Background: Accurate identification of complete or near-complete responders after total neoadjuvant therapy (TNT) is critical for selecting candidates for non-operative management in locally advanced rectal cancer (LARC). While static inflammatory biomarkers have been widely investigated, the predictive value of dynamic changes in systemic inflammation during TNT remains unclear. This study evaluated whether changes in the Pan-Immune Inflammation Value (PIV) correlate with magnetic resonance imaging tumor regression grade (mrTRG) and regrowth risk. Methods: Seventy-three patients with LARC treated with TNT between 2018 and 2024 were retrospectively analyzed. Patients were classified as complete/near-complete responders (C-NCRG; mrTRG1-2) or residual disease group (RDG; mrTRG3-5). The PIV was calculated as (platelet × monocyte × neutrophil)/lymphocyte at treatment initiation (first-PIV), three weeks after completion of chemotherapy (last-PIV), and at regrowth (Rg-PIV). Dynamic changes were defined as Δ-PIV (last-PIV minus first-PIV) and ΔRg-PIV (Rg-PIV minus first-PIV). Receiver operating characteristic analysis identified optimal cutoffs, and logistic regression assessed independent associations. Results: The baseline PIV did not differ between groups. Last-PIV and Δ-PIV were significantly lower in the C-NCRG compared with RDG (p = 0.006). A Δ-PIV cutoff of -36.9 discriminated responders (AUC = 0.705; sensitivity 53.7%; specificity 84.4%) and remained independently associated with MRI response in multivariate analysis. In the non-operative management cohort, ΔRg-PIV was significantly lower in patients without regrowth (p = 0.001), with a cutoff of -77.72 (AUC = 0.794; sensitivity 88.9%; specificity 66.7%). Overall survival was superior in the C-NCRG (p = 0.01). Conclusions: A dynamic reduction in the PIV during TNT is significantly associated with favorable MRI response and lower regrowth risk in LARC. PIV dynamics may serve as a noninvasive complementary biomarker to support response assessment and stratification in organ-preservation strategies.

Background: Anal fissure is a common benign condition, yet its management varies widely. The International Society of University Colon and Rectal Surgeons (ISUCRS) conducted a global snapshot audit to describe contemporary real-world management patterns. Methods: During a 2-week period (June-July 2022), 56 colorectal surgeons from 21 countries prospectively recorded data for consecutive patients presenting with anal fissure. Exclusion criteria included inflammatory bowel disease, pregnancy or lactation, psychiatric disorders, immunosuppression, and anorectal sepsis. Acute fissure was defined as symptoms <6 weeks without sentinel pile; chronic fissure as >6 weeks or fibrotic edges/sentinel pile. The "Cure" was defined as complete symptom resolution or healed fissure on clinical or tele-follow-up. Results: A total of 302 patients were analyzed (mean age 41 ± 13 years; 52% women). Acute fissure was present in 42%, chronic in 58%. Conservative treatment (dietary advice, stool-softeners, topical agents, botulin toxin, pelvic-floor training) was initiated in 236 (78%) patients, while 66 (22%) underwent surgery, most commonly lateral internal sphincterotomy (LIS). At 8-week follow-up, 73% of patients treated conservatively and 88% of those treated surgically achieved clinical resolution of symptoms or healed fissure. Conclusions: Global management of anal fissure remains heterogeneous. Most surgeons favor conservative measures such as first-line therapy, reserving LIS for chronic or refractory fissures. Standardized definitions and outcome reporting are needed to improve comparability and guide future international guidelines.

