INTRODUCTION:Pheochromocytoma (PHEO) arises from the chromophil cells of the adrenal medulla. Surgical resection is the primary treatment for PHEO. Our work aimed to investigate the efficacy and safety of minimally invasive surgery in patients with large PHEO. PATIENTS AND METHODS:This study included patients who were referred to our centre, General Surgery Outpatient Clinic, between January 2007 and December 2023, who were interviewed by a multidisciplinary endocrine board, who were diagnosed with PHEO by clinical and laboratory examination and who decided to undergo unilateral laparoscopic adrenalectomy. RESULTS:A total of 275 patients had laparoscopic unilateral adrenalectomy during the research period. A total of 75 patients were operated on for PHEO. The PHEO group with a tumour size <6 cm consists of 46 patients, while the PHEO group with a tumour size >6 cm consists of 29 patients. The groups showed similar complications, conversion rates and hospital stays. We used multiple regression analysis to identify the independent predictors of prolonged operation time. The tumour size 6-8 cm (odds ratio [OR], 3.214; 95% confidence interval [CI], 1.240-10.819; P < 0.021) and the tumour size ≥8 cm (OR, 6.343; 95% CI, 1.175-34.237; P < 0.031) were the significant predictors of prolonged operation time. CONCLUSION:Minimally invasive surgery can be considered the treatment of choice for <6 cm and ≥6 cm PHEO. Tumour size ≥8 cm and tumour size ≥6-8 cm for PHEO are predictive risk factors for prolonged operative time in LA.

Objective: The second consensus study on idiopathic granulomatous mastitis (IGM) aimed to establish treatment options based on the clinical classification proposed in the first consensus, standardize criteria for treatment discontinuation, and develop follow-up protocols. Method: A structured methodology, identical to the first consensus study, was employed. An 11-member working group of breast surgeons experienced in IGM from various clinics across the country was formed. The modified Delphi method was used, with a consensus threshold of 80% agreement. Results: Three voting rounds were conducted to develop the IGM treatment algorithm. In Round 1, observation was established as the first-line option for Type 1 disease (81%) and pregnancy/lactation cases (85%). Round 2 achieved consensus on systemic steroids (SS) as the first-line treatment for Type 3 cases (84%), combination therapies for resistant cases (82%), and reclassification of recurrent cases to guide treatment planning (94%). In Round 3, consensus was reached on the use of immunosuppressive therapy (IMT) for cases where steroids are contraindicated in Type 3 (81%), the use of IMT for resistant cases (93%), avoiding surgery as the first-line option for Type 1 cases (81%), and requiring complete clinical and radiological response before discontinuing treatment (81%). However, no consensus was reached on the first-line treatment for Type 2 disease. Conclusion: This consensus study successfully developed a treatment algorithm for IGM, prioritizing observation for Type 1 disease and cases involving pregnancy or lactation, and recommending systemic steroids (SS) and immunosuppressive therapies for Type 3 cases. The findings underscore the critical importance of achieving complete clinical and radiological remission before discontinuing treatment. However, the lack of consensus on the treatment of Type 2 disease highlights the need for further research into this challenging subtype.

