Background: The significance of inflammatory markers in forecasting pancreatic fistula development has not been thoroughly investigated in patients who have undergone distal pancreatectomy. This study seeks to assess the predictive value of postoperative inflammatory indices, particularly SII (systemic immune inflammation index), NLR (neutrophil-to-lymphocyte ratio) and PLR (platelet-to-lymphocyte ratio), concerning the onset of pancreatic fistula in these patients. Materials and Methods: This retrospective study analyzed patients who underwent distal pancreatec-tomy for pancreatic cancer between January 2020 and December 2023. Statistical analyses were performed by retrospectively examining the data obtained from the prospectively filled clinical notes of patients who developed pancreatic fistula (Grade B and C) using the SII, NLR and PLR calculated based on the laboratory results obtained on the third postoperative day. Results: The study included 72 patients who fulfilled the established criteria. Pancreatic fistulas were observed in 25 (34.7%) of the patients. In this study, BMI and soft pancreatic tissue were statistically significant risk factors for pancreatic fistula development (p=0.02 for both). SII and NLR from the third postoperative day were statistically significant predictors of pancreatic fistula development, while postoperative PLR did not provide statistically significant results. SII was a more significant predictor of pancreatic fistula than NLR. Conclusions: This study conveys that monitoring the increase in SII and NLR, which are inflammation-related indices, is an effective method for predicting the development of pancreatic fistula after distal pancreatectomy, whereas PLR is not effective in predicting the development of pancreatic fistula.

Background: Sentinel lymph node biopsy (SLNB) is the standard axillary staging procedure in clinically node-negative breast cancer but remains invasive, non-therapeutic and increasingly questioned in contemporary de-escalation algorithms. After neoadjuvant chemotherapy (NACT), however, the safety of omitting SLNB solely on the basis of a negative axillary ultrasound (AUS) is uncertain, particularly across molecular subtypes with heterogeneous chemosensitivity. This study evaluated the diagnostic performance of preoperative AUS after NACT and explored clinicopathological and biological factors associated with SLNB positivity in ultrasound-negative axillae. Methods: In this single-centre retrospective cohort, 135 women with invasive breast cancer who received NACT followed by surgery (2022–2024) were analysed. To avoid spectrum bias, 77 patients with clipped, cytologically or histologically proven node-positive disease at baseline were excluded from the main analysis. All patients underwent preoperative AUS and definitive axillary staging. Ninety-six women with ultrasound-negative axillae who proceeded to SLNB constituted the primary study population. Oestrogen receptor (ER), progesterone receptor (PR), HER2, Ki-67 and immunohistochemistry-based molecular subtype were recorded. Receiver operating characteristic (ROC) analysis and uni/multivariable logistic regression were used as exploratory tools to identify factors associated with SLNB positivity. Results: In the overall cohort, AUS sensitivity, specificity, negative predictive value and false-negative rate for axillary metastasis were 47.8%, 90.9%, 62.5% and 52.2%, respectively. Among ultrasound-negative axillae, SLNB was positive in 37.5%. Compared with SLNB-negative patients, those with SLNB metastases more frequently harboured an intratumoural ductal carcinoma in situ (DCIS) component, showed higher ER/PR expression and lower Ki-67, and were predominantly luminal A or luminal B/HER2−, whereas AUS performance appeared more favourable in HER2-enriched and triple-negative tumours. ROC-derived cut-offs for ER (82.5%), PR (25.0%) and Ki-67 (17.5%) provided only moderate discrimination (area under the curve 0.68–0.70). In multivariable analysis, absence of a DCIS component and low PR expression were independently associated with reduced odds of SLNB positivity, suggesting that DCIS and high PR may act as indicators of residual nodal risk in ultrasound-negative axillae. All estimates are limited by sample size and wide confidence intervals and should be interpreted as hypothesis-generating. Conclusions: Preoperative AUS alone cannot reliably exclude sentinel lymph node metastasis after NACT, particularly in luminal A and luminal B/HER2− tumours with strong hormone receptor expression and a low proliferative index. Until prospective, biology-stratified trials confirm the safety of omission, SLNB should not be withheld solely on the basis of a negative AUS in these subtypes. Axillary management after NACT should systematically integrate both imaging findings and tumour biology when considering further de-escalation of surgery.

