Background/Objective: Cancer cachexia is a multifactorial syndrome that contributes to adverse surgical outcomes in gastric cancer (GC), yet weight-based criteria often fail to detect subclinical cases. This study aimed to assess the prognostic utility of the Cancer Cachexia Index (CXI) in predicting severe postoperative complications after curative gastrectomy. Methods: We retrospectively analyzed 301 patients with GC who underwent curative surgery between January 2020 and October 2023. CXI was calculated as L3 skeletal muscle index × serum albumin/neutrophil-to-lymphocyte ratio (NLR), and patients were stratified into low- and high-CXI groups based on sex-specific medians. Postoperative complications were classified using Clavien–Dindo, with grade ≥ III considered major morbidity. Group comparisons included rates of major complications and hospital stay. Results: The low-CXI group had significantly lower muscle mass and albumin levels, higher inflammatory markers, and more T4 tumors. Major complications occurred more frequently in this group (p < 0.001). In multivariate logistic regression, low CXI independently predicted severe complications (OR: 2.89; 95% CI: 1.42–5.85; p = 0.003), alongside older age and smoking. Receiver operating characteristic (ROC) analysis showed a CXI cut-off of 34.75 yielded high specificity (94.86%) for predicting major morbidity. Conclusions: Preoperative CXI is an effective predictor of severe postoperative morbidity in GC patients, outperforming traditional nutritional and inflammatory markers. Incorporation of CXI into routine preoperative assessment may enhance surgical risk stratification and guide perioperative optimization.

Aims: The COVID-19 pandemic disrupted diagnostic services worldwide, particularly gastrointestinal (GI) endoscopy, raising concerns about delayed diagnoses and stage migration in gastric cancer. Helicobacter pylori (H. pylori), a key factor in gastric carcinogenesis, may also influence mucosal susceptibility to SARS-CoV-2. However, data on how these disruptions affected gastric cancer profiles remain limited. To compare clinical, endoscopic, and pathological features of patients undergoing upper GI endoscopy during and after the COVID-19 pandemic, and to evaluate the association between nutritional status and tumor burden in gastric cancer patients. Methods: This retrospective cohort study included 478 patients who underwent diagnostic upper GI endoscopy due to dyspeptic or alarm symptoms at a tertiary care center in Turkiye. Patients were divided into two groups: pandemic (June 2021 to June 2022; n=216) and post-pandemic (May to October 2023; n=262). Demographics, symptoms, endoscopic and histopathological findings, and body-mass index (BMI) were analyzed. Statistical methods included t-tests, Chi-square tests, logistic regression, and Spearman correlation. Results: Patients evaluated during the pandemic more frequently reported alarm symptoms and had significantly lower weight and BMI. H. pylori positivity (41.7% vs. 28.2%; p=0.03), peptic ulcer (16.7% vs. 8.4%; p=0.04), and gastric cancer (7.4% vs. 2.3%; p=0.02) were all more prevalent in the pandemic group. Among 22 patients with gastric cancer, those diagnosed during the pandemic exhibited more advanced disease (T3-T4: 75.0% vs. 33.3%; p=0.02), more frequent nodal involvement (62.5% vs. 16.7%; p=0.01), and BMI. Pandemic-period endoscopy remained an independent predictor of advanced-stage gastric cancer in multivariable analysis (OR=3.41; 95% CI: 1.31-8.88; p=0.008). Strong inverse correlations were found between BMI and tumor depth (p=-0.73), and between BMI and nodal involvement (p=-0.87). Conclusion: The COVID-19 pandemic was associated with diagnostic delays and increased frequency of advanced-stage gastric cancer. BMI showed a strong inverse relationship with tumor aggressiveness and has potential to serve as a practical indicator of disease burden. These findings underscore the importance of preserving access to endoscopic diagnostics and highlight the prognostic value of nutritional parameters during public health emergencies.