ImportanceIncreasing evidence supports the oncologic safety of de-escalating axillary surgery for patients with breast cancer after neoadjuvant chemotherapy (NAC).ObjectiveTo evaluate the oncologic outcomes of de-escalating axillary surgery among patients with clinically node (cN)–positive breast cancer and patients whose disease became cN negative after NAC (ycN negative).Design, Setting, and ParticipantsIn the NEOSENTITURK MF-1803 prospective cohort registry trial, patients from 37 centers with cT1-4N1-3M0 disease treated with sentinel lymph node biopsy (SLNB) or targeted axillary dissection (TAD) alone or with ypN-negative or ypN-positive disease after NAC were recruited between February 15, 2019, and January 1, 2023, and evaluated.ExposureTreatment with SLNB or TAD after NAC.Main Outcomes and MeasuresThe primary aim of the study was axillary, locoregional, or distant recurrence rates; disease-free survival; and disease-specific survival. Number of axillary lymph nodes removed was also evaluated.ResultsA total of 976 patients (median age, 46 years [range, 21-80 years]) with cT1-4N1-3M0 disease underwent SLNB (n = 620) or TAD alone (n = 356). Most of the cohort had a mapping procedure with blue dye alone (645 [66.1%]) with (n = 177) or without (n = 468) TAD. Overall, no difference was found between patients treated with TAD and patients treated with SLNB in the median number of total lymph nodes removed (TAD, 4 [3-6] vs SLNB, 4 [3-6]; P = .09). Among patients with ypN-positive disease, those who underwent TAD were more likely to have a lower median lymph node ratio (TAD, 0.28 [IQR, 0.20-0.40] vs SLNB, 0.33 [IQR, 0.20-0.50]; P = .03). At a median follow-up of 39 months (IQR, 29-48 months), no significant difference was found in the rates of ipsilateral axillary recurrence (0.3% [1 of 356] vs 0.3% [2 of 620]; P ≥ .99) or locoregional recurrence (0.6% [2 of 356] vs 1.1% [7 of 620]; P = .50) between the TAD and SLNB groups, with an overall locoregional recurrence rate of 0.9% (9 of 976). The initial clinical tumor stage, pathologic complete response, and use of blue dye alone as a mapping procedure were not associated with the outcome. Even though patients with TAD demonstrated an increased disease-free survival rate compared with the SLNB group, this difference did not reach statistical significance (94.9% vs 92.6%; P = .07). Factors associated with decreased 5-year disease-specific survival were cN2-3 axillary stage (cN1, 98.7% vs cN2-3, 96.8%; P = .03) and nonluminal type tumor pathologic characteristics (luminal, 98.9% vs nonluminal, 96.9%; P = .007).Conclusions and RelevanceThe short-term results suggest very low rates of axillary and locoregional recurrence in a select group of patients with cN-negative disease after NAC treated with TAD alone or SLNB alone followed by regional nodal irradiation regardless of the SLNB technique or nodal pathology. Whether TAD might provide a clear survival advantage compared with SLNB remains to be proven in studies with longer follow-up.

Abstract: Background Male breast cancer is a sporadic disease and only one in every 100 new breast cancer patients is male. There are few satisfactory clinical studies on male breast cancers in the literature. We aim to share the clinicopathologic and demographic characteristics of male breast cancer patients admitted to our clinic in the last 12 years and our experience in the treatment of these patients. Methods The data of patients who were referred to our clinic with a diagnosis of breast cancer, suspicion of breast cancer, or who presented to our outpatient clinic with symptoms of breast discharge, palpable mass in the breast and were diagnosed with breast malignancy or suspicion of malignancy between 2010 and 2022 were retrospectively evaluated from the data bank records of our hospital. 28 patients were included in the study. Patients' clinical and pathologic data, treatment options, approach to the axilla, pathology results, and survival were evaluated. Results There were 28 patients in the research. 22 had mastectomies. No surgical intervention was carried out for the five patients who had metastases. One of these patients died during follow-up due to advanced comorbidities and metastatic disease. Another patient declined surgery following neoadjuvant chemotherapy and passed away during follow-up (ex). The third patient passed away during neoadjuvant chemotherapy, and two patients are still undergoing neoadjuvant treatment. Conclusion Male breast cancers are rare diseases. RT after mastectomy increases survival in male patients as well as in female patients. However, RT in male patients is not standardized today. In our study, 15 patients received adjuvant RT.

Background Male breast cancer is a sporadic disease and only 1 in every 100 new breast cancer patients is male. There are few satisfactory clinical studies on male breast cancers in the literature. We aim to share the clinicopathologic and demographic characteristics of male breast cancer patients admitted to our clinic in the past 12 years and our experience in the treatment of these patients. Methods The data of patients who were referred to our clinic with a diagnosis of breast cancer, suspicion of breast cancer, or who presented to our outpatient clinic with symptoms of breast discharge, palpable mass in the breast, and were diagnosed with breast malignancy or suspicion of malignancy between 2010 and 2022 were retrospectively evaluated from the data bank records of our hospital. A total of 28 patients were included in the study. Patients’ clinical and pathologic data, treatment options, approach to the axilla, pathology results, and survival were evaluated. Results There were 28 patients in the research; 22 had mastectomies. No surgical intervention was carried out for the 5 patients who had metastases. One of these patients died during follow-up due to advanced comorbidities and metastatic disease. Another patient declined surgery following neoadjuvant chemotherapy and passed away during follow-up (deceased). The third patient died during neoadjuvant chemotherapy, and 2 patients are still undergoing neoadjuvant treatment. Conclusions Male breast cancers are rare diseases. Radiotherapy (RT) after mastectomy increases survival in male patients as well as in female patients. However, RT in male patients is not standardized today. In our study, 15 patients received adjuvant RT.