Background: Postoperative pancreatic fistula (POPF) is a common and serious complication following pancreatic surgery. While several studies have attempted to predict the development of POPF using drain amylase concentration, predictive values vary widely due to factors like abdominal irrigation and chylous drainage, which can dilute the amylase levels. This study aims to evaluate whether the “Real Amylase Value” (RAV), calculated as the product of drain amylase concentration and drainage volume, provides a more reliable prediction of POPF compared to conventional amylase concentration. Better prediction of pancreatic fistula development could lead to closer clinical monitoring of these patients, reassessment of hospital stay duration, and more careful management of drains over an extended period. Additionally, carefully managing the timing of drain removal may improve patient recovery and discharge process. Methodology: Data from 198 patients who underwent pancreaticoduodenectomy (PD) and distal pancreatectomy (DP) were retrospectively analyzed. Drain amylase concentrations and drainage volumes were measured on postoperative days (POD) 1 and 3, and the RAV (U) was calculated. Real Amylase Value (RAV) (U) was calculated using the formula: RAV (U) = Drain Amylase Concentration (U/L) × Drainage Amount (L). Predictive values for POPF were evaluated using receiver operating characteristic (ROC) curve analysis, comparing conventional amylase concentration (U/L) and RAV (U). Results: On POD1, the RAV (U) demonstrated greater predictive value for POPF compared to the conventional drain amylase concentration (U/L) with an area under the ROC curve (AUROC) of 0.85 versus 0.79, respectively. Similarly, on POD3, RAV showed superior predictive accuracy (AUROC 0.89) compared to amylase concentration (AUROC 0.79). Conclusion: The RAV (U) offers a more accurate and reliable prediction of POPF than traditional drain amylase concentration (U/L), with improved sensitivity and specificity. This method could refine clinical management, particularly in the timing of drain removal and early intervention strategies for patients at high risk of developing pancreatic fistulas.

Aim: The chaos experienced during the Covid-19 pandemic caused disruptions in the treatments of pancreatic cancer patients; both the ones who were newly diagnosed and the ones who had ongoing treatments. It also caused delays in the diagnosis of pancreas tumors and thus changes in the treatments which would be planned. For these reasons, more problems might arise in patients who had pancreatic surgeries during this interval. In this study, we aim to compare postoperative morbidity and mortality of patients who had pancreatic surgery due to diagnosis or suspect of cancer before and during Covid-19 pandemic. Material and Method: Data of patients who had pancreatic surgery due to pancreas cancer between 2017-2022 were recorded prospectively. A total of 226 patients were included. There were 142 patients in Pre-Covid group, and 84 patients with pancreas cancer in the Post-Covid group. Patients who were accepted as inoperative during surgery or the ones who had palliative surgery were excluded. Results: Preoperative biliary stent or percutaneous biliary drainage procedures were compared in patients with pancreatic cancers and these were performed more often in Post-Covid group than in Pre-Covid group during pandemic period. Biliary drainage was performed to 31 patients in Pre-Covid group (28.1%), and 32 (46.3%) patients in Post-Covid group (p=0.013). Five patients (3.5%) in Pre-Covid group, 15 patients (17.8%) in Post-Covid group had neoadjuvant therapy (p=0.000). Patients in Post-Covid group had significantly more neoadjuvant chemotherapy. Vascular resection was performed for 14 patients (9.8%) in Pre-Covid group, and 16 (19%) patients in Post-Covid group. Rate of vascular resection was significantly higher in Post-Covid group (p=0.049). Nine (6.3%) patients in Pre-Covid group, and 12 (14.2%) patients in Post-Covid group had extra-organ resection. Extra-organ resection was significantly higher in Post-Covid group than in Pre-Covid group (p=0.047).

Background: Iatrogenic colonic perforation (ICP) is a rare but serious complication of colonoscopy. Its incidence varies according to whether the procedure is diagnostic or therapeutic. Although surgery has traditionally been the cornerstone of treatment, advances in endoscopic techniques—particularly clip application—have provided less invasive alternatives. This study aimed to present the clinical characteristics, management strategies, and outcomes of ICP in a high-volume tertiary center, with a particular focus on the efficacy and limitations of endoscopic clip closure. Methods: In this retrospective study, all patients diagnosed with ICP between 2019 and 2024 at Kartal Dr. Lutfi Kirdar City Hospital were evaluated. Among 87,526 colonoscopies performed during this period, 42 patients with ICP were included. Patients were classified according to whether colonoscopy was performed for diagnostic or therapeutic indications. Endoscopic clip closure was attempted in 14 patients and was successful in 8 of them (57.1%). Surgical intervention was performed in 34 patients, either after failed endoscopic management or as the primary treatment. Results: ICP developed more frequently during diagnostic procedures (69%). The sigmoid colon (57.1%) was the most common site of perforation, and most perforations were intraperitoneal (81%). Baseline demographic and clinical characteristics did not differ significantly between the diagnostic and therapeutic indication groups ( P >0.05). Successful endoscopic clip closure was associated with early diagnosis, good bowel preparation, and perforation size <2 cm. Patients treated endoscopically had shorter times to oral intake and shorter hospital stays compared with those treated surgically. Conclusions: Endoscopic clip application is an effective treatment option for carefully selected ICP cases with early recognition, favorable local conditions, and small, localized defects. However, surgery remains essential in large perforations, delayed diagnoses, or when clip closure fails. Our findings provide real-world data on the role and limitations of standard clip closure in a resource-limited tertiary center and support guideline-based, individualized decision-making for ICP management.