Objectives: To investigate the value of pretreatment magnetic resonance imaging (MRI) features in predicting a complete response to total neoadjuvant treatment (TNT) in locally advanced rectal cancer (LARC). Methods: The data of patients who received TNT were analyzed retrospectively. MRI features, including T stage, morphology, length, and volume; the presence of MR- detected extramural venous invasion (mrEMVI), the number of mrEMVI, and the diameter of the largest invaded vein; main vein mrEMVI; presence of MR-detected tumor deposits (mrTDs), the number of mrTDs, and the size of the largest mrTD; MR-detected lymph node status (mrLN); tumor distance from the anal verge; mesorectal fascia involvement (mrMRF + ); and mean apparent diffusion coefficient (ADC) values were recorded. Patients were classified as complete (CRs) or noncomplete responders (non-CRs) according to the pathological/clinical outcomes. For patients managed nonoperatively, a sustained clinical complete response for > 2 years was deemed a surrogate endpoint for complete response. The MRI parameters were categorized into three distinct groups: baseline, advanced, and quantitative features, and were analyzed using multivariable stepwise logistic regression. The ability to predict complete response was evaluated by comparing different combinations of MRI parameters, and performance on an "independent" dataset was estimated using bootstrapped leave-one-out cross-validation (LOOCV). Results: The data of 84 patients were evaluated (CRs, n = 44; non-CRs, n = 40). The optimal model, which included baseline and quantitative MRI features, achieved an area under the curve of 0.837 for predicting complete response. Selected predictors were T stage and ADC mean value. Advanced MRI features did not improve the performance of the model. Conclusion: A multivariable model combining T stage and the ADC mean value can help identify LARC patients who are likely to a achieve complete response before the initiation of TNT.

Aim: Despite the increasing popularity of minimally invasive surgery (MIS) in recent years, its efficacy in treating T4 colon cancer remains a subject of ongoing debate. This study aimed to assess the perioperative and oncological outcomes of MIS for T4 colon cancer in comparison with open surgery (OP). Method: We conducted a retrospective cohort analysis on 181 consecutive patients who underwent a T4 colon cancer resection through either MIS or OP between December 2014 and September 2021. Converted patients were evaluated in the MIS group according to the intention-to-treat principle. Propensity score matching (PSM) was employed based on age, gender, American Society of Anesthesiologists score, and the T-stage subgroup (T4a and T4b) to control for potentially confounding factors. Demographics short-term and long-term oncological outcomes were evaluated and compared between the two groups. Results: Post-PSM resulted in 49 patients in each group. Both groups were comparable in terms of patient demographics, clinical stage at diagnosis, and postoperative morbidity. The median operative time was longer in the MIS group (167 vs. 132 minutes, p<0.01). The lymph node yield and the quality of complete mesocolic excision did not differ significantly between the two groups. The conversion rate was 8.2%. The 5-year overall survival (85.0% for the MIS group vs. 88.5% for the OP group, p=0.7) and the disease-free survival (62.5% for the MIS group vs. 70.0% for the OP group, p=0.33) rates were comparable between the groups. Conclusion: MIS is a safe approach for treating T4 colon cancer, demonstrating satisfactory outcomes. The method offers oncologically acceptable results, reinforcing its potential advantages.

Abstract The ERAS guidelines include recommendations for preoperative care, including patient education and counseling, nutritional and physical activity assessment, psychological rehabilitation, lifestyle recommendations, and metabolic assessment of comorbidities. Based on comprehensive assessments, establishing an individualized preoperative care and prehabilitation program is crucial to acquire better postoperative outcomes. Since the release of the latest ERAS guidelines for colorectal surgery in 2018, research on preoperative care and prehabilitation has been accelerating. To standardize this process, it is essential to establish a multidisciplinary team and a prehabilitation unit that includes healthcare professionals from various medical subspecialties and reinforces communication through an institutional and collaborative approach. The positive impact of such preoperative interventions on the postoperative period has been demonstrated in many countries, leading to the establishment of prehabilitation units. However, such prehabilitation units are lacking in Turkiye, highlighting a significant gap that needs to be addressed.

Ileostomy, frequently created after colorectal resections, hinders the physiologic function of the colon and can lead to dehydration and acute kidney injury due to high stoma outputs. This study aimed to evaluate the effectiveness of preventive measures on ileostomy-induced dehydration and related readmissions in a high-volume unit. In this prospective cohort study at a high-volume colorectal surgery department in Turkiye, the Prospective Ileostomy-induced Dehydration Prevention Bundle Project (PIDBP) was assessed from March 2021 to March 2022. The study enrolled patients undergoing colorectal surgery with ileostomy and involved comprehensive inpatient stoma care, education, and a structured post-discharge follow-up. The follow-up included the “Hydration follow-up scale” to monitor ileostomy output and related complications. The primary outcome was the readmission rate due to dehydration-related complications. The patients receiving the bundle intervention were compared with patients treated in the preceding year, focusing on the effectiveness of interventions such as dietary adjustments, fluid therapy, and pharmacological management. In the study, 104 patients were analyzed, divided into 54 pre-bundle and 50 bundle group patients, with no significant differences in patient characteristics. While the overall readmission rate due to dehydration was 12.5

