruction Methods: Patients who underwent rectal surgery between March 11, 2019 and 2021 were included in our study. Patients were classified as before (Group-1) and after (Group-2) the Covid-19 pandemic. Demographic data of the patients, surgical procedure performed, histopathological diagnosis, pathological TNM classification and stage were analyzed. Results: 129 patients were included in the study and 75 (58.13 %) of the patients were male. The median age was 65.3 (59-72.5)/year. There were 73 patients in group-1 and 56 patients in group-2. In the comparison, no statistically significant difference was found in demographic data, surgical procedures and T classification. There was a statistical difference in N classification and stage. Conclusions: In our study, the patients who were operated during the Covid-19 period (Group-2) were found to be in a more advanced N classification and stage. Keywords Background: Traditional TNM staging cannot meet the needs of predicting the prognosis of patients with colorectal cancer in the era of precision medicine. It can be seen that the introduction of tumor molecular markers on the basis of anatomy and pathology will be an important way to improve the prognosis assessment system. Methods: NGS was used to examine the key gene mutations in 104 patients with colorectal cancer. Lasso regression was applied for the preliminary screening of detected genes. Gene and clinicopathological indicators were included in the univariate and multivariate Cox regression. Then a nomogram for prognostic prediction was drawn for possible prognostic indicators. We used the C-index, calibration curve, ROC curves to test the accuracy and differentiation of the proposed model. prognosis of the two subgroups was compared. Online survival database and Human Protein Atlas ( HPA) validate the model results. Results: 469 differentially expressed RBPs were detected, and 10 prognostic-related RBPs were obtained. In the prediction model, the prognosis of high-risk patients in the experimental group is poor in the lower-risk group, and the results of the control group are the same. Cox analysis shows that this model can be used as an independent prognostic factor. The results of online survival analysis tools, HPA and models are consistent. Conclusions: Some RBPs are related to the prognosis of COAD patients, providing new ideas for the treatment of COAD patients. Keywords: Colon adenocarcinoma, RNA binding proteins, Prognostic prediction model, Bioinformatics Modified frailty index predicts high-risk patients for developing chronic anal fistula after initial perianal abscess İstanbul Training and Research Hospital, Department of Surgery, İstanbul, Turkey Background: The modified frailty index (mFI-5) is an index that has been proven to adequately reflect frailty and predict mortality and morbidity. In this study we aimed to evaluate whether mFI could be utilized to predict chronic anal fistula after initial perianal abscess. Methods: A retrospective cohort study was conducted in patients with a first-time perianal abscess between January 2018 and December 2020. A previously described mFI was calculated. Demographics, comorbidities, mFI scores and development of anal fistula were recorded. Patients were divided into 2 groups based on having chronic anal fistula or not. Results: Forty-six patients met inclusion criteria (24 men, 13 women; mean age: 37.4 years). During a mean follow-up of 29 months, in 9 patients (20 %) chronic anal fistula was developed. The mean time for the development of anal fistula was 9 months. There were no significant differences in terms of gender, age, BMI, and smoking status between the groups. Mean mFI score was 0.54 ± 1.48 and 0.15 ± 1.25 in patients who experienced chronic anal fistula and not, respectively. mFI score was significantly high in patients who experienced chronic anal fistula (p = 0.0019). Conclusion: A 5-point modified frailty index correlates with devolopment of chronic anal fistula after initial perianal abscess. Keywords: Anal fistula, Perianal abscess Comparison of the effectiveness of natural orifice specimen extraction between benign and malignant colorectal patients: What should be the limits? Background: In this article, our aim is to determine the limitations of the technique by comparing left-sided benign and malignant lesions with specimen extraction ( NOSE) from natural orifices such as transrectal or transvaginal without abdominal incision. Methods: This was a prospective randomized clinical study conducted in one tertiary-level university hospital. All patients were operated under general anesthesia in the modified Lloyd-Davies position using the standard laparoscopic colorectal surgery technique. The transanal route was chosen as the first option for specimen removal after laparoscopic resection and, if unsuccessful, the transvaginal route was attempted in female patients. SPSS 20.0 for windows used. Results: Seventeen patients with benign (Group 1) and 24 malignant (Group 2) left-sided colorectal diseases were included in the study. The results of the comparison of demographic, clinical characteristics, pre-and post-operative parameters, specimen characteristics and technique of the patients are given in Tables 1, 2 and 3. Conclusions: The fact that female gender, location of the lesion in the rectum, transvaginal removal of the specimen, intracorporeal placement of the anvil were statiscally more significant in Group 1 showed that left-sided benign colorectal diseases could be performed better with the NOSE technique. Keywords: Natural orifice specimen extraction, Laparoscopic colorectal surgery Methods: Combined with the clinical and transcriptome data of colon adenocarcinoma ( COAD) in TCGA, the differentially expressed RBPs in normal and cancer tissues were selected. Cox analysis identifies prognostic-related RBP. All samples were randomly divided into experimental group and control group. Modeling: According to the prognosis-related RBP risk score, the experimental group and the control group were divided into high-risk and low-risk subgroups, and the Within the open surgery group 37(30 %) all had midline laparotomy. The overall incidence of superficial surgical site infection ( SSI) was seen in 14.4 %. Subgroup analysis of the data showed association of SSI with midline laparotomy (24 %), midline extraction site (11 %) and Pfannenstiel extraction site to be (11 %) (p0.34). Conclusions: This study demonstrates that midline incision either for extraction purpose in laparoscopic surgery or laparotomy is associated with higher rates of surgical site infection when compared to Pfannenstiel incisions. Keywords Background: Fluorescence imaging ( FI)makes fluorescence lymphatic mapping ( FLM)possible. There are studies demonstrating peritumoral indocyanine green ( ICG) injection makes lymph nodes ( LN)visible in the mesocolon. Pure peritumoral injection may not be sufficient for demonstrating drainage and mapping may not be reliable since lymph vessels blocked by tumoral cells. We present our ( FLM)technique for right sided colon cancer surgery proposing maximal LN harvesting with selective D3 lymphatic dissection. Methods: 15 mg of ICG prepared. Subserosal injection performed to the colonic wall at caecum, mid-ascendingcolon and hepatic-flexure in addition to the peritumoral injections. After injection;mobilization of the right-mesocolon was started in lateral to medial fashion. When separation of the visceral plane was completed, FI was performed with SPYElite (Stryker,Kalamazoo, MI, USA)before central ligation. Time between the injection and the FI was median 28minutes. This first-FI was done for making sure that ICG was drained to the lymphatics and LN of the right mesocolon. Then, right colectomy was completed and repeat FI was done before ileotransversostomy. The second-FI was performed to identify whether fluorescing LN were left at the resection site. When all fluorescing LN were removed, ileotransversotomy was created. Results: FLM technique was utilized in 5 patients. Residual fluorescing LN's were demonstrated during FI in 2 patients who underwent conventional right-colectomy. Conclusions: FLM technique may offer reduced morbidity by removing only fluorescing D3-LN without comprising oncological quality of the right-colon cancer surgery. Keywords: Colon cancer, Lymphatic mapping Methods: 1884 patients were operated in 2016 and 2020 for acute appendicitis ( AP). 80 patients' pathology resulted as lymphoid hyperplasia and fibrous obliteration and/or whose data could not be reached were excluded. Demographic characteristics, preoperative laboratory findings and radiological examinations were analyzed. Results: There were 23 (11M, 12F) patients. The mean age was 46.2, WBC value was 10.700, CRP value was 52.36, neutrophil percentage was 68.87, and appendix diameter was 16.5 mm. 1781 (1083M, 698F) patients were diagnosed with acute appendicitis and their mean age was 34.5 years. Mean WBC value was 14.160, CRP value was 51.81, neutrophil percentage was 78.62, and appendix diameter was 9.46 mm. Conclusions: The absence of leukocytosis and neutrophil dominance, the appendix diameter > = 12 mm, and the advanced age of the patient are risk factors for AMA. Removing the appendix and its meso without disrupting the tissue integrity is very important. Keywords: Acute appendicitis, Mucinous adenocarcinoma of the appendix Objective: To look at the incidence of SSI in relation to the incision made during both elective and emergency abdominal colorectal surgery. Methods: Prospectively collected data for of patients undergoing laparoscopic or open resection during 2019 were analyzed. Demographics including comorbidities and postoperative clinical outcomes data were collected. SSI is defined according to the US CDC criteria. Results: Total of 124 patients underwent elective and emergency procedures. 