BACKGROUND:This study aims to identify factors predicting recurrence and unfavorable prognosis in cN+ patients who have undergone sentinel lymph node biopsy (SLNB) following neoadjuvant chemotherapy (NAC). METHODS:The retrospective multi-centre "MF18-02" and the prospective multi-centre cohort registry trial "MF18-03" (NCT04250129) included patients with cT1-4N1-3M0 with SLNB+/- axillary lymph node dissection (ALND) post-NAC. RESULTS:A total of 2407 cN+ patients, who later achieved cN0 status after NAC and subsequently underwent SLNB, were studied. The majority had cT1-2 (79.1%) and N1 (80.7%). After a median follow-up time of 41 months, the rates of locoregional recurrence and axillary recurrence (AR) were 1.83% and 0.37%, respectively. No significant difference in locoregional recurrence or AR rates was observed between the SLNB/targeted axillary dissection-only (n = 1470) and ALND (n = 937) groups. Factors significantly linked with AR included age younger than 45 years, nonpathological complete response (non-pCR) in the breast, and nonluminal pathology. Locoregional recurrences were associated with nonluminal or HER2(+) pathology, non-pCR in the breast, and ALND. Poor prognostic factors for disease-free survival (DFS) included having cT3-T4, no breast pCR (non-pCR), ypN(+), and nonluminal pathology. No significant difference was found in DFS or disease-specific survival (DSS) rates among ypN0, ypN-isolated tumour cells, ypNmic, and ypN1. However, significant decreases in DFS and DSS rates were observed when comparing ypN2 or ypN3 disease with ypN0. CONCLUSIONS:The present large registry data indicate that younger patients (<45), those with nonluminal pathology, and those who only partially respond in the breast are more susceptible to axillary and locoregional recurrences.

OBJECTIVE:The role of younger age as a prognostic factor in breast cancer remains debated. Despite its association with an aggressive clinical course, there is insufficient research on its etiology. This study aimed to analyze age-related differences in breast cancer diagnosis among Turkish women. MATERIALS AND METHODS:Data from 23,594 patients in the National Breast Cancer Database (NBCD) were analyzed. The demographic, clinical, and pathological characteristics of patients aged ≤40 years were compared with those >40 years. RESULTS:The median age was 50 years (range 18-97). Among them, 4,535 patients (19%) were 40 years old or younger, with 84% of this subgroup being over 30 years old. Conversely, 19,059 patients (81%) were older than 40. Patients in the younger age group were less likely to have pathologic T1 disease (41% vs. 47%), N0 disease (49% vs. 55%), and Stage I disease (25% vs. 31%) compared to those over 40 (p<0.001). The rates of mastectomy (41% vs. 39%; p = 0.024) and axillary dissection (71% vs. 65%; p = 0.001) were higher among patients diagnosed at 40 years of age or younger. Multivariate analysis identified significant associations in younger patients, including invasive ductal carcinoma (95% CI, 1.06-1.43), estrogen receptor (ER) negativity (95% CI, 1.26-1.87), PR negativity (95% CI, 1.21-1.75), high histologic grade (95% CI, 1.43-1.87), multifocality/multicentricity (95% CI, 1.26-1.72), T3-T4 tumors (95% CI, 1.06-1.66), and axillary positivity (95% CI, 1.025-1.321). CONCLUSIONS:Breast cancer diagnosed at ≤40 years is more likely to exhibit aggressive biology, multifocality, or multicentricity presentation, and present at advanced stages. Consequently, younger patients experience higher rates of mastectomy and axillary dissection. These findings suggest a poorer prognosis, highlighting the need for more intensive therapeutic strategies in this population.

Objective: The aim of the idiopathic granulomatous mastitis (IGM) consensus study was to evaluate the etiology, diagnostic steps, and differential diagnosis and propose a widely accepted clinical classification of this mysterious breast disease. Method: The organization of a national IGM consensus was decided by the joint evaluation of the Turkish Federation of Breast Diseases Societies, SENATURK, and the Society of Breast Surgery. First, a working group of 11 members was formed, and a survey and workshop were organized to reach a common consensus. The modified Delphi method was used in the consensus methodology. Voting rates of 80% and above were considered as acceptance. Results: The consensus was 45/50 (92%) that core needle biopsies are necessary for the diagnosis of IGM and 39/40 (97%) that a new clinical classification is needed. The proposed Turkish clinical classification of IGM was accepted by 94% in three rounds of voting. Conclusion: This disease should be considered etiologically idiopathic. Tissue diagnosis and pathological evaluation are recommended for treatment. The proposed IGM Turkey classification was strongly accepted.