Background An anal fissure is a longitudinal tear in the mucosa of the anal canal, distal to the dentate line. It is usually situated in the posterior midline but can occur in any quadrant. This condition affects both genders and is associated with pain, bleeding, anal discomfort, amongst other symptoms. Aim The aim of this study is to evaluate the global treatment and follow-up of patients with anal fissures in different countries and continents. Method A prospective cohort audit database was created with the cooperation of fifty-six doctors from twenty-one different countries. The patients were evaluated according to the type of anal fissure they had, treatment they underwent and results of 8-week post-treatment. Results Overall, 302 patients were included, with 106 (35%) diagnosed with an acute anal fissure and 196 (65%) a chronic anal fissure. Leading symptoms were painful defecation (n = 280, 92.7%) followed by anal bleeding (n = 194, 64.2%) and painful bleeding during defecation (n = 182, 60.2%). A total of 111 (36.8%) underwent surgical treatment. Out of the 264 (87%) who underwent follow-up at 8-weeks, 116 patients (44%) were cured, 86 (32.6%) showed marked improvements, 46 patients (17.4%) showed some improvement, 16 (5.0%) reported no change and one patient (0.3%) had worsened symptoms. Complications arising after treatment was recorded in 18 (6%) patients, with 15 (83%) complaining of headaches, 2 (5%) indicated hypotension, perineal sepsis, anal bleeding and/or allergies to medications used during treatment. Comparing pre-treatment and post-treatment Wexner Incontinence Scores, no patients had worsening fecal incontinence, 95.7% showed stable scores, while 13 (4.3%) showed improved scores. Conclusion The majority of surgeons chose a non-surgical approach as a first line treatment for anal fissures whether acute or chronic. Overall, 94% of all patients had resolution or improved symptoms, with none of the surgically treated patients developing fecal incontinence afterwards.

Purpose To investigate the performance of computed tomography (CT) in the local staging of colon cancer in different segments, with emphasis on parameters that have been found to be significant for rectal cancer, namely, extramural venous invasion (EMVI) and tumor deposits (TDs). Methods CT and pathology data from 137 patients were independently reviewed by radiology and pathology teams. The performance of CT in categorizing a given patient into good, versus poor prognostic groups was assessed for each segment, as well as the presence of lymph nodes (LNs), TDs and EMVIs. Discordant cases were re-evaluated to determine potential sources of error. Elastic stain was applied for EMVI discordance. Results The T staging accuracy was 80.2%. For T stage stratification, CT performed slightly better in the left colon, and the lowest accuracy was in the transverse colon. Under-staging was more common (in 12.4%), and most of the mis-staged cases were in sigmoid colon. According to the first comprehensive correlative analysis, the sensitivity, specificity, and accuracy of CT for detecting TDs were found to be 57.9%, 92.4%, 87.6%, respectively. These figures were 44.7%, 72.7%, and 63.5% for LN, and 58.5%, 82.1% and 73% for EMVI. The detection rate was better for multifocal EMVI. The detection rate was also comparable (although substantially underestimated) for LNs, with the half of the LNs missed by CT being < 5 mm. Four patients that were classified as TD by CT, disclosed to be LNs by pathology. Correlative analysis led to refinement of the pathology criteria, with subsequent modifications of the initial reports in 13 (9.5%) patients. Conclusion Overall, CT performed well in the evaluation of colon cancer, as did TD and EMVI. It is advisable to include these parameters in CT-based staging. Radiologists should be aware of the pitfalls that occur more commonly in different segments.