87(70 %) had laparoscopic procedure. Within laparoscopy, 56(64 %) patients had a midline incision for specimen extraction, while 31(35 %) patients had Pfannenstiel for specimen extraction. postanal space and ischiorectal fossa with a clamp advanced through posterior incision. Two loose setons were placed bilaterally. During follow-up, both clinical and radiological healing were retrospectively analyzed. Results: Clinical and radiological improvement occurred in 11(85 %) of 13 patients. However, 2 patients described partial clinical healing without any radiological changes. Both of two seton were removed in 6(46 %) patients and one seton was removed in 5(38 %) patients. Abscess recurrence was not observed in the healing group. Fecal incontinence didn't occur in any patient. Conclusions: Modified Hanley procedure using two setons without extensive posterior incision can be performed safely for horseshoe abscesses drainage. Background: The coronavirus disease 2019 ( COVID-19) pandemic has caused changes in health system priorities. The aim of this study is to investigate whether the pandemic causes delay in the diagnosis of colorectal tumors, to compare the clinical characteristics and TNM stage of those before and during the pandemic. Methods: This retrospective single centered study included a total of 140 patients diagnosed with colorectal cancer from January 2019 to May 2021. The patients were divided into two groups: before and during pandemic. The following parameters were compared between the groups; age, gender, CEA level, type of surgery, location of the tumor, neoadjuvant treatment status, clinical and pathological stages, the number of the retrieved and metastatic lymph nodes. Results: The length of the hospital stay was significantly lower during the pandemic. The laparoscopic surgery decreased during the pandemic. There were no statistically significant differences between the groups with regard to the demographic factors. The TNM stage of the tumor did not differ among the groups. Conclusions: There was not a significant difference in the TNM stage. Thus, it seems that the pandemic did not cause a delay in the diagnosis of colorectal tumors at our hospital, serving as a tertiary reference center. Keywords: Colorectal tumor, COVID-19 pandemic Background: Stapler hemorrhoidopexy was defined by Longo in 1998 and has become a preferred method with lesser complications (pain, bleeding, etc.) in early postoperative compared to conventional hemorrhoidectomy. This study aimed to show the early (first 30-day) postoperative results in a highvolume center. Methods: Data of 1460 patients who underwent to stapler hemorrhoidopexy between 2001-2021 were reviewed retrospectively. Postoperative bleeding, early re-admission, pain relief need, bowel movements, duration of surgery, and incontinence complaints of the patients were evaluated. Results: The study included 1460 patients (Male: 875, Female: 585). Median age was 41(21-76) years. Median operation time was 21 (18-46)minutes. Nine hundred sixty (65 %) patients were discharged within 24 hours. During hospitalization, 68 (4 %) patients required additional opioids other than routine non-steroidal anti-inflammatory analgesic. Extra sutures were placed for hemostasis during the operation in 32 (2 %) patients. Urinary retention developed in 51 (3 %) patients. Thirteen (<0.9 %) patients were followed up for postoperative bleeding inpatient/outpatient. In two off these 13 patients, hemostasis was achieved with sutures under general anesthesia. Conclusions: Stapler hemorrhoidopexy is a preferrable technique with low early postoperative complication in highvolume centers with appropriate patient choice Keywords: Longo, Stapled hemorrhoidopexy Further Modified Hanley procedure for the management of horseshoe abscess: single-center results General Surgery, School of Medicine, Marmara University, Istanbul, Turkey Background: Horseshoe abscess is big trouble in surgical practice. This study aimed to evaluate the outcomes of further modified Hanley procedure for horseshoe abscesses. Methods: Thirteen patients with horseshoe abscesses were undergone surgery in a single center. The deep postanal space was accessed through a posterior longitudinal mucocutaneous incision at the level of dentate line. Internal anal sphincter ( IAS) and subcutaneous part of the external anal sphincter ( EAS) were cut. Dissection was carried deeper behind superficial part of EAS into deep postanal space where the abscess was placed. Bilateral external orifices were created on the skin by crossing Methods: This multicentre, national, prospective observational study included all patients referred to general surgeons with either RIF pain or suspected appendicitis. Consecutive patients presenting within 3-month long data collection periods were included. Centres were invited to participate between September and December 2020. Data was captured using a secure online data management system. Results: A total of 3361 patients were included from all participating hospitals across Turkey, of which 43 % was women and 57 % was men. A normal appendix was seen in ~3 per cent of patients included in the study. Appendicectomy was performed in 2477 patients for appendicitis together with or without the presence of associated surgical pathologies. Conclusions: Management of acute appendicitis in Turkey has shown differences across Turkey. A low normal appendix rate is the presumed effect of a preoperative imaging strategy with USG and CT. Keywords: Appendicitis, Acute surgery Is increased age a factor in complicated sigmoid diverticulitis? Complications were wound infection 14.7 %, wound dehiscence 8.8 %, fecal incontinence %5.8, urinary incontinence 5.9 %, anal stricture, rectovaginal fistula, and the mortality rate was 2.9 %. At mean follow-up of 35.8 months, the Wexner score was 3.59. A low Wexner score increases the quality of life. The best results were obtained in obstetric injuries, with a continence success rate of 75.9 %. Hospitalization time and complication rate are lower in patients with colostomy. In ASI, overlapping sphincteroplasty is the current surgical technique because of its good functional results. Keywords: Anal sphincter injury, Overlapping repair The role of EMVI and circumferential tumor location as predictive imaging findings in the neoadjuvant treatment response in rectal cancer Background: Magnetic resonance is the mainstay of imaging for the evaluation of neoadjuvant treatment response in rectal cancer. MRI detected extramural venous invasion ( EMVI) has been shown to correlate with survival and prognosis, but this has not been studied in detail. In this study, we aimed to analyze the effect of a number of mrEMVI features and circumferential tumor location on neoadjuvant treatment response. Methods: 57 patients (mean age:56,9) with biopsy-proven rectal adenocarcinoma who have received neoadjuvant chemotherapy and underwent rectal MRI from 2016 to 2020 were included. Pearson Chi-Square and Mann Whitney U tests were used for the statistical analyses. Results: 17 patients were mrEMVI-(29,8 %), 40 were mrEMVI+ (70,2 %). Complete/near-complete responders had less number of mrEMVI (mean 1,45 vs 2,54; p < 0,05) and smaller diameter mrEMVI (mean 1,8 mm vs 3,30 mm; p < 0,05) compared to partial responders. 13 patients had anteriorly (25 %), 12 had posteriorly (23,1 %) and 27 (51,9 %) had laterally dominant tumors. In the remaining 5 patients, invasive behavior was in a circumferential fashion. Anterior dominant tumors had significantly more residual disease rates when compared with lateral and posterior dominant tumors (p < 0,05). Conclusion: The size and number of mrEMVI, and circumferential tumor location influence the treatment response. Keywords: EMVI, Rectal cancer The learning curve for laparoscopic surgery in colorectal cancer at a new regional hospital: a single surgeon experience of 106 consecutive cases without supervision Background: Laparoscopic surgery in colorectal cancer is mostly performed in university hospitals or experienced centers. The aim of this study is to determine the learning curve of laparoscopic colorectal surgery in a new regional hospital. Methods: From August 2018 to July 2021, 106 consecutive patients undergoing laparoscopic colorectal surgery by a single surgeon were analyzed. The learning curve was evaluated using the cumulative sum ( CUSUM) method. Perioperative outcomes were compared between learning curve phases. Results: Based on the CUSUM analysis, the learning curve consisted of three unique phases: phase I, the initial learning period (first to 53st operation); phase II, the consolidation period (54nd to 68th operation); and phase III, the experienced period (69th to 106th operation). Operative time and estimated blood loss were significantly reduced with increasing experience (p < 0.001). From the postoperative results, stool out time (p < 0.05), oral intake time (p = 0.001) and drain removal time (p < 0.001) were shorter with increasing experience. When compared in terms of histopathological results, the length of the piece and the number of harvested lymph nodes increased with experience (p = 0.001). Conclusions: Laparoscopic surgery for colorectal cancer in a new regional hospital is feasible and safe. The data suggest that the learning phase was achieved after 53 to 68 cases. Keywords: Laparoscopic colorectal cancer surgery, Learning curve Management and outcomes of anal sphincter injuries reviewed from December 2020 to July 2021. We recorded the general condition and postoperative evaluation indicators. Results: The average operative time of 8 patients was (223.75 ± 52.36) min. The intraoperative blood loss was (68.75 ± 30.44) ml. The first feeding time was (17.25 ± 1.58) h. The first ambulation time was (19.88 ± 1.36) h. The first anal exhaust time was (48.38 ± 22.29) h. There were no postoperative anastomotic leakage, abdominal infection, perioperative deaths, and recurrence cases during the follow-up period. Conclusions: The novel transanal NOSES can make the operation easy, and meet with the aseptic and tumor-free principles. The improved surgical method is safe, effective and feasible for selected middle and low rectal cancer patients. Keywords: Transanal natural orifice specimen extraction surgery (Ta-NOSES), Middle and low rectal cancer, Tumor-free Background: Although colon tumors are generally referred as right and left colon tumors, transverse colon tumors occur about 5 % of all colorectal cancers. While the surgical strategy is generally determined preoperatively, in malignancies originating from transverse colon, the operative strategy and type of anastomosis are usually finalized peroperatively according to the condition of the colon and the localization of the tumor. In this study, we evaluated transverse colon malignancies with the choice of anastomosis, retrospectively. Methods: Among 722 patients operated for colorectal cancer between 2015-2019,30 patients had oncological transverse colectomy. Primary tumor was located in mid-transverse colon in 14 patients, whereas 11 tumors were closer to hepatic, and 5 tumors closer to splenic flexure. Results: Of 30 patients included, the female/male ratio was 10/20, and the mean age was 66.4(53-84).The median followup was 32.3 months (1-60 months),the calculated 1-year survival was 86.7 %, and 3-year survival was 36.7 %.The decrease in 3-year survival was interpreted in favor of metastatic disease. Side-to-side anastomosis was performed with linear stapler in 11 patients, end-to-side with circular stapler in 14 patients, and handsewn end-to-side in 5 patients. Conclusions: The approach to transverse colon tumors was examined together with scientific data and recent studies, and anastomosis reliability was reported in the study. Transverse colon tumors are challenging especially in terms of surgical anastomosis management both preoperatively and peroperatively. Keywords: Hemicolectomy, Transverse colon Results: The follow-up period was 120 months. Log-rank univariate analysis showed that T stage, adjuvant therapy and the number of metastases were the influencing factors for the prognosis of metastatic anorectal malignant melanoma after surgery. T stage ( OR = 2.351, P = 0.038), adjuvant therapy ( OR = 0.073, P = 0.041) and the number of metastatic tumors ( OR = 0.545, P = 0.016) were the independent factor for the prognosis of affected the metastatic anorectal malignancy after surgery. Conclusions: T stage, adjuvant therapy and the number of metastases are independent factors that affected the prognosis of metastatic anorectal malignant melanoma after surgery. According to the patient's condition and prognostic factors, adjustment of the treatment mode could prolong the patient's overall survival time. Keywords: Anorectal malignant melanoma, Prognosis A novel transanal NOSES for treating middle and low rectal cancer (with 8 cases report) General Surgery Department, Xiangya Hospital, Central South University, Changsha, China Background: Natural orifice specimen extraction surgery ( NOSES) has less pain, rapid recovery and no wound-related complications with improvement of appearance. However, It is technically complicated and difficult, and controversial in bacteriology and oncology. In this paper, we describe a novel transanal NOSES for treatment of middle and low rectal cancer that can avoid those imperfections above. Methods: The data of 8 patients with middle and low rectal cancer undergoing the novel transanal NOSES from Xiangya Hospital of Central South University were retrospectively be more difficult losing a patient because of unexpected-complications. While 18.1 % indicated that they considered taking a-break for-a-while after mortalities, 11.9 % thought to give-up their surgery-career and 9.8 % avoiding surgical procedures fora-while. 