Abstract Background: Previous prospective studies reported decreased false negative rates in patients presenting with T1-3/cN1 disease, with the removal of 2 or more sentinel lymph nodes (SLNs), using combined technique for SLN biopsy (SLNB), and by targeted axillary dissection (TAD) in initially clinically node-positive patients after neoadjuvant chemotherapy (NAC). The aim of this prospective study is to compare the feasibility and the oncological safety of TAD with SLNB in patients with cN-positive/ycN0 breast cancer following NAC in a prospective study. Methods: This study included patients with a cT1-4N1-3M0 disease from the prospective multicenter MF1803 NEOSENTITURK registry study who were treated either SLNB- or TAD-alone without ALND. TAD included removing the biopsy-proven positive LN marked mostly with a clip as SLN or non-SLN. All patients had nodal and regional irradiation. Results: Between 2019 to 2021, 976 patients with cT1-4N1-3M0 disease from 37 centers underwent either SLNB-alone (n=620) or TAD-alone (n=356). Patients with TAD (median age: 46, range: 24-76) and SLNB (median age:46, range: 21-80) have shown a similar age distribution. The median number (range, 25%-75%) of SLNs and total LNs and total metastatic LNs removed were 3 (2-4), 4(3-6), and 1 (1-2), respectively. Patients with TAD were more likely to have cT1-2 disease (91.9% vs 78.7%, p< 0.001), cN1 disease (85.7% vs 78.5%, p< 0.006), a breast conservative surgery (66.0% vs 51.3%, p< 0.001), the combined technique for mapping (44.1% vs 22.3%, p< 0.0001), and a decreased median (IQR) lymph node ratio as calculated by the total positive lymph node number to the total lymph node number (0.29:0.20-0.40 vs 0.33: 0.20-0.50; p=0.033). Of note, there was a trend for the decreased non-sentinel lymph node positivity in the TAD-group compared to the SLNB-group that did not reach the statistical significance (TAD: 10% vs SLNB: 19%, p=0.07). However, no significant difference could be found in pathological characteristics including tumor type, breast pCR, non-luminal disease such as HER2-positivity or triple negative disease or presence of low volume metastatic disease (ITC or micrometastasis), and extracapsular extension (Table 1). Of note, patients with ypN-positive disease (n=351) were more likely to have SLNs (ypN+, 3.7±1.7 vs ypN0, 3.4±1.7, p=0.008) or total LNs (ypN+, 4.7±1.9 vs ypN0, 3.4±1.9, p=0.001) removed compared to those with ypN0 (n=635). Among those with ypN0 disease, patients with TAD were more likely to have LNs removed compared to those with SLNB (TAD, 4.2±1.9 vs 3.9±1.9, p=0.034) (Table 2). Of those with ypN+, patients with TAD were more likely to have SLNs compared to those with SLNB (TAD, 3.9±1.7 vs 3.5±1.7, p=0.062), whereas patients with SLNB were more likely to have non-SLNs removed compared to those with TAD (TAD, 2.3±1.4 vs 2.9±1.5, p=0.028). At a mean follow-up of 28.8 months (±12.1), the ipsilateral axillary and locoregional recurrence rates were 0.2% (n=2) and 0.4% (n=4) in the TAD-group and SLNB_group, respectively. Of note, no significant difference could be found in ipsilateral axillary, locoregional, and systemic recurrences between cohorts treated with TAD-alone vs SLNB-alone (Table 3). Conclusion: Our findings suggest that TAD might be more feasible in ypN+ patients which resulted in a decreased lymph node ratio and decreased non-SLN positivity. In ypN0 patients, TAD may contrary cause unnecessary lymph node removal that might be important in arm function and lymphedema development. Furthermore, our findings with short-term follow-up indicate that axillary and locoregional recurrences were observed at very low rates in a selected group of ycN0 patients treated with SLN- or TAD without ALND. Therefore, omission of ALND could be safely considered for patients with limited nodal involvement ( <2 LNs) as long as <3 LNs removed and nodal radiotherapy provided. Table 1. Clinicopathologic Characteristics According to the Axillary Surgery: Targeted Axillary Dissection (=TAD) versus Sentinel Lymph Node Biopsy (=SLNB) Table 2. Clinicopathologic Characteristics According to the Pathological Nodal Status Table 3. Locoregional and systemic recurrences in cT1-4N1-3 patients treated with Targeted Axillary Dissection (=TAD) or Sentinel Lymph Node Biopsy (=SLNB) (Nf976) Citation Format: Neslihan Cabıoğlu, Hasan Karanlik, Mehmet Ali Gulcelik, Havva Belma Kocer, Mahmut Muslumanoglu, Abdullah İgci, Mustafa Tukenmez, Cihan Uras, Enver Ozkurt, Gokhan Giray Akgul, Selman Emiroglu, Süleyman Bademler, Ahmet Dağ, Didem Can Trabulus, Nilufer Yıldirim, Guldeniz Karadeniz Cakmak, Ebru Sen Oran, Halil Kara, Gul Basaran, Ayse Altinok, M. Umit Ugurlu, Kazim Senol, Baha Zengel, Niyazi Karaman, Ecenur Varol, Ece Dilege, Yasemin Bolukbasi, Alper Akcan, Yeliz Emine Ersoy, Aykut Soyder, Serdar Ozbas, Mehmet Velidedeoglu, Beyza Ozcinar, N. Zafer Utkan, Bulent Citgez, Burak Celik, Leyla Zer, Gurhan Sakman, Levent Yeniay, Lutfi Dogan, Mutlu Dogan, Fazilet Erozgen, BERK GOKTEPE, Orhan Agcaoglu, Taner Kivilcim, Fatih Levent Balci, Bahadir M. Gulluoglu, Ayfer Kamali Polat, Kamuran Ibis, Vahit Ozmen. Feasibility and oncological safety of targeted axillary dissection or sentinel lymph node biopsy in patients with clinically node-positive disease after neoadjuvant chemotherapy in the prospective MF-1803 NEOSENTITURK-study [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PS01-01.

