Bülent Aksel

Background/Objectives: Acute kidney injury (AKI) is a frequent complication following cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC). The association between preoperative inflammatory and immune-nutritional indices and postoperative AKI after CRS-HIPEC remains unclear. We aimed to investigate whether these prespecified candidate preoperative markers are associated with postoperative AKI in patients undergoing CRS-HIPEC. Methods: This retrospective single-center study included 87 patients who underwent CRS-HIPEC between October 2022 and April 2025. All received intraoperative cisplatin and mitomycin C. AKI was defined according to Kidney Disease: Improving Global Outcomes serum creatinine criteria. Preoperative neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, systemic immune-inflammation index, pan-immune-inflammation value, systemic inflammation response index, and C-reactive protein–albumin–lymphocyte (CALLY) index were calculated from routine laboratory parameters. Each candidate marker was evaluated in a separate model adjusted for age and sex, and then in a second model additionally adjusted for baseline estimated glomerular filtration rate. Discriminatory performance was assessed using receiver operating characteristic analysis. The CALLY index was calculated using albumin in g/dL, lymphocyte count in ×10⁹/L, and C-reactive protein in mg/L. Results: AKI developed in 24 patients (27.6%). In-hospital mortality was higher in patients with AKI than in those without AKI (25.0% vs. 1.6%; p = 0.002). A higher log10-transformed CALLY index remained associated with lower odds of AKI after adjustment for age and sex (adjusted OR, 0.276; 95% CI, 0.113–0.673; p = 0.005). The CALLY index had the numerically highest AUC among the evaluated indices, with moderate discriminatory performance (AUC, 0.708; 95% CI, 0.579–0.836). A data-derived exploratory cutoff of ≤1.640 yielded 79.2% sensitivity and 63.5% specificity. Conclusions: In this selected retrospective cohort of patients without established chronic kidney disease, a lower preoperative CALLY index was associated with postoperative AKI and showed moderate discrimination as an individual marker. The data-derived threshold should be considered exploratory and requires independent validation before clinical application.

Background: Axillary surgical management in breast cancer has recently shifted toward less invasive approaches. Although sentinel lymph node biopsy (SLNB) remains the standard method for axillary staging in clinically node-negative patients, the necessity of performing intraoperative frozen section (IFS) in those undergoing up-front mastectomy continues to be a matter of debate. Method: In this retrospective study, we evaluated 47 women aged 18 years or older who were diagnosed with hormone receptor–positive, HER2-negative cT1–3 breast cancer patients and underwent upfront mastectomy combined with SLNB between October 2022 – January 2026. Our analyses excluded patients who received neoadjuvant therapy, underwent breast-conserving surgery, or demonstrated clinical or radiological evidence of nodal involvement. SLNB was performed using a dual-agent technique. In line with institutional routine practice, SLNB were assessed on paraffin-embedded permanent sections rather than IFS analysis. We analyzed treatment processes together with clinical and pathological variables. Results: Among 47 patients, 39 (83%) were node-negative, while 8 (17%) were node-positive. There were no significant differences between the groups by age, tumor size, histopathologic subtype. Lymphovascular invasion and extracapsular extension were significantly more prevalent in SLNB-positive patients (p = 0.021). None of the node-positive patients underwent axillary dissection; instead, a multidisciplinary tumor board decision was to maintain treatment with axillary radiotherapy. The absence of IFS analysis neither altered therapeutic planning nor necessitated any additional surgical intervention. There were no regional recurrences after a median follow-up of 27 months. Conclusion: In this retrospective cohort of clinically node-negative, hormone receptor–positive, HER2-negative cT1–3 breast cancer patients undergoing upfront mastectomy, omission of intraoperative frozen section (IFS) analysis was not associated with early regional recurrence during the observed follow-up. Routine IFS would likely have altered immediate surgical management in only a small minority of patients in this selected population, suggesting limited clinical utility in similar low-risk cohorts.