41.7 % reported to receive support from their families, 37.9 %from peers, 35.4 % from senior-colleagues, and 3.1 % from institutions. Participants' suggestions for supporting surgeons are: education on coping-with mortality (51.5 %), formal mentoring-system (31.3 %), psychotherapy (27.7 %), and a-timebreak after mortality (13.5 %). Conclusions: Psychosocial consequences of patient mortalities on surgeons are an important occupational-healthissue. Further efforts are needed at a personal-, institutional-, and organizational-level to provide effective support. Keywords: Patient mortality, Surgeons Aim: This study aims to investigate the efficacy, clinical and technical success of self-expandable metallic stents ( SEMS) applied in obstructive left colon and rectum tumors in a tertiary care center. Methods: Patients with obstructive left colon and rectal tumors who underwent SEMS between December 2014 and May 2021 were evaluated retrospectively. Results: Of the 43 patients included in the study, 28(65 %) were male, 15(35 %) were female. The median age was 61 years. The locations of tumors were sigmoid colon (n = 19,44 %), rectum (n = 12,28 %), rectosigmoid (n = 9,21 %) and left colon (n = 3,7 %). SEMS application was failed in three cases, and the technical success was 93 %. Colonic decompression was achieved in 34 of 40 patients with successful stenting. Clinical success was 85 %. SEMS was applied for palliation of advance staged cancer in 18 patients and as a bridge to definitive surgery in 16 patients. Thirteen of them underwent elective laparoscopic surgery. Migration (n = 5,12 %), perforation (n = 2,5 %) and stent occlusion (n = 2,5 %) were the most common complications due to SEMS application. Conclusions: SEMS is an effective and safe procedure for the palliation of malignant colorectal obstruction and as a bridge to definitive surgery. Also, SEMS can enable single-staged elective laparoscopic surgery instead of open emergency surgery. Keywords: Obstructive colorectal cancer, Self-Expandable metal stent Postoperative adhesive intestinal obstruction Parvin Najafguliyeva* Background: Adhesive intestinal obstruction is an inevitable complication of abdominal surgeries. It has high morbidity with associated poor quality of life and predisposition to repeated hospitalization. Most of them can be managed conservatively. Methods: A retrospective study of 27 patients admitted with the diagnosis of postoperative adhesive partial bowel obstruction was conducted by analyzing their medical records. Demographic data, clinical presentation including duration, previous surgical procedures, treatments received for the condition and successful conservative approach versus requirement of operative intervention were assessed. Results: The median age was 29 years. Male predominance was noted. Pelvic surgeries and gynecological surgeries (33 %) were found to be the most common cause of adhesive bowel obstruction followed by appendectomy (21 %). More than two third of the patients (76.7 %) developed symptoms within two years of the initial surgery. Successful conservative treatment was noted in 19 patients (65.5 %) and discharged on fourth day of admission. 10 patients (34.5 %) underwent surgery. They all underwent adhesiolysis and had good outcome. Conclusions: The time-honored practice of expectant management of adhesive partial bowel obstruction has equally good outcome, as compared to various interventions practiced. Keywords: Intestinal obstruction Background: This study aimed to investigate impacts of patient mortalities on general surgeons' psychosocial wellbeing and surgical practices. Methods:Data were collected using a 30-item questionnaire. Results: 480-participants completed the survey. 34.6 % of participants reported patient mortalities affecting their emotional well-being, 34.2 % professional-career, and 23.3 % sociallife. Related patient-mortalities, 90.6 % reported sadness, 47.3 % worry for patients ' relatives, 25.4 % guilty, 19 .0 % worry about reputation, and 13.3 % fear. After mortalities, 16.0 % indicated that they experienced repetitive-memories, 9.2 % a-loss-ofinterest in enjoyable activities, 15.6 % a change in sleeping-pattern, and 21.9 % reported increases in alcohol/tobacco consumption. 37.5 % of participants stated that it's more difficult to lose a patient who is followed for years, and 94.4 % thought to Methods: After obtaining ethical approval from the ethics committee of our hospital, the study was carried out between 01.01.2017 and 31.12.2020.Two cohort groups were formed for patients with type I and IIa PSH who underwent sinusectomyprimary repair (Group I, SPT) and excision-primary repair (Group II, EPT). Results: Of the 114 patients who underwent sinusectomy,83(72.8 %) were male,31(27.2 %) were female, with a mean age of 28.0 years. A statistical significance was found between the two groups in terms of hospital stay, sinus type ( IIA),wound healing time, and anesthesia methods applied. Median followup was 2 years, recurrence rate was 7 %.Median time to return to work was 2 weeks and median wound healing time was 3.7 weeks. Conclusions: We believe that the SPT method, which is accepted as a minimally invasive technique, is a safe method used in type I and IIa PSH with its rapid wound healing, low hospital stay and low recurrence rate. Keywords: Pilonidal sinus disease, Sinusectomy Fournier's gangrene in Turkish population: analysis of two decades Background: Fournier's Gangrene ( FG) is a rare, devastating disease. Its nature and rarity limit conducting clinical studies with large patient population. Here, we aimed to determine risk factors, predictors of mortality of FG among the Turkish population. Methods: A literature search was conducted by using Pub-Med with keywords " FG"and"Turkey".The search revealed 95 published articles between January 2000 and December 2020. Studies including less than 20 patients, consecutive studies of the same author were excluded. Totally, 41 studies were included. The correlation between mortality and the other variables were analyzed. The differences between the first and the second decade were compared. Results: There were 1919 patients reported in 41 studies. Patient number was median 38 per study. Majority of the patients were male (83.11 %)with a median age of 55.Overall, median mortality was 17.39 %.Sixteen studies were published between 2000 and 2010 (first decade).Mortality rate was lower in the studies published between 2010 and 2020 (14.72 %±7.1 vs.22.46 %±11.62,p = 0.011).Cutaneous origin was negatively correlated with mortality (r = −0.615,p = 0.033)while chronic renal failure (r = 0.705,p = 0.005)and fecal diversion (r = 0.371,p = 0.037)were positively correlated. Conclusions: Although FG is still associated with a significant mortality in the last decade, it seems to be reduced comparing the past decade. Avoiding unnecessary fecal diversion, proper assessment of comorbidities and origin of the disease may have impact on the mortality. Keywords: Fournier's gangrene, Turkey Background: ERAS is a multimodal and multidisciplinary protocol developed to improve postoperative outcomes. Studies have shown that postoperative recovery time is shortened, postoperative complications are reduced in surgical patients who underwent the ERAS protocol, and therefore patients are discharged earlier. Methods: Early clinical outcomes of colorectal surgery patients who underwent ERAS protocol between February and July 2021 were evaluated. Results: The ERAS protocol was applied to 40 colorectal surgery patients, 35 of whom were laparoscopic. Thirty of the patients were male, and the median age was 63. Ten of the patients were evaluated as ASA-1, 20 as ASA-2, and 10 as ASA-3. Oral intake was started at the 2nd hour postoperatively, and patients were mobilized at the 4th hour. The median gas discharge time was 1 day. The median length of hospital stay is 7 days. According to the Clavien-Dindo classification, no complications developed in 21 (52.5 %) patients postoperatively. On the other hand, there were 13 (32.5 %) grade 1-2 complications, and only 6 (15 %) complications (5 patient grade 3, 1 patient grade 4) that required any intervention. Conclusions: ERAS should be preferred in colorectal surgery patients for early discharge, more comfortable perioperative period and less interventional complication rates. Keywords: ERAS, Recovery Comparison of sinusectomy-primary closure and excision-primary closure techniques in type I and IIa pilonidal sinus disease: a retrospective cohort study Background: Parastomal hernia ( PH) is a common complication in colorectal surgery and the tangible risk factors for PS development remain unclear at present. The aim of this study was to determine the incidence and risk factors in PS. Methods: Retrospective data from a recent 8 years cohort of 954 ostomy patients from 2013 to 2020 was analyzed. All ostomy patients who had completed follow-up appointments after discharge were included. Results: One or more ostomy complications developed in 39.8 % of patients. PH developed 10.5 % of patients and its incidence increases after the third month. Ostomy location in left lower quadrant, BMI, age, end colostomy and prolapse affected PS in univariate analysis (p < 0.05). Age ( OR = 1.712; 95 % CI = 1.079-2.716), BMI ( OR = 2.167; 95 % CI = 1.328-3.535), left lower quadrant ostomy location ( OR = 2.481; 95 % CI = 1.518-4.056) and prolapse ( OR = 8.854; were independent risk factors in logistic-regression analysis (p < 0.05). Conclusion: The incidence of PH was in nearly one-in ten patients after colorectal surgery with ostomy. Advanced age, ostomy prolapse, location of ostomy and severe obesity were independent risk factors. Patients with these high risks should be followed rigorously for the development of PH. Keywords: Parastomal hernia, Hernia Endoscopic interventions in small sized colorectal polyps Aynur Kamal Safiyeva* Background: Colorectal polyps as a precursor of colon cancer are the most common benign derivatives of the large and small intestine developing from the glandular epithelium of the intestinal mucosa. Dysplasia of ectopic crypts plays an essential role in the development of polyps into cancer Methods: The research was conducted in the Endoscopy Division of the Surgery Department of the Central Customs Hospital in Azerbaijan. Small polyps up to 5 mm in size, found in 42 out of 100 patients, were removed endoscopically and pathohistologically evaluated. Results: The obtained materials were analyzed for pathohistological examination according to several parameters. The identified 42 diminutive polyps are pathologically listed as follows: Hyperplastic polyp -11, inflammatory polyps-11, tubular polyps-19, tubulovillous-1 Background: Machine learning is a branch of artificial intelligence based on