Purpose: The aim of this study is to investigate the effect of obesity on the results of laparoscopic adrenal surgery in patients with Cushing syndrome. Methods: This retrospective study was performed in Department of General Surgery at Erciyes University School of Medicine between January 2010 and January 2023. Our analysis included Cushing syndrome patients who underwent unilateral laparoscopic adrenalectomy (LA) with the transabdominal lateral approach. All patients were evaluated in terms of age, sex, tumor diameter, body mass index (BMI), American Society of Anesthesiologists physical status classification, morbidities, surgery history, tumor side, operative time, conversion to open surgery, complications, and length of hospital stay. Results: A total of 90 patients (75 females and 15 males) underwent a transperitoneal LA. Patients were divided into 2 groups according to their BMI: obese group (>= 30 kg/m(2); n = 53, 58.8%) and nonobese group (<30 kg/m(2); n = 37, 41.2%). All patients were classified into 3 subgroups: obese patient group, BMI >= 30-39 kg/m(2) (n = 23); morbidly obese patient group, BMI >= 40 kg/m(2) (n = 14); and nonobese patient group, BMI < 30 kg/m(2) (n = 53). There was no significant difference in intraoperative complications, conversion to open surgery, operative time, or length of hospital stay between the groups. Only conversion to open surgery was a risk factor for postoperative complications in univariate and multivariate analyses (odds ratio, 15.4; 95% confidence interval, 1.277-185.599; P = 0.031). Conclusion: Our results showed that LA is safe and effective in patients with Cushing syndrome with morbid obesity, allowing acceptable morbidity and length of hospital stay.

