Background/Objectives: Papillary thyroid carcinoma (PTC) accounts for the majority of thyroid cancers, with lymph node metastasis, including skip metastasis (SM), playing a crucial role in guiding prognosis and therapeutic planning. SM, characterized by lateral lymph node spread in the absence of central compartment involvement, has been observed in PTC with a wide range of reported frequencies. The identification of risk factors for SM is crucial for preoperative evaluation and surgical planning. This research aims to explore the clinicopathological features and potential risk factors linked to SM in patients with PTC, while also offering valuable insights for preoperative risk evaluation. Methods: A retrospective cohort study was conducted on 81 PTC patients who underwent central and lateral cervical lymph node dissection (LND) in our center. Clinical, demographic, and pathological data, including age, sex, tumor size, location, subtype, extrathyroidal extension, lymphovascular invasion, and the number of lymph node metastases were analyzed. Clinicopathological characteristics were analyzed between SM-positive and SM-negative patient groups using suitable statistical methods. Additionally, a regression analysis was performed to identify the risk factors for SM. Results: Of the 81 patients, 17.3% (n = 14) were diagnosed with skip metastasis (SM). The SM-positive group had a significantly higher age (p = 0.006), smaller tumor size (p < 0.001), and higher rates of extrathyroidal extension (p = 0.006). The proportion of female patients was elevated in the SM-positive group, but this observation did not achieve statistical significance (p = 0.128). Tumors located in the upper pole were more common in the SM-positive group (p = 0.016). Multivariate analysis revealed that female sex, older age, and tumor location in the upper pole were significant risk factors for SM (p = 0.031, p = 0.004, and p = 0.017, respectively), while a lower number of lateral lymph node metastases was significantly associated with SM (p = 0.010). Additionally, an age over 43.5 years predicted SM with a sensitivity of 78.6% and a specificity of 72.7%. Conclusions: Skip metastasis is not uncommon in PTC and may be associated with older age, female sex, upper pole tumor location, and fewer lateral lymph node metastases. Recognizing these factors during preoperative assessment may aid in anticipating atypical lymphatic spread patterns and optimizing surgical strategies.

Background and Objectives: In contrast to the standardization of laparoscopic gastrectomy techniques, the complexity of intracorporeal anastomosis techniques in totally laparoscopic total gastrectomy, the lack of standardization, the positional challenges posed by working in a confined space, and varying complication rates have prevented a consensus on the optimal intracorporeal digestive tract reconstruction method. Selecting an appropriate reconstruction method for esophagojejunostomy is crucial for a successful surgical outcome. This study aims to define a modified anastomotic technique for TLTG and share our experience with this technique. Materials and Methods: A total of 21 patients who underwent TLTG with D2 LND between July 2024 and December 2024 using the sutureless L-shape esophagojejunostomy (SLEJ) technique at the Surgical Oncology Clinic of Gulhane Training and Research Hospital due to gastric cancer were included in the study. In our technique, gastrectomy, lymph node dissection, anastomosis preparation, esophagojejunostomy anastomosis, and enteroenterostomy anastomosis were all performed laparoscopically and intracorporeally. Results: The mean operative time was 180.48 min, with a mean EJ anastomosis duration of 40.24 min. In the standard technique, two Endo GIA™ staplers were used for pyloric and small bowel transection, two for EJ anastomosis, and one for intracorporeal jejunojejunostomy. In only one patient, three staplers were used for anastomosis. Therefore, the average number of staplers was 5.05, with a mean of 2.05 staplers used for anastomosis. The mean hospital stay was 8.19 days, and there were no mortalities. The number of patients with an anastomotic leakage was 1. Since the patient’s general condition remained stable, percutaneous drainage or laparotomy was not planned. The patients’ esophagojejunostomy anastomotic leak was classified as Class 1 and Grade 3a according to the Clavien–Dindo classification. The average size of our widest incision was 3.28 cm, and surgical site infections were developed in two patients. Conclusions: Sutureless L-Shape With Endoscopic Assistance (SLEJ) is an easily applicable, technically simpler, shorter-in-duration, easier-to-learn, and safer intracorporeal EJ anastomosis technique with a low rate of postoperative complications.

