Jeison Carrillo-Peña

Objective: To develop a preoperative nomogram to predict axillary lymph node involvement in clinically node-negative hormone receptor-positive/HER2-negative (HR+/HER2-) breast cancer. Materials and methods: We analyzed a retrospective cohort of consecutive patients with invasive HR+/HER2- breast cancer treated at Fundación Jiménez Díaz University Hospital (Madrid, Spain) between January 2019 and June 2024. All patients underwent breast surgery with axillary staging. Preoperative clinical, imaging, and pathological variables were collected. Predictors of axillary lymph node involvement were identified using multivariable logistic regression with LASSO regularization to construct a points-based nomogram. Model discrimination was assessed by the area under the receiver operating characteristic curve (AUC) and calibration using standard metrics. Diagnostic performance was calculated across various probability thresholds. Results: Among 540 patients, 173 (32.0%) had axillary nodal disease. Independent predictors included suspicious axillary ultrasound findings (OR 16.42, 95% CI 8.93–31.92; p < 0.001), lymphovascular invasion (OR 2.61, 95% CI 1.51–4.51; p = 0.001), larger tumor size (per mm OR 1.04, 95% CI 1.02–1.06; p < 0.001), and multifocality/multicentricity (OR 1.88, 95% CI 1.01–3.47; p = 0.048). Histological grade was retained for clinical relevance. The nomogram demonstrated good discrimination (AUC 0.83, 95% CI 0.79–0.87) and calibration (E/O ratio 1.002; Brier score 0.135). Conclusion: This nomogram integrates axillary ultrasound findings with preoperative tumor characteristics to accurately estimate nodal involvement in clinically node-negative HR+/HER2- breast cancer. The tool may support individualized risk stratification and inform axillary management in the context of surgical de-escalation. External validation is required prior to clinical implementation.

Background: In recent years, the use of minimally invasive approaches in pancreatic surgery has progressively increased. One of the key components of pancreaticoduodenectomy is the creation of a pancreato-enteric anastomosis, due to the high risk of postoperative complications, particularly the development of postoperative pancreatic fistula. Among the types of anastomoses, the Blumgart technique has gained popularity due to its ease of reproducibility. Methods: In this guide, we summarize and systematize step by step how to perform a feasible, reproductible and safe robotic Blumgart pancreaticojejunostomy, providing some instructions for its successful completion. Results: Despite the heterogeneity of the published data, duct-to-mucosa Blumgart anastomosis seems to be superior in terms of clinically relevant postoperative pancreatic fistula rates compared with other types of pancreato-enteric anastomosis. The advantages of robotic surgery, such as improved precision, greater control, and enhanced visualization, make robotic Blumgart anastomosis a safe, practical, and reproducible technique in the context of robotic pancreaticoduodenectomy. Conclusions: Robotic Blumgart pancreaticojejunostomy is a safe and feasible technique for pancreato-enteric anastomosis following pancreaticoduodenectomy when surgical technique is systematized step by step.