Background: Idiopathic granulomatous mastitis (IGM) is an uncommon, benign, chronic inflammatory breast disease. There are several hypotheses about the etiology of IGM. The interaction between growth arrest-specific protein 6 (Gas6)/Tyro, AXL, and Mer (TAM) affects the regulation of innate immune reactions and promotes the induction of phagocytosis and a reduction in proinflammatory cytokine expression. We analyzed the potential implications of the Gas6/sAXL signaling pathway, which is essential for the inflammatory response to the pathophysiology of IGM, the cause of which is yet unknown. Methods: This study included 37 patients. Nineteen of these patients achieved a complete response solely through medical treatment (Group R), while the remaining 18 comprised individuals who, following medical treatment, did not achieve a complete response and necessitated supplementary surgery (Group NR). Logistic regression analysis was used to define predictive factors. The optimal cutoff values of the predictive prognostic factors for resistance to treatment were identified using receiver operating characteristic (ROC) curve analysis. Results: No significant differences were detected between the two groups in terms of lesion size, age, parity, attack frequency, white blood cell count, presence of accompanying axillary lymphadenopathy (LAP), or smoking history (p>0.05). Significant differences were detected in terms of Gas6, sAXL, and the presence of accompanying abscess (p<0.05). Conclusions: Decreased Gas6 and sAXL levels can be explained by two mechanisms. Inflammation may have developed due to Gas6 deficiency. The finding that low Gas6 levels are an independent risk factor for IGM treatment resistance will be a new method for treating this disease.

BackgroundThe omission of axillary lymph node dissection (ALND) remains controversial for patients with residual axillary disease after neoadjuvant chemotherapy (NAC), regardless of the residual burden. This study evaluated the oncologic safety and factors associated with outcomes in patients with residual axillary disease. These patients were treated solely with sentinel lymph node biopsy (SLNB) or targeted axillary dissection (TAD), without ALND, after NAC.MethodsA joint analysis of two different multicenter cohorts-the retrospective cohort registry MF18-02 and the prospective observational cohort registry MF18-03 (NCT04250129)-was conducted between January 2004 and August 2022. All patients received regional nodal irradiation.ResultsFive hundred and one patients with cT1-4, N1-3M0 disease who achieved a complete clinical response to NAC underwent either SLNB alone (n = 353) or TAD alone (n = 148). At a median follow-up of 42 months, axillary and locoregional recurrence rates were 0.4% (n = 2) and 0.8% (n = 4). No significant difference was found in disease-free survival (DFS) and disease-specific survival (DSS) rates between patients undergoing TAD alone versus SLNB alone, those with breast positive versus negative pathologic complete response, SLN methodology, total metastatic LN of one versus >= 2, or metastasis types as isolated tumor cells with micrometastases versus macrometastases. In the multivariate analysis, patients with nonluminal pathology were more likely to have a worse DFS and DSS, respectively, without an increased axillary recurrence.ConclusionsThe omission of ALND can be safely considered for patients who achieve a complete clinical response after NAC, even if residual disease is detected by pathologic examination. Provided that adjuvant radiotherapy is administered, neither the SLNB method nor the number of excised LNs significantly affects oncologic outcomes.

Background: The present study aimed to evaluate the safety and efficacy of transperitoneal laparoscopic adrenalectomy (LA) for large adrenal tumours by comparing the outcomes of tumours larger than 6 cm with those smaller than 6 cm and also to identify the risk factors associated with prolonged operative time in transperitoneal LA. Patients and Methods: One hundred and sixty-three patients underwent LA at our clinic from January 2014 to December 2020. Bilateral LA was performed in 20 of these 163 patients. A total of 143 patients were included in this study. Data were analysed retrospectively from the patients’ medical records collected. Results: Large tumour (LT) group consists of 33 patients and the small tumour (ST) group consists of 110 patients. There was no statistically significant difference between the groups regarding conversion to open surgery and complications. A multiple regression analysis was conducted to identify the independent predictors of prolonged operation time. The tumour size ≥8 cm (odds ratio [OR], 19.132; 95% confidence interval [CI], 3.881–94.303; P < 0.001) and diagnosis of pheochromocytoma (OR, 2.762; 95% CI, (1.123–6.789, P = 0.026) were the significant predictors of prolonged operation time. Conclusion: Our study shows that LA can be considered the treatment of choice for small and large adrenal tumours. The tumour size ≥8 cm and diagnosis of pheochromocytoma are the independent risk factors for the prolonged operative time in transperitoneal LA.