BACKGROUND:The FLOT 4-AIO trial established the docetaxel-based regimen's superiority over epirubicin-based triplet therapy in terms of survival rates and acceptable toxicity for locally advanced resectable gastric (LARGC). Yet, fewer than half of the patients achieved completion of eight prescribed FLOT cycles. We proposed that administering all FLOT cycles in the form of total neoadjuvant therapy may improve completion rates and downstaging. This study contrasted total neoadjuvant therapy (FLOT x8) with standard neoadjuvant therapy (FLOT 4+4) for patients LARGC adenocarcinoma who underwent curative resection with routine D2 lymphadenectomy, focusing on histopathological outcomes, toxicity, and survival outcomes. METHODS:We reviewed patients with histologically confirmed advanced clinical stage cT2 or higher, nodal positive stage (cN+), or both, with resectable gastric tumors and no distant metastases (January 2017 to July 2023). We divided patients into two groups, FLOT 4+4 and FLOT x8; FLOT 4+4 patients underwent four preoperative and four postoperative bi-weekly cycles of docetaxel, oxaliplatin, leucovorin, and fluorouracil, while FLOT x8 patients received all eight cycles preoperatively after a gradual practice change starting from January 2020. Propensity score matching adjusted for age, clinical stage, tumor location, and histology. RESULTS:Of the 77 patients in the FLOT x8 group, 37 were propensity-matched to an equal number in the FLOT 4+4 group. Demographics, duration of surgery, and hospital stay showed no significant differences between the groups. The FLOT x8 group exhibited a significantly higher all-cycle completion rate at 89.1% compared to FLOT 4+4's 67.6% (p < 0.01). Both groups demonstrated comparable hematological and non-hematological toxicity rates, Clavien-Dindo ≥ 3 complications, and CAP tumor regression grades. The mean number of harvested lymph nodes was 42.5 and 41.2 in the FLOT 4+4 and FLOT x8 groups, respectively. Similar rates of disease-free survival and overall survival were noted in both groups, despite a trend toward a higher pathological complete response rate, albeit not statistically significant (8.1% vs. 18.9%, p = 0.29), in the FLOT x8 group at a median follow-up of 36 months. CONCLUSION:Total neoadjuvant therapy with the FLOT x8 protocol corresponds to higher treatment completion rates, a safety profile similar to standard perioperative therapy, and a twofold increase in complete pathological response. Further research on long-term oncological outcomes is needed to confirm the effectiveness of total neoadjuvant therapy.

Background: Anastomotic leak rates after colorectal surgery remain high. In most left-sided colon and rectal resection surgeries, a circular stapler is utilized to create the primary bowel anastomosis. However, it remains unclear whether a relationship between circular stapler technology and anastomotic leak in left-sided colorectal surgery exists. Methods: A post-hoc analysis was conducted using a prospectively collected data set of patients from the 2017 European Society of Coloproctology snapshot audit who underwent elective left-sided resection (left hemicolectomy, sigmoid colectomy, or rectal resection) with a manual circular stapled anastomosis. Rates of anastomotic leak and unplanned intensive care unit stay in association with manual circular stapling were assessed. Patient-, disease-, geographical-, and surgeon-related factors as well as stapler brand were explored using multivariable regression models to identify predictors of adverse outcomes. Results: Across 3305 procedures, 8.0% of patients had an anastomotic leak and 2.1% had an unplanned intensive care unit stay. Independent predictors of anastomotic leak were male sex, minimal-access surgery converted to open surgery, and anastomosis height C11 (lower third rectum) (all P < 0.050). Independent predictors of unplanned intensive care unit stay were minimal-access surgery converted to open surgery and American Society of Anesthesiologists grade IV (all P < 0.050). Stapler device brand was not a predictor of anastomotic leak or unplanned intensive care unit stay in multivariable regression analysis. There were no differences in rates of anastomotic leak and unplanned intensive care unit stay according to stapler head diameter, geographical region, or surgeon experience. Conclusion: In patients undergoing left-sided bowel anastomosis, choice of manual circular stapler, in terms of manufacturer or head diameter, is not associated with rates of anastomotic leak and unplanned intensive care unit stay.