Background and Objectives: Lymphedema is one of the most important morbid complications of modified radical mastectomy (MRM) surgery. It can cause limb movement restriction and psychosocial deformities in some patients. This study aimed to determine and compare the physiological and pathological changes that develop in the axillary venous structures in patients who underwent axillary lymph node dissection (ALND) and sentinel lymph node biopsy (SLNB). Materials and Methods: Patients diagnosed with breast cancer who underwent MRM and breast-conserving surgery (BCS) plus SLNB between 2017 and 2022 were retrospectively examined. The patients’ operation side and contralateral axillary vein diameter and the difference between them, axillary vein flow rate and the difference between them, axillary vein wall thickness and the difference between them, severity of lymphedema, extremity joint restriction examination, and the Nottingham Health Profile (NHP) data were recorded. The relationship of these parameters with the lymph node dissection width and radiotherapy was analyzed. Results: Fifty-eight patients in total were included in the study. In the distribution of lymphedema and lymphedema severity according to ALND groups, there is a statistically significant difference (p < 0.001). A statistically significant difference was determined in the distribution of the difference in the axillary vein blood flow rate and axillary vein diameter difference between the two arms according to the lymph node dissection groups. In the distribution of physical therapy and rehabilitation scales according to the lymph node dissection groups, a significant difference was found in the disabilities of the arm, shoulder, and hand (DASH), shoulder flexion restriction variables, and NHP sleep variables (all p < 0.001). Conclusions: This study demonstrated that ALND leads to more pronounced physiological and pathological changes in axillary venous structures—including increased vein wall thickness, altered flow rates, and diameter differences—compared to SLNB combined with breast-conserving surgery. These changes may be attributed to lymphovenous disruption and postoperative edema. Furthermore, radiotherapy appears to contribute to these changes, though to a lesser extent than ALND. Therefore, SLNB followed by radiotherapy may be preferable in eligible patients to reduce postoperative complications such as lymphedema, joint restriction, and sleep disturbances.

Background and Objectives: Intra-corporeal esophagojejunostomy after totally laparoscopic total gastrectomy (TLTG) remains one of the most technically demanding steps of minimally invasive gastric surgery. The management of the common entry hole in linear stapler-based reconstructions still relies on advanced intra-corporeal suturing. The sutureless L-shape esophagojejunostomy with endoscopic assistance (SLEJ) technique, previously described by our group, was developed to overcome this limitation by combining an L-shaped linear stapler configuration with intraoperative endoscopic quality control. Building upon our initial results on the perioperative feasibility of the technique, the present study aimed to evaluate its intermediate-term anastomotic, functional, and oncological outcomes. Materials and Methods: Patients who underwent TLTG with D2 lymph node dissection and SLEJ reconstruction for gastric cancer between July 2024 and January 2026 were evaluated. Eligibility criteria included a minimum postoperative follow-up of six months, clinical and endoscopic surveillance, and complete contrast-enhanced thoraco-abdominopelvic computed tomography records. Protocol-based upper gastrointestinal endoscopy was performed at six-month intervals irrespective of symptoms to objectively assess anastomotic lumen width, mucosal healing, reflux findings, and possible intraluminal recurrence. The primary endpoint was anastomosis complication-free survival (anastomotic stenosis, alkaline reflux/reflux esophagitis, marginal ulcer, bleeding due to ulceration, and intraluminal recurrence); secondary endpoints were disease-free survival (DFS), local recurrence and changes to nutritional status. Results: A total of 26 patients (18 men and 8 women; mean age 59.0 ± 7.8 years) were analyzed. Anastomotic stricture developed in two patients and was successfully managed with two sessions of endoscopic balloon dilation in both. Similarly, alkaline reflux was documented in two additional patients and resolved under medical treatment. None of the patients required surgical revision. The mean ACFS follow-up duration was 12.42 months with ACFS rates of 92.3% at six months and 81.1% from the twelfth month onward. No local anastomotic recurrence was detected during follow-up. Disease progression occurred in four patients (15.4%), presenting as distant organ metastasis (n = 2) or peritoneal carcinomatosis (n = 2). The mean DFS follow-up duration was 12.62 ± 6.18 months, and the twelve-month OS and DFS rates were 82.1% and 84.0%. Postoperative body weight decreased significantly compared with preoperative values (76.69 ± 15.59 kg vs. 63.23 ± 10.55 kg; p < 0.001). A significant decrease was observed in the mean SMI between the preoperative and follow-up assessments (p < 0.001). The mean preoperative SMI was 49.90 ± 9.04 cm²/m², compared with 44.53 ± 7.98 cm²/m² at follow-up. No statistically significant changes were observed between the preoperative and follow-up periods for serum albumin and PNI variables (p = 0.703 and p = 0.970). Conclusions: The present intermediate-term analysis suggests that the SLEJ technique is feasible and associated with acceptable intermediate-term anastomotic, functional, and oncological outcomes in this preliminary single-center cohort. By standardizing common entry-hole management without intra-corporeal suturing and incorporating intraoperative endoscopic quality control, the technique offers a feasible alternative to established linear stapler-based reconstructions.