Background: Laparoscopic adrenalectomy (LA) is a widely accepted method for most adrenal lesions. However, bilateral LA is performed less often than unilateral adrenalectomy. The most common indication for bilateral LA is adrenocorticotropin hormone (ACTH)dependent Cushing's syndrome, including persistent Cushing's disease following unsuccessful transsphenoidal surgery and ectopic ACTH syndrome. Objectives: This retrospective study was conducted to assess the indications, safety, efficacy, and outcomes for bilateral LA with the transabdominal lateral approach. Methods: This retrospective study was conducted between January 2004 and February 2022. During the study period, transperitoneal LA was performed on 279 patients, among whom, 258 cases were unilateral LA. Therefore, our analysis included 21 consecutive patients who underwent laparoscopic bilateral LA with the transabdominal lateral approach. The surgery indication, tumor side and weight, operation time, conversion to open surgery, need for an additional trocar, complications, hospital stay, and follow-up information were analyzed. Results: Indications of bilateral LA were refractory Cushing's disease (n=14), occult ectopic primary bilateral macronodular adrenal hyperplasia (n=5), ACTH secretion (n=1), and bilateral pheochromocytoma (n=1). The mean operative time was 207.8 +/- 21.3 min, including repositioning time. Intraoperative and postoperative complications were seen in 3 (14%) and 4 (19%) patients, respectively. No conversion to open surgery was observed. Median hospital stay was 7 (range, 5-10) days and median follow-up was 81 (range, 55-94.5) months. Three patients died at 62, 64, and 88 months after adrenalectomy due to heart failure, renal failure, and myocardial infarction, respectively. No adrenal insufficiency or signs of recurrent hypercortisolism was observed. Conclusion: Our results demonstrated that laparoscopic bilateral LA was safe and effective, allowing acceptable morbidity and hospital stay. The most common surgical indication was ACTH-dependent Cushing's syndrome, followed by ACTH-independent Cushing's syndrome. The lateral transperitoneal approach obtains an excellent anatomical view. In our series, operative time and conversion to open surgery rate were in line with the literature.

Background: Whether axillary lymph node dissection (ALND) following sentinel lymph node biopsy (SLNB) could be spared in patients with initially clinically positive axilla after neoadjuvant chemotherapy (NAC) is still controversial even though recent studies indicate that axillary recurrence seems to be a rare event. Our aim is to find out whether omitting ALND could be oncologically safe in patients undergoing SLNB after NAC. Material and Methods: Of patients presented with c T1-4N1-3M0 disease, those undergoing SLNB after NAC were included in the prospective multicentre registry trial " MF18-03/BHWG" (ClinicalTrials.gov/NCT04250129). Cases with inflammatory breast cancer, distant metastases, pregnancy, bilateral breast cancer, or other cancers and those without adjuvant nodal radiotherapy were excluded from the study. The end points of the present report are the axillary nodal recurrence (AR) and locoregional recurrence (LRR) rates at a median follow-up more than 2 years, and determine factors associated with AR and LRR . The locoregional recurrences included ipsilateral, and contralateral axillary recurrences, infra-and supraclavicular recurrences, and recurrences in the mammaria interna region. Results: Between January 2018 to January 2021, 2358 patients with cN(+) disease, who became cN0 after NAC, and underwent SLNB, were analyzed. Median age was 47 (range, 21-86). Of those, the majority of patients had cT1-2 (80.5%) and N1 (80.3%) disease. Following NAC, half of the patients (50%) had breast conserving surgery, whereas the remaining half had mastectomy (50%). Of 2358 patients, 908 (38.5%) had ALND following SLN (ypN+, 85%) and 1450 (61.5%) underwent SLNB alone (ypN0, 72%). SLNB was performed by using the blue dye technique-alone in 66.6% of patients and by targeted axillary dissection in 659 patients (27.9%). Of those, 819 (34.8%) were HER2(+) and 373 (15.8%) were triple negative. The pCR rates for the axilla, breast and both for the axilla and breast were 50%, 35% and 28%, respectively. At a median follow-up time of 28 months (range, 12-62), the LRR, AR and isolated AR rates were 0.6% (n=14), 0.25% (n=6) and 0.13% (n=3), respectively. Furthermore, no significant difference could be found in LRR- and AR- rates between SLNB-alone and ALND groups regardless of the definitive nodal pathology (Table 1). Nodal recurrences were seen at a median of 12 months after the surgery. Of 6 cases with AR, 3 had synchronous local recurrences in breast, and 2 of them also had lung metastases in addition to local recurrence. All patients with AR were interestingly found to have HER2(+) or triple negative breast cancer at the initial diagnosis, and had residual invasive cancer in the breast surgical specimen. Logistic regression analyses revealed that patients with AR were significantly more likely to be younger than 45 (RR=7.81 ; 95% CI, 0.91-66.91) and have a cN2-3 (RR=4.1; 95% CI, 0.83-20.38), and non-luminal breast cancer (RR=12.47; 95% CI, 1.45-106.9) at the initial diagnosis (Table 2). Similarly, patients with LRR were more likely to present with cN2-3 disease (RR=3.09; 95% CI, 1.07-8.94) and non-luminal pathology (RR=6.27; 95%CI, 1.96-20.06) . Conclusion: This large prospective registry data also suggest that nodal recurrences can be detected at very low rates within 3 years after surgery in patients with clinically node-positive disease following NAC regardless of the extent of axillary surgery or nodal pathology as long as regional nodal radiation is provided. Since patients with early nodal recurrences have an agressive tumor biology with a potential of systemic recurrences, effective adjuvant systemic therapies should be considered in those with HER2(+) or triple negative residual breast cancer after surgery following adjuvant nodal radiation. Table 1. Local locoregoinal and systemic recurrences in cT1-4N1-3 patients with ypN0/ypN(+) diseases (n =2358) Table 2. Factors associated with axillary and locoregoinal recurrences (AR = axillary recurrences, LRR = locoregoinal recurrences, pCR = pathologic complete response) Citation Format: Neslihan Cabıoğlu, Hasan Karanlik, Mehmet Ali Gulcelik, Abdullah İgci, Mahmut Muslumanoglu, Havva Belma Kocer, Cihan Uras, Gokhan Giray Akgul, Mustafa Tukenmez, Serkan Ilgun, Didem Can Trabulus, Guldeniz Karadeniz Cakmak, Ahmet Dağ, Nilufer Yıldirim, Baha Zengel, Ebru Sen Oran, Kazim Senol, Halil Kara, Selman Emiroglu, M. Umit Ugurlu, Bulent Citgez, Yeliz Emine Ersoy, Atilla Celik, Ece Dilege, Yasemin Bolukbaşı, Niyazi Karaman, Gul Basaran, Aykut Soyder, Ayfer Kamali Polat, Gurhan Sakman, Serdar Ozbas, Ayse Altınok, Leyla Zer, Alper Akcan, Ibrahim Ali Ozemir, Levent Yeniay, N. Zafer Utkan, Lutfi Dogan, Mutlu Dogan, Mehmet Velidedeoglu, Beyza Ozcinar, Fazilet Erozgen, Abut Kebudi, Kemal Atahan, Vafa Valiyeva, Serdar Yormaz, Ali Sevinc, Cumhur Arici, Atilla Soran, Vahit Ozmen. PD15-01 AXILLARY NODAL RECURRENCE IS RARE IN PATIENTS WITH NODE-POSITIVE BREAST CANCER UNDERGOING SLNB FOLLOWING NEOADJUVANT CHEMOTHERAPY : EARLY RESULTS OF THE NEOSENTITURK-TRIAL/MF-18-03 [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD15-01.