the idea that systems can learn from data, identify patterns and make decisions with minimal human intervention. Our aim is to predict acute appendicitis, which is the most common emergency surgery indication, using machine learning algorithms with an easy and inexpensive method. Methods: Patients who were treated surgically with a prediagnosis of acute appendicitis in a hospital between 2011 and 2021 were analyzed.189 positive and 156 negative appendectomies were found. Gender and hemogram were used as features. Machine learning algorithms and data analysis were made in Python (3.7) programming language. Results: The success rate in the test data was 82.7 % in logistic regression, 68.9 % in support vector machines, 78.1 % in k-nearest neighbors, 83.9 % in neural networks, 79 % in decision trees, and 73.5 % in gradient boosting The success rate in the voiting classier created with logistic regression, k-nearest neighbor, support vector machines and artificial neural networks was 86.2 %. In Voting classifier, sensitivity was 83.7 % and specificity was 88.6 %. Conclusions: Voting classifier achieved the highest success with 86.2 %, and an easy and fast estimation method was developed for the diagnosis of acute appendicitis. These algorithms will have a higher success rate when integrated into appendicitis scoring systems Keywords: Acute appendicitis, Machine learning Oncological competence of emergency surgery in colon cancer: a single-center retrospective comparative study Istanbul University, Istanbul Faculty of Medicine, Department of General Surgery, Istanbul, Turkey Background: This study aims to compare the status of the resection margins and the number of lymph nodes ( LN) harvested in patients who underwent emergency surgery and elective surgery for colon cancer. Methods: Patients who underwent emergency or elective colon cancer surgery between January 2016 and December 2020 were included. Results: A total of 224 patients were included in the study. The median age was 69 (20-87) years. Eighty-eight (39 %) Methods: 270 consecutive surgical patients who applied to our hospital with the diagnosis of colon cancer or rectum cancer between riables of clinical outcome were analyzed, including postoperative complications, hospital stay, cost of hospital stay, and postoperative outcome. Results: The rate of postoperative complications was higher in "risk-free" patients who did not receive postoperative nutritional support compared to patients who received postoperative nutritional support (2.40 ± 1.51 vs 1.23 ± 0.60, P = 0.000) and who stayed longer in the postoperative hospital. stay (23.00 ± 15.84 days vs. 15.27 ± 5.89 days, P = 0.009). Patients who received preoperative total parenteral nutrition ( TPN) had a higher cost of hospitalization than patients who did not receive preoperative TPN (6713.50 ± 507.66 TL vs 4178.00 ± 359.68 TL, P = 0.014). Administration of postoperative enteral nutrition shortened the postoperative fasting time (5.16 ± 1.21 days vs. 6.40 ± 1.84 days, P = 0.001) and postoperative hospital stay (11.92 ± 4.34 days vs 15.77 ± 6.03 days, P = 0.002). Conclusions: Appropriate and moderate nutritional intervention may improve postoperative outcomes of colorectal cancer patients. Keywords: Colorectal cancer, Nutritional support The frequency of colorectal malignancies in patients performed colonoscopy due to occult blood positiveness in cancer screening center Background: Stool occult blood test is one of the screening methods. In this study, we aimed to evaluate the colonoscopic findings, to determine the frequency of polyps, histopathological types and the frequency of colorectal malignancy in patients who underwent colonoscopy due to positive stool occult blood test in our endoscopy unit. Methods: Patients who were positive for occult blood in the stool between. Colonoscopy was performed to evaluate the terminal ileum after appropriate preparation. Results: 201 patients underwent colonoscopy due to occult blood positivity in the stool. Of the patients, 104 (52 %) were male and 97 (48 %) were female. Adenomatous polyp in 67 (32 %) cases, adenocarcinoma in 13 (6.1 %) cases. The mean age of 41 male and 26 female patients with polyps was 61.5 ± 9 years. 76 % of the polyps were in the left colon and 80 % of the malignancies were in the rectosigmoid colon. In 74 % of the cases, no pathology was found to explain the positivity of occult blood in the stool. Conclusions: It is seen that colorectal cancers and precancerous lesions can be detected early and survival rates can increase thanks to screening programs. Keywords Background: Pararectal masses are rare tumors mostly located in retrorectal or presacral space which may display different histopathological characteristics. In this case-series, we aimed to present our experience with patients treated with surgery for pararectal tumors. Methods: Patients who were treated between August 2006-May 2021 in a tertiary-referral center were included in the study. Patient demographics, presentation characteristics, perioperative results were retrospectively analyzed from a prospectively maintained database. Results: There were 27 patients treated with surgery for pararectal tumors. Mean age was 40(range:19-74) and 19(70.1 %) were women. Most common presenting symptom was perineal pain (14-51.9 %). All tumors were evaluated with pelvic MRI. Sixteen (59.3 %) were treated with posterior approach while 10(37 %) were treated anteriorly. Of those who were treated anteriorly, 5 patients had undergone laparoscopic, 1 patient had undergone combined surgery. Mean length of stay was 4 days (1-16). Pathological results revealed 5 tumors as malignant (21 %). Of all benign tumors (22) Background: Transanal endoscopic surgery is an alternative therapy to either radical surgery or endoscopic mucosal resection for rectal neoplasms. either nonoperative management ( NOM) or total mesorectal excision ( TME) following neoadjuvant treatment. Methods: This retrospective case series was conducted at two cancer centers. All LADRC patients with clinical complete response (cCR) following neoadjuvant therapy, who agreed to NOM or TME revealing a pathologic complete response (pCR) were enrolled into the study. Patients were analyzed for local regrowth/recurrence ( LR), distant metastases ( DM) and survival status. Results: Patients in the NOM group (n = 67) compared with the patients in the pCR group (n = 69) revealed no differences regarding baseline characteristics and tumor location (p > 0.05). Ten (15 %) patients with LR in the NOM group were detected on surveillance and treated with salvage surgery (100 %). Pelvic control after salvage surgery was maintained in sixty-five patients (97 %). No LR occurred in the pCR group, but three (4,4 %) patients had DM. At five years, the pCR group had improved disease-free survival (p < 0,001), although no difference was observed in overall survival between these two groups (p = 0,089). Conclusion: NOM is a promising treatment option compared to the standard trimodal treatment strategy with its equivalent pelvic tumor control and OS in strictly selected patients. Keywords: Nonoperative management, Pathologic complete response Aim: The aim of this study is to evaluate the feasibility and clinical outcomes of salvage surgery in locally advanced distal rectal cancer ( LADRC) patients with local regrowth following nonoperative management ( NOM). Methods: All LADRC patients managed with nonoperative management after neoadjuvant therapy with clinical complete response (cCR), who developed local regrowth during surveillance between January 2015-December 2019, were enrolled into the study. Patients were analyzed for the rate of salvage surgery, disease-free survival and overall survival. Results: Eleven out of 63 patients developed local regrowth after a mean of 8,4 (3-15) months during surveillance. The mean follow-up period was 40,7 (24-59) months. Eleven (100 %) patients underwent salvage surgery due to the principles of total mesorectal excision ( TME). Local excision was not performed. One (9,1 %) patient experienced local recurrence and three (27,3 %) patients developed distant metastasis after a mean surveillance period of 33,7 (17-47) months. The three-years local recurrence rate, systemic recurrence rate, disease-free survival, and overall survival in the patients undergoing surgical treatment were 9,1 %, 73 %, 63,7 % and 91 %, respectively. Conclusion: All patients with regrowth after a NOM strategy were amenable for salvage surgery with curative intent and jus- Clinicopathological features, such as tumor metastasis and lymph node involvement, are important factors affecting cancer progression. For this reason, predictive biomarker determination studies have recently gained momentum in order to detect these steps earlier and cheaper. In our study, we aimed to examine the relationship of neutrophil-lymphocyte ratio ( NLR) and platelet-lymphocyte ratio ( PLR) with clinicopatological characteristics of CRC. Methods: In our study, 354 patients who underwent surgery for CRC in Istanbul University-Cerrahpasa General Surgery Clinic between 2018 and 2020 were included. Preoperative patient data were obtained from the hospital clinic records. IBM SPSS Statistics 26.0 was used for the statistical analysis. Results: Based on the positive lymph node ratio of 0.2, a significant difference was found in PLR and NLR values of the patients (p < 0.05). Elevated PLR were associated with metastasis. NLR was correlated with positive lymph node ratio (p < 0.05, r = 0.155). NLR value >3,07 was found to be 61 % sensitive and specific in predicting lymph node involvement rate (p < 0.05). Conclusions: Present results indicate that PLR and NLR may be useful for colon cancer nomograms. Keywords: Neutrophil-lymphocyte ratio ( NLR), Plateletlymphocyte ratio ( PLR) full-thickness skin incision with punch biopsy instrument and cleaning of the sinus tract with brush and curette, the sinus tract was visualized with sinuscope. Then, laser probe was introduced into sinus tract and ablation was performed. Demographics, postoperative complications and follow-up period were assessed. Results: A total of 62 patients (13 females) with a mean age of 28 years met inclusion criteria. Of those, 4 patients had recurrent PSD. Mean hospital stay was 1 ± 0.27 days. Mean healing time was 2-6 weeks. Two patients had chronic pain and two patients had seroma, these patients responded well to conservative treatment with analgesics and antibiotics. Only one recurrence occurred during a 12 ± 6.18 months of follow-up period. Conclusions: Video-assisted laser ablation and microsinusectomy is a safe and feasible procedure and also effective minimal invasive procedure for recurrent PSD. Keywords: Pilonidal sinus, Laser Comparison of the application between circular stapler and linear stapler in right hemicolectomy University of Health Sciences, Haseki Training and Research Hospital, Clinic of General Surgery, İstanbul, Turkey Background: Right sided hemicolectomy for right sided colonic cancer is a common performed procedure. Multiple surgical techniques can be used in the surgical treatment of right colon cancer. In open surgical technique, linear and circular stapler can be used. This study compares the results of both techniques. Clavien Dindo scoring was also used in the comparison. Methods: Between 2018-2021, 107 operation was performed. We obtained the data of patients who had undergone right hemicolectomy surgery with using circular and linear stapler. Results: Linear stapler was used in 58 operations and circular stapler was used in 49 operations. Anastomosis leakage was observed in 9 patients after linear stapler and 4 patients after circular stapler. There was no significant difference in terms of age, sex, operation time between the two groups. Anastomosis leakage was significantly lower in operations using circular stapler. The leight of stay in the patient was found to be statistically significantly lower in circular stapler patients. According to Clavien Dindo score, there was no statistically significant difference between two techniques. Conclusions: Although the circular stapler may seem more expensive, the complications increase the cost even more. For this reason, we recommend the use of circular staplers in right colon surgeries. Keywords: Right hemicolectomy, Linear vs circular stapler Background: Fournier's gangrene is a necrotizing and gasforming soft tissue infection of perineum. Normally, the decision for creating the stoma should be based on the condition of the anal sphincter tone, but in some cases it can also be used to divert stool. In this study we aimed to identify the affects of stoma and vacuum associated closure systems on postoperative mortality and hospital stay of Fournier's gangrene. Methods: Patients that have Fournier's gangrene including anorectal region between 2010-2021 were analyzed retrospectively. Age, sex, comorbidities, number of debridements, stoma creation, tissue culture results, mortality and postoperative hospital stay were defined as parameters. Results: A total of 66 patients were detected. 