General Surgery

HIPEC by Koray Topgül

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He focuses on oncology surgery for the last 20 years of his professional life, especially on gastrointestinal system cancers. Since he focuses on Peritoneal Carcinomatosis (late stage manifestation of several gastrointestinal malignancies including appendiceal, colorectal, and gastric cancer), he has wide experience with HIPEC that directly targets this diagnosis.

Thus there is no specific certification that authorize surgeons to perform HIPEC, Prof. Topgül regrets this negligence and states that only experienced oncology surgeons should perform this method taking difficulty of post-operative follow up and possible complication management processes into consideration.

“Surgeon has to be experienced and sincere about HIPEC”.

When Prof. Koray Topgül compares conventional treatment method (surgery and chemotherphy at post-operative period) and HIPEC ( surgery+HIPEC followed by chemotherphy at post-operative period), he highlights researches that showed life expectancy in 5 years after the surgery is 15 to 20% in the conventional method whereas around 50% in the HIPEC procedure in colorectal cancers.

 

After the discharge international patients are welcomed to receive therir systemic checmotheraphy in their home country. Prof. Topgül contineues to provide his services for his patients via mail and whatsapp and encourages them to share their foloow up test results with Turkey and consult in case they have a problem.

In addition to HIPEC, Prof. Koray Topgül calls attention to PIPAC which is a variation of HIPEC that emerged in the last 10 years. PIPAC means Pressurized Intraperitoneal Aerosol Chemotherapy and applied laparoscopically. This method can mainly be classified as palliative and preferred in cases where HIPEC couldn’t be performed. He explains that patients with spread tumors in the intestines and at which resection is not promising are main candidates of PIPAC.

In this procedure there is no extensive surgery but only a laparoscopy at which liquid chemotherapy solution is turned into aerosol form with a special PIPAC device. The procedure lasts around 30 minutes. Chemotherapy agents in gaseous form disperse homogeneously and because of the pressure related to laparoscopy technique, penetration into tissues is enhanced.

Generally PIPAC procedure is repeated several times in 6 weeks periods, while systemic chemotherapy continues in between sessions.

 

He mentions 2 topics for the success in surgical oncology:

  • Experience of the surgeon in the field of surgical oncology
  • The infrastructure and available resources that the hospital provides

Teamwork is an inseparable component of surgical oncology for Prof. Topgül and he mentions Medical Oncologists, Radiation Oncologists, Radiologists, sometimes Interventional Radiologists as his close counterparts.

Prof. Koray Topgül underlines the experience of the physician pointing at issues other than technical surgery skills. For him a good surgeon is not only a good technician to perform the procedure but also should be sufficiently experienced to deal with decisions, timing, management of possible complications, creating solutions and communicating these to the patients.

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