Abstract Background: Over the past few decades, nonoperative management (NOM) has become increasingly prevalent as an effort to preserve organs and improve functional outcomes compared to surgery. Objectives: This study aims to compare the clinical outcomes of patients with locally advanced distal rectal cancer (LADRC) following neoadjuvant treatment with either total mesorectal excision (TME) or NOM. Design: The study was conducted retrospectively. Patients and Methods: The study was conducted at two comprehensive cancer centers between January 1, 2014, and October 31, 2019. The study included all LADRC patients with clinical complete response (cCR) following neoadjuvant treatment, and who agreed to NOM or had a pathology report concluding that they had achieved pathologic complete response (pCR) following TME. Main Outcomes and Measurements: We evaluated patients for the presence of local regrowth or recurrence (LR), distant metastases (DM), and survival. Sample Size: A total of 462 individuals were identified from the database of the centers. Among them, 137 (31.8%) were confirmed to have achieved cCR. Results: Out of 137 patients with cCR, 67 patients were treated with NOM and 70 patients underwent TME, with 69 of them achieving pCR. In terms of baseline characteristics and tumor location, the patients in the NOM group (n = 67) did not differ from those in the pCR group (n = 69) ( P > 0.05). Surveillance of the 67 patients in the NOM group revealed that 10 (15%) developed local regrowth and required salvage surgery. As a result of salvage surgery, 65 patients (97%) maintained pelvic control. Although there was no evidence of pelvic recurrence in the pCR group, three patients (4.3%) underwent metastasectomy for DM. In the NOM group, DM was observed in two (20%) out of ten patients after salvage surgery for local regrowth, whereas no DM was detected in NOM patients without local regrowth. In the NOM group, DM was significantly associated with local regrowth compared to those who did not develop pelvic regrowth (20% vs. 0%; P < 0.05). It was observed that the pCR group had improved disease-free survival rates (95.7% vs. 85.1%, P = 0.034); however, there was no difference in the overall survival rates (100% vs. 98.5%, P = 0.248). Conclusion: Compared with the traditional trimodal treatment strategy, NOM is a safe and promising treatment option for selected LADRC patients with an acceptable rate of pelvic control and overall survival. Consequently, close endoscopic and radiologic monitoring is essential to maximize the likelihood of an early detection of recurrence and a successful salvage surgery. Limitations: Due to its retrospective nature, this study has limitations primarily related to data collection from patients’ records and databases after the completion of follow-up. Conflict of Interest: The authors have no conflict of interest to declare.

The aim of this study is to evaluate the clinicopathologic associations of tumor budding (Bd) as well as other potential prognosticators including lymphovascular invasion (LVI) in T3/4aN0 colon cancer patients and to investigate their impact on the outcome. The patients were enrolled in three groups according to the number of budding as Bd1 (0–4 buds), Bd2 (5–9 buds), and Bd3 (> 10 buds). These groups were retrospectively compared in terms of demographic features, other tumor characteristics, operative outcomes, recurrences, and survival. The mean follow-up time was 58 ± 22 months. A total of 194 patients were divided as follows: 97 in Bd1, 41 in Bd2, and 56 in Bd3 groups. The Bd3 group was associated with significantly higher LVI and larger tumor size. The rate of recurrence increased progressively from 5.2

OBJECTIVE:In this study, we aimed to compare long term oncological outcomes of upfront surgery versus neoadjuvant treatment in patients with locally advanced gastric cancer. METHODS:A total of 183 patients who were operated for gastric cancer were retrospectively analyzed. The patients received either standard gastrectomy or preoperative NACT + gastrectomy. Neoadjuvant therapy was administered with FLOT regimen (docetaxel, oxaliplatin, fluorouracil, and leucovorin) or DCF regimen (docetaxel, cisplatin, and 5-fluorouracil). RESULTS:Of the patients receiving NACT, 33 received FLOT regimen and 14 received DCF regimen. The number of male patients was higher in both standard gastrectomy and NACT + gastrectomy groups (p=0.385). Leukopenia and neutropenia were the most common hematological toxicities, while anemia and nausea were the most frequent non-hematological side effects in the both of NACT group. The outcomes of the grades of postoperative complications according to the Clavien-Dindo classification is similar between groups. There was no statistically significant difference in the length of hospital stay after surgery between the groups (p=0,001). According to the disease stage, it was found no statistically significant difference in the OS and DFS between the NACT and standard gastrectomy groups. CONCLUSION:Although we found no significant difference between the patients undergoing standard gastrectomy and those undergoing NACT before gastrectomy, we believe that NACT may contribute to the favorable prognosis of patients with locally advanced disease with improved OS and DFS and this should be examined in future studies. KEY WORDS:FLOT, Gastric Cancer, Neoadjuvant Treatment.