37 (56.1 %) of the patients were also have urogenital involvement additionally to anorectal area. 44(66.7 %) of them were male. Age was the only parameter that affects the mortality (p = 0,013). Also urogenital involvement was associated with (p = 0,039). VAC systems were found to increase the need for debridement and length of stay (p = 0,042 and p < 0,001. In addition, stoma was not associated with mortality and postoperative length of stay (p = 0,190 and p = 0,079). Conclusions: Stoma opening and VAC systems are not decreasing mortality and postoperative hospital stay in patients with Fournier's gangrene. Keywords: Fournier's gangrene, Stoma Background: Acute colonic diverticulitis are common emergencies. There has been a tendency toward non-operative treatment of abscesses caused by diverticulitis. In this report, we aimed to present the treatment strategies of diverticulitis with localized abscess. Methods: We retrospectively evaluated patients treated for diverticulitis between 2014 and 2020. The clinical data, CT findings, length of stay, treatment methods and mortality status of the patients were recorded. Patients with Hinchey Ib and Hinchey II were evaluated. Results: Of the 148 patients, 73 were female. The mean age was 60.5 ± 15.9 years. A total of 35 patients with Hinchey Ib and Hinchey II were evaluated. Of 23 patients whose abscess size was less than 4 cm, 18 had medical treatment, 1 had percutaneous drainage, and 4 had surgery. Medical treatment was applied to 5 of 12 patients with abscess size larger than 4 cm, percutaneous drainage to 4, and surgery to 2 patients. The mean length of stay was 8.57 days. All patients were discharged without any problem, except for one patient who died as a result of subarachnoid hemorrhage. Conclusions: Medical therapy and percutaneous drainage are usually sufficient in the management of diverticulitis with localized abscess and surgical therapy is rarely necessary. Keywords: Diverticulitis, Abscess consolidation group (18/88). Surgery was performed in 10 weeks (8-12) after completion of radiation therapy. Conclusions: The pCR rates were similar compared to neoadjuvant short-course radiotherapy/consolidation and longcourse CRT/consolidation chemotherapy strategy groups and both could be an alternative to the conventional chemoradiotherapy for patients diagnosed with rectal cancer. Keywords: Rectal cancer, Consolidation therapy Assessment of familial history of early versus late onset colorectal cancer: a multicentric epidemiological study from high-volume tertiary care centers Results: A total of 42 patients were detected. 29(69 %) of them were male and 24(57 %) of them were operated for crohn disease. Although mechanical bowel obstruction was the most common cause of operation for both, bleeding was more common for UC and fistula was more common in Crohn's disease. NLR and PLR may be parameters for IBD that can be used to differentiate between Crohn's and UC (p = 0,031; p = 0,009). However, none of these ratios were found to be related for postoperative early and delayed complications, mortality and reoperation. Conclusions: NLR and PLR can be used to differentiate between Crohn's and UC, but NLR, PLR and LMR are not associated with postoperative complications and mortality. Keywords: inflammatory bowel disease Methods: 51 patients who underwent laparoscopic resection and 25 patients who underwent open resection for T4 colorectal cancer between January 2014 and December 2018 were analyzed retrospectively. Results: The mean age, BMI, and the female to male ratio of the patients were 64/66, 26/27 and 0.82/0.92 respectively for laparoscopic and open group without any significant difference in demographic data. All patients achieved R0 resection independent of the surgical technique. The conversion rate was 13.7 % and the 30-day complication rate was 23.5 % and 44 % for laparoscopic and open surgery group respectively. Anastomotic leakage (3.9 % in laparoscopy cohort vs 12 % in open surgery), reoperation rate and Clavien-Dindo scores were comparable between two groups, while readmission rate within 30 days was lower in laparoscopic surgery group (p = 0.03). Laparoscopic surgery resulted in shorter hospital stay (8/d vs 13/d, p < 0.01) and comparable operative time (141/m vs 142/m). Longer OS and similar DFS was shown for laparoscopic surgery (75 % vs 53.3 %, p = 0.03; 63.8 % vs 52.1 %, p = 0.39). Conclusion: This study showed that laparoscopic surgery in the treatment of T4 colorectal cancer is safe and has satisfying results if en-block resection can be achieved. Keywords: T4, laparoscopicsurgery Background: The De Ritis ratio (Aspartat transaminase/alanine transaminase) is a critical prognostic factor for some kinds of malignant tumors. Nevertheless, the De Ritis ratio's prognostic value in preoperative colon cancer staging is unclear. The purpose of this research was to determine the De Ritis ratio in colon cancer and to determine its prognostic significance for colon cancer. Methods: The clinicopathological data of 271 individuals with malign colon cancer were analyzed retrospectively, from January 2010 to January 2018 at a single center. The relationship between the De Ritis coefficient and clinicopathological findings in patients were evaluated before treatment. To compare groups, the Mann-Whitney U test and the Kruskal Wallis test were performed Results: The results indicated that there were no statistically significant differences between the groups, in terms of pre-treatment De Ritis ratio assessment as a staging, localization, tumor diameter, lymph node metastasis, age and overall survival. However, differences in T staging between groups of male participants were shown to be statistically significant. Conclusions: The De Ritis ratio evaluated before to treatment was not an independent variable a prognostic factor in the diagnosis and staging of colon cancer. However, future study may demonstrate the significance of the De Ritis ratio with more participants. Keywords: Colon Cancer, De Ritis Are NLR, PLR, LMR predictive for postoperative complications and mortality in inflammatory bowel disease? General Surgery Department, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey Background: Although inflammatory bowel diseases ( IBD) are tried to be controlled with medical treatment, surgical intervention may be required as a result of complications. Neuthrophil-to lymphocyte, platelet-to-lymphocyte and lymphocyte-to monocyte ratios could be potential inflammatory biomarkers of systemic inflammation in chronic diseases. In this study, we aimed to determine whether these ratios could be predictive of postoperative mortality and complications for IBD (ulcerative colitis and crohn disease). Methods: Patients that operated for IBD between 2010-2021 were analyzed retrospectively. Age, sex, comorbidities, NLR, PLR, LMR, postoperative complications, mortality and postoperative hospital stay were defined as parameters. ity and specificity, cut-off value of leak score was 78. Patients with a leak score > 78 were found to have significantly higher anastomotic leak rates (p < 0.01). Conclusion: Leak score can be a valuable diagnostic tool to detect patients at risk for anastomotic leakage after colorectal surgery. Prediction of anastomotic leak sooner might be helpful in avoiding unwanted complication and might prevent morbidity, mortality and associated cost. Keywords: Anastomotic leakage, Leak score Background: ERAS is a multimodal and multidisciplinary protocol developed to improve postoperative outcomes such as rapid recovery, fewer complications, and early discharge. There are recommendations under 25 headings in the guideline published for colorectal surgery. Many studies showed that the higher the rate of compliance to these recommendations, the better the postoperative results. Method: Compliance of the colorectal surgery patients to ERAS protocol between February and July 2021 were evaluated. Results: Compliance rates of the patients ranged from 68 to 88 %. Except for 2 patients, the compliance rate of all patients (38 patients) was 76 % or over, and it was determined as a good compliance according to the previous studies. The least adapted principles were preoperative patient optimization, prehabilitation and drain usage (100 % non-compliance for each one). The mean compliance rate of 19 patients who developed complications was 78.53 % ± 4.46, while it was 81.9 % ± 3.49 for 21 patients who did not (p = .01). Conclusion: All ERAS principles are recomendations for guiding clinicians, and compliance rates may vary regarding patient, hospital or surgeon related factors. However, as compliance with ERAS protocols increased, the complications were less common. Therefore, it should be recommended to comply with ERAS protocol as much as possible. Keywords: ERAS, Compliance Tumor location enigma: Does the site effect survival in colorectal cancer Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey Background: In this study we aimed to reveal the impact of tumor location on survival in patients at the same stage. Methods: The records of 641 Colorectal cancer patients undergone surgery by the same surgery team between 2015 and 2020 at Prof. Dr. Cemil Taşcıoğlu Hospital were analyzed retrospectively. Stage IV was excluded. Patients were devided groups according to the stage (Stage I+ II as early stage Gruop1 and Stage III as locally advanced Group2) and tumor location (ascending colon, transverse colon, descending colon, sigmoid colon, rectum). Kaplan-Meier method was used for analyzing overall survival ( OS) rates. Our clinical experience in the surgical approach to Crohn's disease complications Ömer Kubat*, Hüseyin Göbüt, Aydın Yavuz, Hasan Bostancı, Osman Yüksel Gazi University Faculty of Medicine, Department of General Surgery, Ankara, Turkey Background: Surgery for CD is often performed to treat complications, and the