Sentinel lymph node biopsy (SLNB) is the standard axillary staging method in early-stage breast cancer; however, its associated morbidity and evolving systemic treatment paradigms have prompted reconsideration of its necessity in selected low-risk patients. This study aimed to develop a preoperative nomogram based on ultrasonographic (USG) findings and clinical parameters to predict axillary metastasis risk and define a truly low-risk subgroup eligible for selective SLNB omission. A total of 452 patients with early-stage, clinically node-negative (cN0) invasive breast cancer who underwent upfront surgery between 2010 and 2024 were retrospectively analyzed. Preoperative imaging included axillary USG and ancillary 18F-FDG PET/CT, the latter used solely to exclude patients with hypermetabolic axillary nodes. A multivariate logistic regression model was constructed using clinical T stage, axillary USG findings, tumor location, and multicentricity. Patients with unicentric, non-retroareolar tumors classified as T1a–b or T1c ≤ 1.7 cm, and negative axillary USG findings, whose predicted axillary metastasis probability was < 5%, were considered low risk. This threshold was retrospectively tested for clinical validity by assessing the observed false-negative rate (FNR) in the identified low-risk population. Axillary USG findings, tumor size, tumor location, and multicentricity were significant predictors of axillary metastasis. The nomogram demonstrated good discriminatory performance, yielding an AUC of 0.816 in the development cohort and 0.830 following internal validation.A total of 123 patients (27.2%) met the criteria for the low-risk group. In this group, the observed macrometastasis rate was 4.1%, and an additional 0.7% had micrometastasis, yielding a total FNR of 4.8%. Aggressive molecular subtypes and premenopausal status were not associated with increased metastasis rates in the low-risk group. However, guideline recommendations emphasize caution when considering SLNB omission in these populations. This USG-based preoperative nomogram provides a clinically applicable tool to identify early-stage breast cancer patients with a truly low risk of axillary metastasis, in whom SLNB may be safely omitted. The < 5% predicted probability threshold was confirmed to correspond to an observed FNR < 5%, supporting its clinical validity. Prospective validation studies are warranted to further confirm these findings and optimize axillary management strategies.

Objective: Iatrogenic bile duct injury (IBDI) is a serious complication of cholecystectomy that may crucially affect long-term quality of life and have major morbidities. Furthermore, even after reconstructive surgical treatment, such injuries still reduce the long-term quality of life. Therefore, there remains a need to investigate long-term quality of life of the patients since it is considered that there is a long-term decrease in both physical and mental quality of life. Accordingly, this study aimed to investigate the clinical evaluations and long-term quality of life of the patients who had undergone reconstructive surgery for iatrogenic bile duct injury. Material and Methods: This clinical study included 49 patients (38 females/11 males) with cholecystectomy-associated bile duct injury and who underwent reconstruction surgery. Several parameters, including the type of bile duct injury, reconstructive surgical procedures, length of hospital stay, and complications were evaluated. Moreover, the effects of reconstructive surgical timing (perioperative, early postoperative, late postoperative) on quality of life were assessed. Long term quality of life (LTQL) levels were evaluated using the SF-36 questionnaire in patients whose follow-ups ranged from two to nine years. The SF-36 questionnaire scores were compared to the average SF-36 norm values of the healthy Turkish population. Results: Our results showed that 73.5% of biliary tract injuries occurred after a laparoscopic surgery while 26.5% after open cholecystectomy. Of the injuries, 32.7% developed in patients with acute cholecystitis. Thirty of the patients were treated with hepaticojejunostomy. When SF-36 questionnaire scores of the study were compared to those of the healthy Turkish population, energy-vitality was found to be lower significantly in male patients (p= 0.041). However, there was no significant deterioration in female patients. Although general health perception was better in hepaticojejunostomy according to the type of reconstructive surgery performed, no significant difference was observed in the quality of life. Mental health, energy-vitality (p= 0.019), and general health perception (p= 0.026) were found to be lower in women who had E¹ -E² injuries. Only seven of the injuries were detected perioperatively. Physical function (p= 0.033) and general health perception (p= 0.035) were found to be lower in the early postoperative treatment group in male patients in terms of the time of reconstructive surgery. Conclusion: IBDIs cause serious morbidity. Furthermore, even after reconstructive surgical treatment, such injuries still reduce LTQL. Our results suggest that LTQL is lower, especially in male patients undergoing postoperative early biliary repair for Strasberg E³ -E⁴ type injuries.

Surgical site infections (SSIs) are among the most frequent healthcare-associated infections, leading to prolonged hospitalization, increased costs, and impaired recovery. This retrospective cohort study aimed to identify the determinants and microbial patterns of SSIs following hepatobiliary and pancreatic (HPB) surgery to inform preventive strategies and optimize clinical outcomes. The patients undergoing hepatobiliary and pancreatic surgery from 2014 to 2024 in a tertiary university hospital are reviewed. SSI was defined according to Centers for Disease Control and Prevention (CDC) criteria, and microbiological isolates were identified through routine culture methods and susceptibility testing. Clinical, operative, and microbiological data of patients who underwent hepatobiliary and pancreatic surgery were extracted, including demographics, comorbidities, operative characteristics, and postoperative outcomes. Among 553 hepatobiliary and pancreatic surgery patients, SSI occurred in 48.6%. Gram-negative bacteria predominated, with E. coli as the leading pathogen. SSI was linked to open surgery, longer operative time, and higher ASA scores; malignancy, renal insufficiency, anemia, and COPD were independent risk factors. Age by itself was not a reliable predictor of infection, while operative duration demonstrated moderate predictive performance, with a sensitivity of 66%. These findings underscore the multifactorial pathogenesis of SSIs and emphasize the importance of refined perioperative strategies to mitigate postoperative infectious complications.