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Artificial intelligence (AI)–based decision support systems are increasingly explored in surgical oncology. However, their concordance with multidisciplinary tumor board (MTB) decisions, particularly in complex gastrointestinal malignancies, remains insufficiently characterized. This retrospective observational study included 47 patients who underwent oncological surgery and were discussed at a multidisciplinary tumor board during an eighteen-month period. For each patient, concordance between MTB-established treatment decisions and subsequent AI-generated recommendations (ChatGPT-based) was assessed. Concordance was categorized as discordant (0), partially concordant (1), or fully concordant (2). Discordant cases were further analyzed across predefined domains, including staging discrepancies, resectability assessment, interpretation of metastatic disease burden, and treatment sequencing. Full concordance was observed in 18 cases (38.3%), partial concordance in 22 cases (46.8%), and discordance in 7 cases (14.9%). Overall, 85.1% of cases demonstrated at least partial concordance. Discordance was more frequent among male patients (5 of 19; 26.3%) compared with female patients (2 of 28; 7.1%). Qualitative analysis revealed that discordance most commonly arose from differences in resectability assessment and staging interpretation. AI recommendations tended to favor broader surgical candidacy, whereas MTB decisions more frequently excluded surgery based on nuanced clinical and contextual factors. AI-generated recommendations show substantial overlap with MTB decisions in most cases but diverge at critical surgical decision points, particularly regarding resectability and staging. These findings suggest that AI may serve as a complementary decision-support tool rather than a substitute for multidisciplinary clinical judgment for oncological surgery care.

This study aimed to evaluate the predictive value of osteosarcopenia for the Peritoneal Cancer Index (PCI) and completeness of cytoreduction (CC score) in patients with peritoneal carcinomatosis. Additionally, the study investigated the impact of osteosarcopenia on major postoperative complications. A total of 80 patients who underwent cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) between January 2015 and October 2024 were retrospectively analyzed. Patients were divided into two groups based on the presence of osteosarcopenia. Demographic characteristics, PCI and CC scores, nutritional and inflammatory markers, and postoperative outcomes were compared. Major postoperative complications were defined as Clavien–Dindo grade ≥3. Independent predictors of major complications were identified using multivariable logistic regression analysis. Osteosarcopenia was detected in 22 patients (27.5%). The proportion of patients with PCI ≥5 was significantly higher in the osteosarcopenia group compared with those without osteosarcopenia (86.4% vs. 62.1%; p = 0.041). Nutritional and inflammatory markers, including PNI, CALLY and LCR, were significantly lower in patients with osteosarcopenia (p=0.031; p=0.044; p=0.019, respectively). Major postoperative complications occurred more frequently in the osteosarcopenia group (36.4% vs. 22.4%; p = 0.004). In multivariate analysis, osteosarcopenia (OR 2.45; p=0.021), PCI ≥5 (OR 3.00; p=0.018), and CC-1 cytoreduction (OR 2.00; p=0.043) emerged as independent predictors of major complications.Osteosarcopenia is associated with higher PCI values and serves as an independent risk factor for major postoperative complications. These results suggest that osteosarcopenia can be considered a useful biomarker in preoperative risk stratification and surgical decision-making for patients undergoing CRS and HIPEC.

The preoperative identification of patients who are at high risk for serious postoperative outcomes after pancreaticoduodenectomy is important for their management. Our aim was to investigate the factors affecting the serious complications after pancreaticoduodenectomy (PD). 92 patients who were operated for periampullar region tumor were retrospectively analyzed between November 2017 and July 2024. Patients were divided into two groups (patients without serious complication (woSC) and patients with serious complication (wSC)) and these groups were compared with demographic data, laboratory results, pathological findings, perioperative findings, and 30-day mortality rate. Risk factors affecting postoperative serious complications were determined. Logistic regression analyses were performed to identify the risk factors of postoperative serious complication. Twenty-four (26%) patients developed serious complications after PD. The albumin levels were significantly lower in the wSC group compared with the woSC group (p=0.035). The albumin was found to be an independent factor in multivariate analysis. Receiver operating characteristic (ROC) curve analysis showed that 37.8 g/L was the optimal cut-off value for postoperative serious complication in PD. So, lower albumin level (≤37.8 g/L) is associated with increased postoperative serious complications in PD for periampullar cancer.