choice of surgical procedure varies by patient. Our aim in this study is to share our surgical treatment results for the complications of CD. Methods: We reviewed 17 patients retrospectively who were operated due to complications of CD between 2010-2020. Results: 10 of the patients were operated for intestinal obstruction, 3 for enteroenteric fistula, 2 for enterovesical fistula, 2 for perforation. Ileocecal resection was performed in 7 patients, small bowel resection was performed in 10 patients, sigmoid colon resection was performed in 4 patients. İleostomy was performed in 4 patients. In the postoperative period, wound infection was observed in 4 patients, intra-abdominal abscess in 2 patients, ileus in 1 patient. There was no need for reoperation in the follow-up of the patients for CD. While medical treatment was not started in 2 of the patients, medical treatment was started in 3 patients within the first 3 months, 3 patients within 3-6 months, 4 patients between 6-12 months, 5 patients after 1 year after symptoms were observed. Conclusions: In the control of the complications of Crohn's disease, the rate of recurrence and reoperation can be reduced with the right surgical technique and preferences. Keywords: Crohn's disease, Surgery The prognostic effect of log odds of positive lymph nodes (LODDS) in rectal cancer Gazi University Faculty of Medicine, Department of General Surgery, Ankara, Turkey The TNM classification is still the most commonly used classification to show the prognostic value of colorectal cancers that is the third most common cancer. This study aimed to compare the effectiveness of TNM, log odds of positive nodes ( LODDS) and lymph node ratio ( LNR) on the prediction of prognosis in patients who underwent curative surgery. Methods: This study retrospectively compares the prognostic effect of LODDS, LNR and TNM classifications of 128 rectal cancer patients who underwent R0 surgery at Gazi University Hospital between January 2010 and December 2018. Results: Overall survival ( OS) for 1, 5 and 10 years for LODDS, TNM and LNR classifications were compared. For TNM classification OS rates were 100 %, 85.2 %, %79.5 for Stage I; 100 %, 78.8 %, 63.7 % for Stage II and 97.6 %, 44.9 %, 0 % respectively (p: 0.0001).For LODDS classification; 100 %, 81.4 %, 69.3 % for LODDS0; 96.3 %, 50.3 %, 0 % for LODDS1 and 83.3 %, 23.8 %, 0 % for LODDS2, respectively (p: 0.0001). Conclusions: Our study suggests that a staging system using LODDS might be used for rectal cancer prognostic classification T Assessment of PET-CT for synchronous colonic cancers in patients with left-sided obstructive colorectal cancer: Is postoperative total colonoscopy necessary? Akgün Erhan: 0530 Alizade Elchin: 0424 Ağcaoğlu Orhan: 0579 B Baca Bilgi: 0200, 0558 Bayraktar Adem: 0356, 0519, 0521 Benlice Çiğdem: 0200, 0558 Biçer Mehmet: 0125, 0257, 0453, 0532 Bişgin Tayfun: 0140 Bozkurt Halil Alper: 0524 Çalışkan Cemil: 0530, 0542 Celayir Mustafa Fevzi: 0364, 0410, 0503, 0506 Cengiz Fevzi: 0343, 0346 Çolak Tahsin: 0117 Dalkilic Muhammed Said: 0150 Damburacı Nurullah 0397 Doğan Ertekin Cemalettin: 0424 Esmer Ahmet Gündoğdu Ramazan: 0464 Güngör Feyyaz: 0343, 0346 Güzel Gökmen: 0272 H Hacibeyoğlu Gülçin Harmantepe Ahmet Tarık: 0477 He Songbing Işık Özgen: 0271, 0288, 0376 Liu Zheng: 0101, 0102, 0103 0367 Najafguliyeva Parvin Özata İbrahim Halil: 0224, 0577 Oğuz Cebrail: 0294 P Pach Radoslaw: 0293 Şengün Berke: 0356 0308 Sever Tolga: 0623 Şevik Hüsnü Sığırlı Deniz: 0448 U Ulusoy Cemal: 0384 Uprak Tevfik Kıvılcım: 0335 Uylaş Ufuk: 0238, 0239, 0281, 0333 Uzunoğlu Hakan: 0170 V Vatansever Safa 0277 Yiğit Merve Yoldaş Tayfun: 0530 Yılmazlar Tuncay: 0271, 0288 How should nutritional support be given to patients after colorectal cancer surgery? Ahmet Serdar Karaca, Feza Yarbuğ Karakayalı, Ramazan Gündogdu* Başkent University, Faculty of Medicine, Department of General Surgery, Istanbul, Turkey Background: To review the nutritional support practice in patients after colorectal cancer surgery and to suggest appropriate nutritional strategies. The risk factors for development of parastomal hernia: A single institution experience Tayfun Bisgin* 1 , Cahide Ayik 2 , Deniz Cenan 3 , Berke Manoglu 1 , Dilek Ozden 2 , Selman Sokmen 1 Background: Rectal cancer has high morbidity and mortality rate. It is encountered more frequently in elders considering that cancers are diagnosed at a more advanced, at least, locally advanced stages. In our study, changes in the treatment of rectal cancers in octogenarian patients were shown.Methods: We performed a retrospective cohort study which included patients diagnosed with rectal cancer at the age of 80 years or older between 2016-2021.At the same time, a monitored control group included consecutive patients younger than 80 years diagnosed with rectal cancer which was numbered as group1.Whereas octogenarians were numbered in group2.We compared clinicopathological characteristics, treatment and the outcome.Results: From 184 rectal cancer patients,166 were in group1,whereas 18 were in group2.The follow-up period was 36 patients underwent emergency surgery due to obstruction and perforation (group A). One hundred thirty-six patients (61 %) underwent elective surgery (group B). The median number of LN harvested was similar in two groups (group A 27 (6-95) vs group B 23 (5-119), p = 0.216). The rate of node-positive patients was higher in group A (4 vs 2, p < 0.001). According to the median number of LN removed, there was no difference between right hemicolectomy (group A 28 (6-64) vs group B 24 (5-69), p 0.361), and anterior resection (group A 23 (6-45) vs group B 20 (8-53), p 0.183). There was no positive margin in group A while two patients had a positive margin in group B.Conclusions: Appropriate cancer surgery can be performed in patients with resectable tumors that require emergency surgery.Keywords: Emergency colon resection, Lymph nodes Background: In the right hemicolectomy, the incidence of anastomotic leakage ( AL) for ileocolic anastomosis is between 0.2 % and 7.2 %.Adequate circulation in the anastomosis line and a good surgical technique are essential for an effective anastomosis. We compared circular stapler side-to-end and linear stapler side-to-side after a standard right hemicolectomy technique for right colon and/or hepatic flexure cancer.Methods: This study was planned as a retrospective study. Emergent operations and handsewn ileocolic anastomoses were excluded and the ileocolic anastomosis was done using circular stapler and linear stapler.Results: Among 120 patients who underwent through the right hemicolectomy between 2018-2021,31(25.8 %)of patients underwent anastomosis with circular stapler. The other 89(74.2 %) patients underwent through ileocolic anastomosis with a linear stapler. AL developed in 2 (6,4 %) in end to side anastomosis and 6(6.7 %)in side to side anastomosis (p> = 0.05). The rate of intraoperative blood transfusion was high in those who developed anastomotic leakage (p = 0.007).There was no significant difference between the groups in terms of duration of operation, onset of bowel movements, duration of hospitalization, comorbidity, and 1-month and 6-month mortality rates (p> = 0.05).Conclusions: This study determined that the use of different staplers in the ileocolic anastomosis after right hemicolectomy did not increase the risk of AL.Intraoperative blood transfusion has been shown as an independent risk factor for anastomotic leakage.Keywords: Anastomotic leakage, StaplerAim: This study compares the clinical outcomes of locally advanced distal rectal cancer ( LADRC) patients treated with were treated with six cycles of FOLFOX. Patients with a cCR following CNCRT were managed with NOM.Results: A total of 89 patients treated between May 2016 and May 2020 were enrolled in this prospective, observational case series study. Forty-five (51 %) patients with an incomplete response underwent surgery after nCRT and 44 (49 %) patients received CNCRT. Following CNCRT 36 (82 %) patients with cCR were followed up with NOM. The rate of local regrowth was 19.4 % with all patients having an endoluminal growing pattern confined to the first two years. Distant metastases were diagnosed in 2 (6 %) of 36 patients. 5-year overall survival was 97,2 % and 5-year disease-specific survival was 77,8 %.Conclusions: The long-term clinical outcomes of NOM were promising in terms of pelvic tumor control and overall survival in strictly selected patients who had cCR after CNCRT.Keywords: Distal rectal cancer, Non-operative management Background: Total pelvic exenteration ( TPE) is a potentially curative surgery for locally advanced primary or recurrent rectal carcinoma. The aim of this study was to discuss our results in TPE for rectal carcinoma.Methods: Prospectively maintained data of 32 patients with rectal carcinoma who underwent TPE was analyzed. Twentythree patients presented with primary rectal tumors; nine had recurrent disease.Results: 29(90.6 %) of the patients received neoadjuvant chemoradiotherapy, and 9(28.1 %) patients received secondline RT after recurrence. Sacrectomy was also performed in 5(15.6 %) patients due to sacral involvement. Perineal reconstruction was done with primary closure in 24, gluteal rotation flap in five, vertical rectus abdominis myocutaneous flap in one, and prosthetic mesh in two patients. Clavien-Dindo grade III-IV morbidity developed in 16(50 %) patients. Perioperative mortality occurred in 2(6.5 %) patients. The mean follow-up was 13.8 months (range: 27 days-36.4 months). Seven (21.8 %) of the patients had local re-recurrence, 11(34.3 %) had intra-abdominal disease and 8(25 %) had distant metastasis. The 1-and 2-years survival rates were 49.1 % and 20.2 %, respectively.Conclusion: TPE can be performed to salvage advanced or recurrent rectal carcinoma in patients with low mortality but high morbidity rate. TPE has a crucial role in multimodal management of advanced primary or recurrent rectal carcinoma.Keywords: Total pelvic exenteration, rectal carcinoma Methods: Grades 3 and 4 hemorrhoids are operated with Ligasure by coagulation and cutting of the hemorrhoids at positions 5, 7 and 11 hour. The patients received premedication, analgesia and intravenous 500 mg metronidazole preoperatively. Under anesthesia, placed in a lithotripsy position, the anoscope is placed with a easy retraction, than a 5 mm V shape incision is made with the scalpel at the anocutaneous border. The nodule was lifted with an instrument and the LigaSure was placed on the base of the nodule (leaving 2 mm enough mucosa above the sphincter), coagulated and incised. The control check, 24 hours later and sent home with oral analgesic and metronidazole therapy. Follow-up 7, 14 and 28th day. A retrospective data collection of transanal endoscopic surgery procedures performed through Ege University Hospital, from 2014 to 2020 was conducted. TEO® platform (Karl Storz) was used in all patients.Results: A total of 56 patients were included in this study. Thirteen (23 %) of the patients were women. The mean age was 62 (±13). The mean distance of the tumor from the anal verge was 7 cm (±3). The mean tumor diameter was 3 cm (±2). Histopathological examination revealed malignancy in 38 (68 %) patients [pTis: 15 (39 %), pT1: 9 (24 %), pT2: 11 (29 %), pT3: 3 (8 %)]. Complications were seen in three (5 %) patients. The mean follow-up period was 34 months (±18). Three (5 %) patients required re-excision.Conclusions: Transanal endoscopic surgery allows the excision