Objective: Thyroid cancer (TC), the most common endocrine malignancy worldwide, has a 10-year survival rate of more than 90% and a better prognosis than other malignancies. However, there are still conflicting data on the stimulators of cancer development, and benign thyroid diseases, such as goiter, benign thyroid nodules, Graves’ disease, chronic thyroiditis, breast cancer and various factors including age, gender, consumption of vegetables, fiber food, hypercaloric diet, and tobacco and alcohol use are considered to be responsible. In this study, we aimed to evaluate patients with thyroid neoplasms who underwent surgical treatment in terms of etiological factors discussed in light of the literature. Material and Method: In our study, patients who underwent surgery with the diagnosis of thyroid gland neoplasms between 2010 and 2020 were evaluated. A total of 371 patients were included in the study. Statistical analyses were performed using IBM SPSS Statistics v. 22. Results: Of the 371 cases included in the study, 78.16% were female and 21.83% were male. The histopathological distribution of diagnoses was as follows: 76.28% papillary thyroid carcinoma (PTC), 4.31% follicular thyroid carcinoma (FTC), 14.29% follicular adenoma (FA), 0.54% Hurthle cell carcinoma (HCC), 3.77% Hurthle cell adenoma (HCA), and 8.08% medullary thyroid carcinoma (MTC). A total of 567 etiological factors were detected in 371 cases, and the highest factors ratio (1.94) being detected in the FTC group and the lowest (1.49) in the FA group. The most common of these factors was chronic lymphocytic thyroiditis (CLT) (35.31%). While the most common etiological factor in the PTC diagnosis group was thyroid and other non-breast cancers and the history of radiotherapy resulting from their treatment, it was a family history of thyroid cancer in the HCA group. Other systematic organ diseases, CLT, and breast cancer were the most common factors. The body mass index was the highest in the MTC group and the lowest in the PTC group. Conclusion: Increased human development index, technological developments, greater accessibility of ultrasonography, and better diagnostic sensitivity have led to an increase in the detection of TC. Knowledge of the underlying etiological factors is important for the development of preventive measures and achieving more successful results in terms of diagnosis and treatment.

Introduction: The working principle of artificial intelligence in medicine is primarily as follows: The data are collected and entered into the system, the computer uses an algorithm to gather information via these data, and finally, it analyzes this algorithm to utilize in the diagnosis and treatment of the disease. In this study, we investigated the achievement of mammographic breast area/microcalcification cluster area ratio (BA/MCA) in the grouping of BI‐RADS 4 (a, b, c) lesions. We planned to contribute to the development of artificial intelligence in medicine with a simple calculation program to be attached to the mammography computer.Methods: 125 patients who underwent surgery with the diagnosis of mammographic BI‐RADS 4 lesion (could not be detected in lesion‐specific ultrasonography) between 2019 and 2022 in the Department of Surgical Oncology of Health Sciences University Gulhane Medical Faculty Training and Research Hospital were retrospectively examined. The mammographic MCA was divided by the breast area and their ratio was calculated. The relationship between the ratios we found and the BI‐RADS values defined by radiology was analyzed.Results: We found the median BA/MCA value of BI‐RADS 4a patients to be 24943.5, BI‐RADS 4b patients to be 12609.2, and BI‐RADS 4c patients to be 11547.1 (p = 0.003). According to ROC curve analysis, we detected the BA/MCA ratio for BI‐RADS 4c to be 14183.34 (AUC = 0.686, p = 0.005, sensitivity 54.2%). This ratio is inversely related, and the probability of BI‐RADS 4c increases in patients with a BA/MCA ratio less than 14183.34. We revealed that the malignancy rate of radiological BI‐RADS 4c patients was 90%, and the cutoff value of BI‐RADS 4c patients was 72%. Using both classifications together, we detected the malignancy rate to be 98%.Conclusion: The increase in the ratio of MCA to BA might have a place in the differentiation of BI‐RADS 4 lesions. We foresee that artificial intelligence could also have a place in the classification of BI‐RADS lesions with software to be installed on the mammography computer.