Artificial intelligence (AI) has become a transformative tool in medical education and assessment. Despite advancements, AI models such as GPT-4o demonstrate variable performance on high-stakes examinations. This study compared the performance of four AI models (Llama-3, Gemini, GPT-4o, and Copilot) with specialists and residents on European General Surgery Board test questions, focusing on accuracy across question formats, lengths, and difficulty levels. A total of 120 multiple-choice questions were systematically sampled from the General Surgery Examination and Board Review question bank using a structured randomization protocol. The questions were administered via Google Forms to four large language models (Llama-3, GPT-4o, Gemini, and Copilot) and 30 surgeons (15 board-certified specialists and 15 residents) under timed, single-session conditions. Participant demographics (age, gender, years of experience) were recorded. Questions were categorized by word count (short, medium, long) and by difficulty level (easy, moderate, hard), rated by three independent board-certified surgeons. Group accuracy rates were compared using ANOVA with appropriate post-hoc tests, and 95% confidence intervals were reported. Board-certified surgeons achieved the highest accuracy rate at 81.6% (95% CI: 78.9–84.3), followed by surgical residents at 69.9% (95% CI: 66.7–73.1). Among large language models (LLMs), Llama-3 demonstrated the best performance with an accuracy of 65.8% (95% CI: 62.4–69.2), whereas Copilot showed the lowest performance at 51.7% (95% CI: 48.1–55.3). LLM performance declined significantly as item difficulty and length increased, particularly for Copilot (68.3% on short vs. 36.4% on long questions, p < 0.001). In contrast, human participants maintained relatively stable accuracy across difficulty levels. Notably, only Llama-3 ranked within the human performance range, placing 26th among 30 surgeons, while all other LLMs failed to surpass the 60% accuracy threshold (p < 0.001). Current LLMs underperform compared to human specialists when faced with questions requiring high-level medical knowledge, reinforcing their current role as supplementary tools in surgical education rather than replacements for expert clinical judgment.

Background and Objectives: Effective pain management is essential for optimizing recovery after laparoscopic cholecystectomy (LC). Ultrasound-guided erector spinae plane (ESP) and transversus abdominis plane (TAP) blocks are validated techniques, but may be limited by equipment requirements and technical complexity. This study aimed to evaluate whether surgeon-delivered local anesthetic infiltration provides comparable analgesic efficacy. Materials and Methods: This prospective, randomized, controlled, single-center trial enrolled 172 patients undergoing elective LC between November 2020 and June 2022. Patients were randomized into four groups: Group A—surgeon-delivered port-site and intraperitoneal bupivacaine infiltration; Group B—ESP block; Group C—TAP block; and Group D—control. Primary outcomes were postoperative pain assessed by Visual Analog Scale (VAS) scores at 1, 3, 6, 12, and 24 h, and Behavioral Pain Scale (BPS) scores at 1 and 3 h. Secondary outcomes included 24 h tramadol consumption, patient satisfaction, additional rescue analgesia requirement, and procedure duration. Results: All intervention groups (A–C) demonstrated significantly lower VAS and BPS scores compared to controls (VAS at 24 h: 1.8 ± 0.9 vs. 2.8 ± 1.3, p < 0.001). Tramadol use was also reduced (≈82 mg vs. 97 mg, p < 0.001), with fewer opioid-related adverse effects. No significant differences were observed among Groups A–C. Patient satisfaction was higher in the intervention groups, and no major complications were reported. Conclusions: Surgeon-delivered local infiltration achieved analgesic efficacy equivalent to ESP and TAP blocks. Considering its simplicity, safety, and minimal resource demands, this method may represent a practical alternative for enhanced recovery pathways following LC.

Objectives: Thyroid nodules, although frequently benign, carry a malignancy risk in approximately 8–16% of cases. The use of structured classification systems such as TIRADS and cytological evaluation via fine needle aspiration biopsy (FNAB) help guide clinical decision-making and avoid unnecessary surgery. This study aimed to evaluate the sensitivity, specificity, and diagnostic accuracy of TIRADS classification and FNAB in predicting malignancy in thyroid nodules and to assess their correlation with final histopathological outcomes after thyroidectomy. Methods: A retrospective analysis was conducted on 489 patients who underwent thyroidectomy between January 2016 and July 2020, in accordance with ATA guidelines. Data collected included demographic features, comorbidities, ultrasound-based TIRADS classifications, FNAB results (Bethesda classification), preoperative and postoperative biochemical parameters, and final histopathological diagnoses. Results: Malignancy was detected in 9.48% of cases. The mean age of malignant cases was 48.8 years. FNAB showed a sensitivity of 50%, specificity of 98%, negative predictive value of 87.4%, and positive predictive value of 88.5%. Among nodules categorized as “suspicious for malignancy” by FNAB, 51.4% were confirmed as malignant on final pathology. The malignancy rates according to TIRADS scores 1 to 5 were 7.1%, 20.3%, 27.1%, 37.1%, and 57.1%, respectively. When only malignant and suspicious-for-malignancy FNAB results were considered positive, the malignancy risk was 33.6% for TIRADS 4 and 83.3% for TIRADS 5 nodules. Conclusion: This study revealed notable malignancy rates even in TIRADS 1 and 2 nodules, which are generally considered benign in current guidelines. TIRADS categories 4 and 5 showed statistically significant correlations with malignancy, reinforcing their utility in preoperative risk stratification.

Objective: According to the Tokyo 2018 guidelines, white blood cells (WBCs) are the only markers used in the staging of acute cholecystitis. We aimed to inve...