BackgroundAnastomotic leakage is a major complication in colorectal surgery, resulting in significant morbidity and mortality rates. Despite substantial progress in surgical technique, anastomotic leakage rates remain stable. An early diagnosis of anastomotic leaks was proven to reduce adverse outcomes and improve survival.ObjectiveThis study aims to find a novel scoring system for detecting anastomotic leaks using inflammatory and nutritional indicators after colorectal surgery. Our purpose was to analyze the diagnostic accuracy of leak scores ((CRPPOD3)(CRPPOD1)∗preoperativealbuminlevel) in predicting postoperative complications.DesignThe study included colorectal cancer patients who underwent curative surgery at Koc University Hospital between 2014 and 2018. Patients were categorized into two groups depending on the presence of anastomotic leaks and compared in terms of preoperative albumin levels, CRP levels in postoperative days 1 and 3, anastomotic leakage rates, length of hospital stay, and CRP quotient, which was calculated by dividing POD 3 CRP level to POD 1 CRP level. The bedside leak score is calculated by dividing the CRP quotient by the preoperative albumin level. The predictive value of bedside leak score, CRP quotient, and preoperative albumin levels in estimating anastomotic leakage was analyzed, and a cutoff value for the leak score was calculated.ResultsA total of 184 patients were included in the study. The leak score, CRP POD 3–1 ratio, and preoperative albumin levels were found to successfully detect anastomotic leakage. The area under the curve for the leak score was calculated as 0.78. The optimal cutoff value was found to be 50.3 for the bedside leak score, which shows 90.9% sensitivity and 59.3% specificity.ConclusionThe leak score may represent a valuable diagnostic tool for detecting patients at risk for anastomotic leakage after colorectal surgery and planning a better strategy to reduce morbidity and mortality rates and associated costs. However, further multicenter studies with large cohorts are necessary to confirm these results.

This study aimed to compare local regrowth rates after total neoadjuvant therapy (TNT) versus standard neoadjuvant chemoradiotherapy (SNCRT) in locally advanced rectal cancer (LARC) patients that were strictly selected and assessed with a multimodal approach. Secondary outcomes were 4-year disease-free (DFS) and overall survival (OS) rates. Locally advanced rectal cancer patients without distant metastases treated at Koç Healthcare Group between January 2014 and January 2021 were included. Patients were assessed for complete response with a combination of digital rectal exam, endoscopy, and magnetic resonance imaging with a dedicated rectum protocol. The systemic evaluation was performed with an upper abdomen MRI using intravenous hepatobiliary contrast agent and a thorax CT. Of the 270 patients with LARC, 182 fulfilled the inclusion criteria. Ninety-seven (53.3

Purpose This study aims to adapt and validate the Cleveland Clinic Colorectal Cancer Quality of Life Questionnaire (CCF-CaQL) in Turkish, addressing the significant need for reliable, language-specific QoL measures for colorectal cancer (CRC) in Turkiye. This effort fills a critical gap in CRC patient care, enhancing both patient-provider communication and disease-specific QoL assessment. Methods The CCF-CaQL was translated into Turkish, verified for accuracy, and reviewed for clarity and relevance. Eligible patients who underwent colorectal surgery for cancer between July 2021 and July 2022 from six hospitals completed the CCF-CaQL and SF-36 questionnaires. For analysis, confirmatory factor analysis using Smart PLS 4 and descriptive statistics were employed. The questionnaire’s reliability and validity were assessed using Cronbach alpha, composite reliability, and the heterotrait-monotrait (HTMT) ratio, along with multicollinearity checks and factor loadings. Nonparametric resampling was used for precise error and confidence interval calculations, and the Spearman coefficient and split-half method were applied for reliability testing. Results In the study involving 244 colorectal cancer patients, confirmatory factor analysis of the CCF-CaQL indicated effective item performance, with one item removed due to lower factor loading. The questionnaire exhibited high internal consistency, evidenced by a Cronbach alpha value of 0.909. Convergent validity was strong, with all average variance extracted (AVE) values exceeding 0.4. Discriminant validity was confirmed with HTMT coefficients below 0.9, and no significant multicollinearity issues were observed (VIF values < 10). Parallel testing with the SF-36 scale demonstrated moderate to very strong correlations, affirming the CCF-CaQL’s comparability in measuring quality of life. Conclusion The Turkish version of the CCF-CaQL was validated for assessing quality of life in colorectal cancer patients. This validation confirms its reliability and cultural appropriateness for use in Turkiye. The disease-specific nature of the CCF-CaQL makes it a useful tool in clinical and research settings, enhancing patient care by accurately monitoring treatment effects and interventions in the Turkish colorectal cancer patient population.