Spontaneous and uneventful anal expulsion of expanded polytetrafluoroethylene (e-PTFE) vascular graft after living donor liver transplantation - Turkish Journal of Surgery

Background and Objectives: We investigated how pretreatment body-composition parameters relate to pathologic complete response (pCR), disease-free survival (DFS), and overall survival (OS) in women with non-metastatic breast cancer who received neoadjuvant chemotherapy (NAC). Materials and Methods: We retrospectively analyzed 278 women treated with NAC at a single institution between January 2010 and December 2022. On computed tomography (CT) or PET-CT, visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), skeletal muscle mass (SMM), and skeletal muscle density (SMD) were measured at the third lumbar vertebra (L3) with a semi-automated technique. Receiver operating characteristic (ROC) analysis was used to define optimal SMM cut-offs, and survival was examined by Kaplan–Meier estimation and Cox proportional-hazards regression. Results: The median follow-up was about 62 months. BMI was correlated with VAT (r = 0.449) and SAT (r = 0.482) but not with SMM (r = 0.075; p = 0.211). SMM was higher in women who attained pCR (107.4 ± 14.4 vs. 101.1 ± 16.1; p = 0.003). Derived by ROC analysis against distant metastasis—the event defining DFS—the SMM cut-off was 105 cm² (AUC = 0.725); values below it predicted poorer DFS on both univariable (HR = 4.80; p < 0.001) and multivariable testing (adjusted HR = 3.83; 95% CI 1.78–8.26; p = 0.001). The recurrence/metastasis rate was far higher among sarcopenic obese women (n = 34) than non-sarcopenic obese women (n = 56) (41.2% vs. 10.7%; log-rank p = 0.0004). With adjustment for molecular subtype, greater SMM remained an independent correlate of pCR (adjusted OR 1.26 per 10-cm² increment; 95% CI 1.04–1.53; p = 0.020). SMM was not significantly related to OS (univariable HR 1.75; p = 0.081). Sensitivity and specificity of the 105-cm² cut-off were 92.3% and 48.2%, respectively. Conclusions: In this retrospective cohort, greater pretreatment skeletal muscle area was independently linked to pathologic complete response and lower area to worse disease-free survival, while no significant link emerged with overall survival. Since BMI captures muscle mass poorly, body composition obtained from CT/PET-CT may add complementary prognostic information; nevertheless, because the design was observational and the cut-offs internally derived, these hypothesis-generating results need prospective external validation before clinical adoption.

Background and Objectives: This study aimed to evaluate and compare the early postoperative outcomes of patients who underwent pancreaticoduodenectomy (PD) with total mesopancreatic excision (TMpE) versus conventional pancreaticoduodenectomy (Co-PD) for pancreatic head ductal adenocarcinoma (PDAC). Materials and Methods: Patients who underwent PD for pancreatic head cancer between January 2021 and December 2024 in our clinic and had a pathological diagnosis of PDAC were included. Patients were stratified into two groups according to the surgical technique performed (TMpE-PD vs. Co-PD). Demographic characteristics and early postoperative clinicopathological data were compared between the groups. Results: A total of 41 patients were included: 17 (41.5%) underwent TMpE-PD and 24 (58.5%) underwent Co-PD. Demographic and clinicopathological parameters were comparable between the groups. Although not statistically significant, the TMpE-PD group demonstrated higher R0 resection rates (58.8% vs. 45.8%; p = 0.412) and greater lymph node yield (33.9 vs. 29.1; p = 0.757) compared to the Co-PD group. Overall postoperative complications were more frequent in the TMpE-PD group (82.4% vs. 63.4%; p = 0.034). A smaller pancreatic duct diameter was associated with an increased risk of postoperative complications in both groups, approaching statistical significance (p = 0.053). Multivariable logistic regression analysis revealed that the surgical technique was not an independent risk factor for postoperative complications (OR: 0.64; 95% CI: 0.14–2.83; p = 0.56). No direct correlation was found between resection margin status (R0 vs. R1) and the development of postoperative complications. Conclusions: TMpE demonstrated non-significant trends toward higher R0 resection rates and greater lymph node yield compared with conventional PD. These findings suggest possible oncological benefits without significantly increasing perioperative morbidity.

Background: The aim of this study was to evaluate the clinical utility of the monocyte distribution width (MDW) as an early diagnostic biomarker for detecting postoperative complications in pancreatic surgery patients. Complications from pancreatic surgery, particularly pancreatic fistulas, significantly reduce patient survival rates. Compared with conventional markers, changes in the MDW may be detected earlier, facilitating timely intervention and potentially improving patient outcomes. Methods: The MDW, C-reactive protein (CRP) level, and white blood cell (WBC) count were measured preoperatively and on postoperative days 1, 3, and 7. Complications—including clinically relevant pancreatic fistulas (CR-POPF) and anastomotic leaks—were classified using standardized criteria. Statistical analysis involved ROC curves and multivariate modelling to assess diagnostic accuracy and independent predictors. This retrospective analysis of a prospectively collected cohort included 82 patients who underwent elective pancreaticoduodenectomy (PD) for cancer at a single centre between May 2021 and March 2024. Results: In this cohort of 82 patients with prospective data collection and retrospective analysis who underwent PD, the MDW emerged as a significant early predictor of postoperative complications. On postoperative day 3, the MDW was independently associated with CR-POPF (AUC 0.781; OR 1.31, p = 0.044) and anastomotic leaks (ΔMDW days 0–3: OR 1.30, p = 0.015). Compared with conventional markers, the MDW demonstrated superior diagnostic performance, with ROC AUC values ranging from 0.770 to 0.818 across different complications. A day 3 cut-off value of > 23.1 showed high sensitivity (84%) and yielded positive likelihood ratios of up to 3.7. Furthermore, the MDW on day 3 was moderately to strongly correlated with subsequent inflammatory markers, such as the CRP level, on day 7 ( r = 0.468, p < 0.001). Multivariate models confirmed the independent prognostic value of the MDW for predicting overall complications, anastomotic leaks, and CR-POPF. Conclusion: Compared with the CRP level and WBC count, the MDW demonstrated superior and earlier predictive ability for detecting postoperative complications. Its elevation by day 3 provided early warning, especially for CR-POPF and leaks. As a rapid, cost-effective marker available from routine blood counts, the MDW may enhance postoperative monitoring and guide timely intervention.