AIM We aimed to evaluate (immunohistochemically) the YAP expression in breast cancer patients undergoing neoadjuvant chemotherapy and to clarify the relationship between the molecular characteristics, treatment response and survival data and the YAP expression, and hence, to clarify the prognostic significance. MATERIAL AND METHODS One hundred and four patients who were diagnosed with Breast Cancer between 2015-2020 and underwent Neo Adjuvant Chemotherapy were included in the study. Estrogen Receptor(ER), Progesterone Receptor(PR), Human Epidermal Growth Receptor-2(HER2) and Ki-67. Expression are routinely stained immunohistochemically. In this study, existing immunohistochemical markers were reviewed and also, the relationship of YAP with these biological markers was evaluated by using immunohistochemistry and its effect on prognosis has been investigated. RESULTS The average age of the patients was 52.37. While YAP was positive in 78 patients (75%), it was negative in 26 patients (25%). In the evaluation after neoadjuvant therapy, pathological complete response (MillerPayne Grade5 response) in 28 patients (26.9%), relapse in 6 patients (5.8%), and exitus in 6 patients (5.8%) were detected. In the pathological evaluation, invasive Ductal Carcinoma was the most common one observed in 88 patients (84.6%). As a result of the statistical evaluation, no significant result was obtained between the parameters and YAP negative/positive. CONCLUSION As a result of staining with additional YAP in patients who were diagnosed with breast cancer and routinely stained with ER, PR, Cerb B2 and Ki-67 in pathology samples, we could not reach a result that would contribute positively to survival. Longer studies to be conducted prospectively will be meaningful. KEY WORDS Breast Cancer, Chemotherapy, Neoadjuvant, Yes Associated Protein.