Hyperthermic intraperitoneal chemotherapy (HIPEC) combined with cytoreductive surgery (CRS) has become an increasingly preferred treatment for women with ovarian cancer presenting with peritoneal involvement. However, due to the high morbidity of HIPEC, accurate preoperative patient selection is essential. This study aimed to evaluate the prognostic value of immunonutritional indices—CALLY (C-reactive protein, albumin, lymphocyte) and Prognostic Nutritional Index (PNI)—in predicting early mortality and recurrence in patients undergoing CRS and HIPEC. A retrospective analysis was conducted on 49 female patients. Low CALLY (

Paraganglioma, genellikle retroperitoneal yerleşimli ve kromaffin hücrelerden köken alan nadir bir nöroendokrin tümördür. Feokromositoma gibi katekolamin salgılayarak kardiyovasküler sistem üzerinde ciddi etkiler oluşturabilir. Özellikle cerrahi girişim, travma veya anestezi gibi stres faktörleri, ani ve yoğun katekolamin salınımını tetikleyerek feokromositoma krizine yol açabilir. Bu klinik tablo, kardiyovasküler instabiliteye ek olarak nadir ancak ciddi bir komplikasyon olan akut respiratuvar distres sendromu (ARDS) ile birlikte seyredebilir. ARDS, alveol-kapiller bariyerin bozulması sonucu gelişen yaygın pulmoner ödemle karakterize olup, zamanında müdahale edilmediğinde mortal seyredebilir. Bu olgu sunumunda, paraganglioma nedeniyle opere edilen ve postoperatif dönemde feokromositoma krizine sekonder olarak ARDS gelişen nadir bir vaka sunulmuştur. 53 yaşındaki kadın hasta, mevcut hipertansiyon, diyabetes mellitus ve pankreatit öyküsüne ek olarak ani gelişen hipertansif ataklar nedeniyle ileri tetkiklerle değerlendirilmiş ve retroperitoneal yerleşimli paraganglioma tanısı almıştır. Preoperatif dönemde uygulanan alfa ve beta bloker tedaviye rağmen cerrahi sonrası erken dönemde hemodinamik instabilite ve hipoksemik solunum yetmezliği gelişmiş; toraks bilgisayarlı tomografi (BT) ile ARDS tanısı doğrulanmıştır. Yoğun bakım ünitesinde invaziv mekanik ventilasyon desteğiyle takip edilen hasta, klinik iyileşme sonrası ekstübe edilerek şifa ile taburcu edilmiştir. Sonuç olarak, paraganglioma cerrahisi öncesinde feokromositoma krizi ve ARDS gibi hayatı tehdit eden komplikasyonların öngörülmesi büyük önem taşımaktadır. Tanı ve tedavi sürecinde multidisipliner yaklaşımın etkinliği kritik rol oynamaktadır.

Purpose: Intestinal ischemia in strangulated abdominal wall hernias is a life-threatening condition that requires early detection and timely intervention. Since both systemic inflammation and nutritional status play a crucial role in surgical outcomes, identifying reliable predictive markers is essential. This study explores the potential of albumin-based nutritional indices—the CALLY Index, Prognostic Nutritional Index (PNI), and modified Glasgow Prognostic Score (mGPS)—to assess their ability to predict the risk of intestinal ischemia and the need for surgical resection. Methods: We retrospectively analyzed 125 patients who underwent surgery for incarcerated abdominal hernias between January 2015 and August 2024. Patients were categorized based on whether they had intestinal or omental ischemia. Key demographic data, perioperative findings, and laboratory parameters—including CRP, albumin, lymphocyte count, PNI, CALLY, and mGPS—were recorded. We performed univariate and multivariate regression analyses to identify independent risk factors, while ROC analysis was used to determine the optimal cutoff value for the CALLY Index. Results: Out of 125 patients, 66 (52.8%) were female, and the median age was 67 (58–76) years. Intestinal ischemia was found in 73 (58.4%) of the patients, while 23 (18.4%) had only omental necrosis. In the multivariate regression analysis, GPS 2 (OR: 19.299, p = 0.015) and CALLY < 2.5 (OR: 5.397, p = 0.017) were identified as independent predictors of intestinal ischemia. ROC analysis showed that a CALLY value below 2.5 had strong predictive power (AUC: 0.828, 95% CI: 0.753–0.902, p < 0.001). Conclusion: Our findings suggest that the CALLY Index and mGPS are valuable tools for predicting intestinal ischemia in strangulated abdominal hernias. By incorporating inflammatory and nutritional markers into risk assessment, these indices can assist in early diagnosis and timely surgical decision-making.