of rectal lesions that cannot be excised with a conventional approach, with a low morbidity rate. It can also be used for definitive histopathological diagnosis of lesions whose pathology has not been fully revealed, and for the removal of early stage malignant rectal tumors with appropriate surgical margins.Keywords: Rectal tumor, Transanal endoscopic operation Early stoma complications and risk factors in emergency and elective colorectal surgery Background: The effect of emergency and elective colorectal surgery on ostomy complications shows conflicting results. The aim of this study was to determine the effect of emergency and elective surgery on early ostomy complications.Methods: Retrospectively collected data of 872 ostomy patients was analyzed. Patients who followed-up regularly during the first post-operative month were included.Results: Ostomy related complications developed in 65.7 % of the patients. The most common complications were peristomal irritant contact dermatitis ( PICD) (33.3 %) and mucocutaneous separation ( MS) (30.7 %). Necrosis (7.4 %vs3.4 %), MS (37.2 %vs27.1 %), and bleeding (6.1 %vs2.1 %) were more common in patients undergoing emergency surgery (p<.01); PICD (37.3 %vs.26 %) and hyperplasia (8.6 %vs.4.5 %) were more common in elective surgery (p<.05). In emergency surgery group co-morbidity ( OR = 1.810), malignancy ( OR = 1.675) and loop ostomy ( OR = 2.089) were independent risk factors for PICD; end ostomy ( OR = 1.606), ostomy height of <10 mm ( OR = 2.104) and malignancy ( OR = 1.805) were independent risk factors for MS. In elective surgery male gender ( OR = 1.832), ileostomy ( OR = 2.322) preoperative IRT/ CT( OR = 2.178) were risk factors for PICD; ostomy height of <10 mm ( OR = 1.613) was independent risk factor for MS.Conclusion: Ostomy complications were affected by the type of surgery in the early period. Factors relating to the patient and stoma were effective in the complication development. Thus, strict follow-up of patients in the early period is extremely important. Background: This study aims to assess the completeness of pathology reports of T1 colorectal cancers from different healthcare centers and the change of treatment decision after reevaluation of the polyps.Methods: In this single center retrospective cohort study several pathology reports of endoscopically excised malignant colorectal polyps at diverse healthcare centers in Turkey were reassessed at a comprehensive cancer center in Istanbul. Reassessment was mainly focused on core elements such as size of invasive carcinoma, histologic type and grade, tumor extension, surgical margin (deep and mucosal) and lymphovascular invasion.Results: Sixty-seven endoscopically resected malignant polyps were analyzed. The mean age of patients was 62,2 years and 38 (58 %) patients were male. Tumor size, histological type and grade, surgical margin (deep and mucosal) and lymphovascular invasion were reported in 11 %, 100 %, 31 %, 9 % and 19 %, respectively. All five prognostic factors were reported only in one (1,5 %) pathology report. Due to missing data pathologic examination of 59 (88 %) patients were determined to be insufficient to make a treatment decision.Conclusions: Several variables are not considered and frequently missing for decision making, suggesting the reassessment of the pathology report by a second pathologist at a highvolume comprehensive cancer center.Keywords: Malignant polyps, Treatment strategy Results: 52 patients undergoing LH surgery, with an average age of 42.5 years. 59 % are women and 56 % are grades III. Average operative intervention 17.0 + 4.1 minutes, hospital stay 1.2 days, Postoperative pain (VAS1-6) 3. Urinary retention 0.4 %. Minor bleeding 5.6 %. Pruritus in 5.6 %, gas incontinence 7.6 %. No stenosis or incontinence.Conclusions: LH is an effective and safe surgical method and it should be used as a routine.Keywords: Hemorrhoidectomy; Vessel sealing The lymph node ratio has prognostic significance in patients with rectal cancer who received neoadjuvant therapy Ege Üniversitesi Tıp Fakültesi, Genel Cerrahi Anabilim Dalı, İzmir, Turkey The aim was to compare the number of lymph nodes in patients who received and did not receive neoadjuvant therapy and to determine the role of lymph node ratio in these patients.Methods: Patients who underwent elective surgery for rectal adenocarcinoma between January 2008 and June 2016 were retrospectively analyzed. Demographic, clinical, and histopathological parameters and overall survival of the patients were evaluated.Results: A total of 386 male and 247 female patients were included in the study. 54.7 % of the patients were received neoadjuvant treatment. The mean number of dissected lymph nodes was 14.00 ± 8.86. The mean number of lymph nodes in the neoadjuvant treatment group was 11.31 ± 6.53 and 17.24 ± 10.15 in the control group. When the lymph node ratio was classified as below 25 %, 25-50 %, or over 50 %, the mean survival times were 76.7 ± 4.8 months, 54.6 ± 8.1 months and 45.3 ± 8.4 months, respectively. According to the result of the ROC analysis, the cut-off value for the lymph node ratio was determined as 16 %.Conclusions: Neoadjuvant treatment negatively effects the number of resected lymph nodes in rectal cancer patients. In neoadjuvant rectum cancer patients, the lymph node ratio can be used as a prognostic factor.Keywords: Lymph node ratio, Rectum cancer Clinicopathological significance of preoperative neutrophil-lymphocyte ratio ( NLR), plateletlymphocyte ratio ( PLR) in colorectal cancer patients Background: Small bowel obstructions ( SBO) are common conditions in practice of surgery. Determining the etiology and deciding for the surgery at the right time is crucial for the surgeon. It was investigated treatments of the patients hospitalized due to adhesion-related SBO ( ASBO) vary according seasonal differences.Methods: All patients hospitalized due to SBO at general surgery clinic between July 2016-2021 have been analyzed. Demographic findings, etiology, date and surgeries have been recorded. Early postoperative SBO's has been excluded from the study.Results: Out of total 300 patients, 57.7 % (n = 173) of them has been hospitalized due to ASBO. The average age of patients was 54.2 and 68.2 % of were male (n = 118). Surgical treatment has been required for 24.9 % (n = 43) of patient. Adhesiolysis has been sufficient in 67.4 % (n = 29) of the patients.While the rate of patients operated during autumn was 14 %, winter was %21 and 35 % in the summer (p < 0,05). The highest operation rate was determined as 55 % in June; no patient underwent surgical treatment in November.Conclusions: Mostly ASBO's resolve without surgery. We concluded that having a higher rate of surgery during the summer months in our data series caused by dehydration and intense stool plug. Larger series studies are needed.Keywords: Adhesion, Bowel obstruction Microsinusectomy with video-assisted laser ablation for pilonidal sinus disease: Single center experienceBackground: This multicentric retrospective cohort study is aimed to investigate the relationship between family history and anatomical distribution of colorectal cancer ( CRC), and age at diagnosis for patients underwent surgery for CRC.Methods: Patients underwent surgery for CRC between 2014-2021 were queried from two high-volume tertiary care centers. Demographics, family history, histopathologic and surgical data were gathered. Family history of CRC was collected on all first/second/third degree relatives (parents, siblings, and children). Patients diagnosed earlier or later than 45 were compared and analyzed.Results: A total of 1507 patients met the inclusion criteria [mean age:60 and female: 915 (71 %)]. Distribution of cancer location as following: right-sided (24 %, N:359), left-sided (27 %, N:410) and rectum (49 %, N:734) . More distal location was observed for patients diagnosed earlier than 45 (rectum:56.5 %) compared to later onset (47.7 %). Family history of CRC was present at 268 patients (17.8 %) among entire cohort, which was significantly increased for patients diagnosed earlier than 45 (27.3 %, N:53) compared to later onset (16.4 %, N:215) (p < 0.008). HNPCC-related cancer was observed 9.7 % of patients diagnosed earlier than 45.Conclusions: Early onset cancers tend to located more distally, have a more prominent family history and hereditary component than later onset cancers, which might guide for earlier CRC screening strategies.Keywords: Family history, Colorectal cancer has been argued that the limiting factor for the use of laparoscopic procedures is the number of surgeons with adequate skills to perform a laparoscopic. We aimed to investigate our clinic's expertise on laparoscopic colorectal surgery during last ten years regarding this concept. Methods: We have scrutinized the patients' records which had undergone colorectal surgery during last ten years. Patients' demographic data, benign and malignant etiology, lymph node number extracted, mesocolon resection, postoperative complications, operation time, hospital stay, and patient selection criteria were screened.Results: Between 2011-2021, 1278 colorectal surgical operations of which 223 was laparoscopic were performed. From 2014 on, the proportion of laparoscopic surgery increased until 2019. Lymph node number excised, complete mesocolon resection rate, postoperative complications and hospital stay were similar in open and laparoscopic surgery groups. Surgeon experience, operational planning, and operation room facilities were the most important determinants in patient selection and decision making.Conclusions: Our study have shown that minimally invasive colorectal surgery are still underused in our clinics due to the lack of surgical facilities. Thus, implementation of the laparoscopic approach requires more efforts in teaching surgeons.Keywords: Laparoscopy, Colorectal surgery Comparison of long-course chemoradiotherapy versus short-course radiotherapy followed by consolidation chemotherapy in locally advanced rectal cancer: Preliminary results of a multicenter cohort study Background: This multicentric study was designed to compare pathological clinical response (pCR) rates between different neoadjuvant treatment strategies in patients undergoing total mesorectal excision ( TME) for locally advanced rectal cancer ( LARC).Methods: Consecutive patients who received neoadjuvant short-course radiotherapy (5 × 5Gy) followed by consolidation chemotherapy or long-course chemoradiation therapy ( CRT) undergoing TME for LARC between January/2014 and June/2021 were queried from three high-volume tertiary care centers. Tumor responses, surgical complications and longterm oncologic outcomes were reviewed and compared. Pathologic complete response was defined as no viable tumor cells in the primary tumor and in the lymph nodes (ypT0N0) by histopathological assessment of the surgical specimen after CRT.Results: A total of 270 patients underwent surgery met the study inclusion criteria. A pCR was achieved in 10 patients (22.7 %) in the short-course CRT and consolidation group (10/44), 13 patients (9.4 %) in the long-course CRT group (13/138), and 18 patients (20.4 %) in the long-course RT and Background: After the establishment of total neoadjuvant therapy ( TNT) the rate of clinical complete response (cCR) in locally advanced distal rectal cancer ( LADRC) patients and the application of nonoperative management ( NOM) has gradually increased. But consideration must be given to local