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: Computed tomography (CT)-defined skeletal muscle mass, nutritional status, and anemia are widely proposed markers of perioperative vulnerability before gastrectomy, but published estimates are heterogeneous and derive largely from East Asian, upfront-surgery cohorts. It is unclear how frequently these abnormalities occur in a predominantly neoadjuvant-treated cohort, and how precisely a single-center series can relate them to severe early morbidity. Materials and Methods: This retrospective, single-center observational cohort included 107 consecutive patients who underwent gastrectomy for histologically confirmed gastric carcinoma. The outcome was an in-hospital Clavien–Dindo grade ≥III complication. Exposure prevalence is reported with Wilson 95% confidence intervals (CIs). Exploratory unadjusted logistic regression was used to estimate odds ratios (ORs), and Firth bias-reduced logistic regression was used as a sparse-event sensitivity analysis. Sensitivity analysis applied gastric-cancer-specific muscle thresholds and excluded completion gastrectomies. Results: CT-defined low skeletal muscle mass, low Prognostic Nutritional Index (PNI < 46), and anemia were present in 67 (62.6%; 95% CI 53.2–71.2), 45 (42.1%; 33.1–51.5), and 71 (66.4%; 57.0–74.6) patients, respectively. Fifteen patients (14.0%; 95% CI 8.7–21.8) had major complications, of whom 14 (93.3%) had undergone open surgery. All estimates were unadjusted and imprecise, with confidence intervals spanning potentially clinically important associations in both directions: low skeletal muscle mass (OR 1.23, 95% CI 0.39–3.89), SMI per 5-cm²/m² decrease (OR 1.20, 0.88–1.65), PNI per 5-unit decrease (OR 1.18, 0.80–1.75), low PNI (OR 1.24, 0.42–3.72), and anemia (OR 1.02, 0.32–3.23). Firth penalized estimates were materially similar to the conventional estimates. Substituting gastric-cancer-specific muscle thresholds lowered the prevalence of low muscle mass from 62.6% to 21.5% without resolving the estimate (OR 1.40, 0.40–4.88). Excluding the 20 completion gastrectomies (87 patients, 11 events) moved the low-muscle-mass estimate below unity (OR 0.74, 0.21–2.65) without improving precision. Conclusions: These abnormalities were highly prevalent, but with only 15 events, the confidence intervals did not exclude clinically important associations in either direction. The concentration of major events among patients undergoing open surgery underscores the potential influence of operative case mix and residual confounding. The results support neither causal nor independent-effect inference whether assessment of these parameters adds to perioperative risk stratification remains a hypothesis to be tested in larger, multicenter, well-characterized cohorts.

Background and Objectives: Post-amputation flap necrosis in diabetic foot patients is associated with a high risk of reamputation, level-up amputation, and limb loss. Intralesional epidermal growth factor (iEGF) has been shown to promote wound healing in diabetic foot ulcers; however, its role in the management of post-amputation tissue defects and flap necrosis remains unclear. This study aimed to evaluate the association between iEGF use and clinical outcomes in diabetic foot patients with post-amputation flap necrosis and to characterize longitudinal changes in wound macrophage-associated cell populations. Materials and Methods: This single-center observational cohort study, with retrospective identification of eligible patients and longitudinal follow-up, included 164 diabetic foot patients who developed flap necrosis, wound-healing disorders, or tissue defects following transmetatarsal, Lisfranc, Chopart, or below-knee amputations. Eighty-four patients received an iEGF-containing multidisciplinary limb-salvage strategy, while 80 patients received a multidisciplinary limb-salvage strategy without iEGF. The primary endpoint was treatment success, defined as preservation of the original amputation level without reamputation or proximal level-up amputation, together with satisfactory wound healing at the last available clinical follow-up. Secondary endpoints included mortality during follow-up and, in a flow cytometry sub-study of 12 iEGF-treated patients with available paired wound samples, changes in CD38⁺ and CD209⁺ cell proportions within the CD45⁺CD14⁺ macrophage-enriched population in paired wound-tissue samples. Results: Overall treatment success was 68.3% (112/164), and the observed crude cumulative mortality proportion was 21.3% (35/164). Treatment success was higher in the iEGF group than in the control group (95.2% [80/84] vs. 40.0% [32/80], p < 0.001), whereas the observed crude cumulative mortality proportion was lower (2.4% [2/84] vs. 41.3% [33/80], p < 0.001). In the flow-cytometry sub-study (n = 12), CD38⁺ cell proportions within the CD45⁺CD14⁺ macrophage-enriched population increased from 10.8% to 20.3%, whereas CD209⁺ cell proportions increased from 14.5% to 25.7% in paired samples collected before and after the iEGF treatment cycle (both p < 0.001). Conclusions: In this observational cohort of high-risk diabetic foot patients with post-amputation flap necrosis, wound-healing disorders, or tissue defects, iEGF administered as part of a multidisciplinary limb-salvage strategy was associated with higher treatment success, while a lower crude cumulative mortality proportion was also observed in the iEGF group. The mortality difference represents a crude cumulative comparison and should not be interpreted as evidence of a time-adjusted or treatment-associated survival benefit. Given the non-randomized treatment allocation, differences in vascular management and adjunctive therapies, and the potential for residual confounding, these findings should be interpreted as associative rather than causal. The paired tissue substudy demonstrated pre–post changes in CD38+ and CD209+ cell populations; these exploratory findings do not establish macrophage polarization or a causal biological mechanism.