Purpose: The aim of the study is to demonstrate the prognostic impact of preoperative nutritional status indicators, including prognostic nutritional index (PNI), hemoglobin-albumin-lymphocyte-platelet (HALP) score, sarcopenia index (SI), and bone mineral density (BMD) values, on postoperative complications and survival in patients with resectable pancreatic cancer (PC). Materials and methods: The medical data and computed tomography (CT) images of 85 patients who undergone surgery for PC between January 2017 and 2023 were evaluated retrospectively. Patients were grouped according to the presence or absence of sarcopenia and osteoporosis, high and low PNI and HALP scores. The groups were compared in terms of the complication development rate, 30- and 90-day mortality, and 5-years overall survival (OS). Sarcopenia and osteoporosis were determined from CT images (sarcopenia index used for sarcopenia, bone mineral density for osteoporosis). Results: Except from OS (p < 0.0001), no differences were found between sarcopenic and non-sarcopenic groups in terms of postoperative complications, 30- and 90-day mortality (p = 0.775, p = 0.704, p = 0.196, respectively). There were no differences between the groups with and without osteoporosis in terms of the presence of postoperative complications, 30- and 90-day mortality, and OS (p = 0.770, p = 0.608, p = 0.196, p = 0.09, respectively) as low and high HALP score groups (p = 0.236, p = 0.696, p = 0.299, p = 0.45, respectively). Except from a 30-day mortality (p = 0.03), no differences were found between low and high PNI groups in terms of postoperative complications, 90-day mortality, and OS (p = 0.82, p = 0.09, p = 0.18, respectively). Conclusion: PNI may be used as prognostic data for early postoperative mortality, while sarcopenia may be indicative of 5-year OS in patients with resectable PC. Our results suggest that providing nutritional support may potentially improve prognosis. Future studies, in which other factors effective in prognosis are evaluated together with nutritional status, will show more information on this subject.

Aim: Fournier gangrene disease (FGD) is a condition that requires emergent surgery due to its high risk of mortality. The use of biomarkers to predict outcomes after surgery for patients with FGD may be critical, as they assist in tailoring treatment approaches to individual needs. Our aim in our study is to investigate the presence of simple and easily accessible biochemical markers that can be used to predict early mortality.Methods: The medical records of 100 patients diagnosed with FGD at our hospital between January 2015 and December 2023 were retrospectively reviewed. Clinical and laboratory variables were assessed, and predictive factors for mortality were analyzed using multivariate logistic regression.Results: Demographics and perioperative clinical data of the whole study group, and subgroups according to the mortality status are evaluated. CRP was found to be independent predictor for 30‐day mortality in FGD. In ROC curve analysis provided a cutoff value of 121.3 mg/L for CRP which was significantly associated with 30‐day mortality for FGD.Conclusion: Preoperative CRP ≥ 121.3 mg/L value could be predict 30‐day mortality in patients diagnosed with FGD.

Backround/AimKnowing the adenoma volume in patients with primary hyperparathyroidism (PHPT) is useful for surgeons during parathyroidectomy. The primary aim of our study was to determine how to calculate adenoma volume with the greatest accuracy. Our secondary aim was to determine the relationship between adenoma volume and preoperative biochemical parameters (parathyroid hormone [PTH] and calcium levels).Material and MethodsWe prospectively collected the medical history of 75 patients who underwent surgery for a single parathyroid adenoma. After excision, the adenomas were placed in water-filled syringes and the actual volume was determined according to the amount of water displaced. The radiological volume of the adenomas was calculated using the ellipsoid body formula according to the ultrasonographic dimensions. The parathyroid hormone and calcium levels of the patients were obtained from their hospital records.ResultsThe calculated radiological volumes correlated with the actual adenoma volumes, but there were significant differences between the two measurements. A new formula was conducted based on actual volumes and radiological volumes. A positive correlation was found between the adenoma volumes and the preoperative PTH and calcium levels.ConclusionAdenoma volume calculated using a mathematical formula with ultrasound does not accurately reflect the actual volume. The higher a patient’s preoperative calcium and PTH levels, the larger that patient’s adenoma will be.