regrowth, systemic dissemination and adverse effects of chemotherapy.Case presentation: We present the case of a 56-year-old women with no significant past medical history and rectal cancer. The patient's initial staging revealed to be at locally advanced stage and received long-term neoadjuvant chemoradiotherapy (50,4 Gy and concomitant 5-fluorouracil) and consolidation chemotherapy consisting of six cycles of FOLFOX (5-fluorouracil and oxaliplatin). After restaging for neoadjuvant treatment assessment clinical complete response on endoscopy and pelvic magnetic resonance imaging ( MRI) at the primary tumor site and ascites on abdomen computer tomography ( CT) scan was detected. With the suspicion of peritoneal carcinomatosis, the patient received further eight cycles of FOLFOX without sampling or histological examination of the ascites. In later clinical and surgical evaluations the etiology of ascites was found to be oxaliplatin-induced liver cirrhosis.Conclusion: NOM is a widely accepted treatment option for LADRC patients with cCR. But care must be given to local regrowth, systemic dissemination and adverse effects of chemotherapy.Keywords: Non operative management, Consolidation chemotherapy Laparoscopic surgery can be safely performed in elderly patients with colon cancer İbrahim Halil Özata 1 , Salih Nafiz Karahan* 1 , Mesut Yeşilsoy 1 , Derya Salim Uymaz 1 , Serkan Zenger 2 , Emre Özoran 1 , Emre Balık 1 , Dursun Buğra 2 1 Koç University Hospital, Department of Surgery, Istanbul, Turkey 2 VKV American Hospital, Istanbul, Turkey Aim: Despite being underresearched, laparoscopic colorectal surgery is expected to be the gold standart even in the elderly patients due to proven advantages.Method: This study included patients >75 years of age with colon cancer operated at VKV Hospitals between 2014-2019. 68 patients were eligible for this study with 34 patients in each groups. The two groups were compared in terms of patient demographics, pathologic outcomes, perioperative results, and oncologic outcomes.Results: Two groups were similiar in terms of demographics. The average age was 81.3/82.2, the mean BMI of patients was 26.5/26.4 for laparoscopic and open surgery groups respectively. Laparoscopic surgery didn't prolong the operative time and proved to decrease the LOS by a mean of 3.6 days (p = 0.042), decrease time to flatus and increase the number of harvested lymph nodes (41.7 vs 36, p = 0.03). Short term outcomes such as complications, readmission and reoperation within 30 days and long term outcomes like DFS and OS rates were similar in both groups.Conclusion: Considering merits of laparoscopic surgery, our findings stress the importance of laparoscopic colon surgery especially in the more complication-prone elderly population.Keywords: Elderly patients, Laparoscopic surgery A novel predictive score for early detection of anastomotic leakageİbrahim Halil Özata* 1 , Emre Bozkurt 1 , Serkan Sucu 1 , Salih Nafiz Karahan 1 , Emre Özoran 1 , Orhan Ağcaoğlu 1 , Emre Balık 1 , Dursun Buğra 2 1 Koç University Hospital, Department of Surgery, Istanbul, Turkey 2 VKV American Hospital, Istanbul, TurkeyAim: This study aims to find a novel scoring system to detect anastomotic leak after colorectal surgery using inflammatory and nutritional indicators.Method: Colon cancer patients, who underwent curative surgery in Koc University Hospital between 2014 and 2018 were included in our retrospective study. Patients were categorized into two groups depending on the presence of anastomotic leak and compared in terms of preoperative albumin levels. Leak score is calculated dividing CRP quotient by preoperative albumin, the cut-off value was calculated.Results: A total of 185 patients were included in our study. 11 out of 185 patients had anastomotic leakage (%5). Leak score, CRP POD 3 to 1 ratio and preoperative albumin levels were found to successfully detect anastomotic leakage (p < 0.01 for all). Area under the curves were calculated. With 75 % sensitiv-Background: This study aims to compare the success and complication rates of the primary anastomosis ( PA) and Hartmann's procedure ( HP) in patients who underwent emergency surgery for an obstructive left-sided colon tumor.Methods: Patients who underwent resection due to obstructive colon tumors between January 2010 and December 2020 were analyzed retrospectively. Patients with an obstructive tumor between the splenic flexure and rectosigmoid junction were included in the study.Results: A total of 159 patients were included in the study. Eighty-three of them (52 %) were female. The median age was 62 (26-90) years. The PA was performed in 112 (70 %) patients while HP was performed in 47 (30 %) patients. In the PA group, 31 (%28), 13 (12 %) and 68 (60 %) patients underwent anterior resection, left hemicolectomy, and subtotal colectomy, respectively. Anastomotic leakage occurred in four (4 %) patients. Stoma complications developed in 11 (23 %) patients who underwent HP (4 % vs 23 %, p < 0.001). The most common stoma-related complication was retraction (n = 6). There was no statistically significant difference in mortality in both groups ( AP 9 % vs. HP 15 %, p 0.267).Conclusions: Primary anastomosis is a safe option to achieve one-stage surgery in patients with obstructive left-sided colon tumors according to the results of this study.Keywords: Obstructive colon tumor, One-stage surgery A rare disease presacral cysts: a retrospective analysis of 6 patients Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, TurkeyBackground: Retrorectal tumors are rare lesions located in the pararectal area. They are frequently seen in middle-aged women and detected incidentally. The majority are benign and have malignant potential.Methods: Six patients who were operated by the same surgical team in our clinic between 2000 and 2020 with a preliminary diagnosis of retrorectal cyst were retrospectively analyzed.Results: In our study, 5 of the patients were female and their mean age was 37.4. While complaints of abdominal pain were observed in 66.6 % of the patients, the average diagnosis time was 8.5 months. Because suspicion of malignancy, one of the patient evaluated with biopsy. Transperineal parasagittal approach was applied to 4 patients, Kraske approach (transcoccygeal) was applied to 1 patient, and anterior abdominal approach was applied to 1 patient. The average hospital stay was 11.3 days, and postperative abscess was observed in 33 % of them as complication. The mean follow-up period was 65 months. In 2 of 6 patients, reoperation was required due to the development of recurrence.Conclusions: Because of retrorectal tumors are rare and surgeons encounter tumors infrequently, there is need for diagnosis and treatment algorithms which created by multidisciplinary teams considering case series.Keywords: Retrorectal cyst, Malignant potential Results: 465 patients were analyzed with a mean follow up period of 30.1 months. Group1 (n = 272) OS rate was 84.9 % and Group2 (n = 223) OS rate was 61.4 %. In Group1 the longest survival was in left colon tumor location (92.5 %) and shortes was in the sigmoid (81.4 %). In Group2 longest survival was sigmoid (69.4 %) and shortes was rectum (51.4 %). Statiscally there were no significant differences in OS between patients according to the locations of tumor at the same stage.Conclusions: This study revealed that tumor location is not the predictor of survival in Colorectal cancer patients. Early stage have better survival rates than locally advanced stage.Keywords Background: Anastomotic leak ( AL) is a dreadful complication in restorative rectal surgery. AL is associated with significant morbi-mortality rates and worsened outcomes. The aim of the study was to analyze our center's results of AL in rectal cancer surgery.Methods: Prospectively maintained database of 491 patients who underwent restorative rectal surgery was analyzed. 53(10.7 %) patients with AL were included the study.Results: The mean age was 57.3 ± 27.8 years and 39(%73) of the patients were male. 25(47 %) of the patients had an additional co-morbidity and coronary artery disease (20.7 %) was the most common of these. The mean tumor distance from the anal verge was 7.78 ± 3.47 cm and tumor localization was in the lower rectum in 27(%) patients. 45(84.9 %) patients had chemoradiotherapy. Loop-ileostomy was constructed in 43(81 %) patient. 17(32.1 %) patients had SIRS symptoms at the time of diagnosis. Of the 53 Al patients were treated successfully with conservative measures with antibiotics in 5, stenting in 1, endoluminal vacuum-assisted therapy in 3, endoscopic clip in 1, percutaneous drainage in 9, and surgical intervention in 4 patients. Methods: HCT-116 colorectal cancer cell line is embedded in 1:3 matrigel in dropwise manner into 96-well plates. HIPECmimicked treatment has been performed on the 3D model with oxaliplatin (80-160-320-640-1280 µM) for 60 minutes at 37 °C and 42 °C individually. After 48 hours of incubation at 37 °C, cell viability was measured.Results: As expected, the model claims that 42 °C treatment has a more cytotoxic effect than 37 °C in every oxaliplatin dose. Especially higher doses of oxaliplatin show more significant differences than lower doses.Conclusions: The 3D colorectal peritoneal metastases model could be improved to become a preclinical tool for predicting the most effective parameters for HIPEC treatment.Keywords: HIPEC, Cell culturePublisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Methods: Etiology, fistula size and location, previous interventions, seton applications, diversion ostomy, and surgical methods were evaluated. Functionally, Wexner and FSFI scales were used.Results: The mean age of 35 patients included in the study was 44.8 ± 14.6 (22-75); The mean BMI values were 27.7 ± 4.8 (20-38). Recurrence developed in 8 (23 %) patients, 44 surgeries were performed in 35 patients; Transperineal repair 28, Transvaginal repair 2, Rectal flap application 11, Martius flap 3. Recurrence rate was found to be statistically significantly higher in patients with prior surgical repair and high BMI. In the LR analysis, the independent risk factor affecting recurrence was found to be previous surgical repair (odds ratio 8.6 (95 % CI 1.2-16.9).The median FSFI score of the patients was 35 (0-53), and the median WEXNER score was 3 (1-11).In patients who developed complications, Wexner incontinence score was highly statistically significant.Conclusions: For a successful outcome, choosing a surgical technique suitable for the patient and etiology in the first attempt and surgical experience are important.Keywords: Rectovaginal fistula, Recurrence Novel in-vitro model to predict the prognosis of stage I/II colon cancer Background: In this study, we aimed to develop a model that can be used to predict recurrence in early-stage colon cancers (eCC) and to decide on adjuvant therapy in patients with predicted recurrence. In our previously study shown that the high MALAT1 and low PTENP1 expressions play a role in drug resistance mechanisms and recurrence. In line with our findings, it was predicted that when the expression levels of MALAT1 and PTENP1 were brought to the levels in normal colon epithelial, the ability of tumor cells to metastasize and form drug resistance would be suppressed.Methods: Metastatic CC cells ( HT-29FUR) were generated by subjecting HT-29 cells to increasing concentrations of 5-FU for 6 months. Transfection, WST-1, Annexin V, RT-PCR, colony formation and wound healing analyzes were used