Introduction. Sentinel lymph node biopsy (SLNB) has significantly advanced axillary staging in clinically node-negative breast cancer, offering lower morbidity compared to traditional axillary lymph node dissection (ALND). Nonetheless, precise prediction of non-sentinel lymph node (non-SLN) involvement remains essential for optimizing surgical decisions and preventing unnecessary ALND. Methods. A retrospective cohort analysis was performed on 176 patients with clinically node-negative breast cancer who underwent SLNB. Clinicopathological data were reviewed to evaluate associations between various predictive factors and non-SLN involvement. Variables analyzed included tumor size, histological grade, lymphovascular invasion (LVI), Ki-67 proliferation index, and sentinel lymph node characteristics. Results. Multivariable logistic regression identified the type of SLN metastasis (OR=21.4; 95% CI 1.7–43.6; p=0.01), the number of positive SLNs (OR=5.66; 95% CI 1.18–36.6; p=0.03), and the number of negative SLNs (OR=0.04; 95% CI 0.006–0.27; p=0.001) as independent predictors of non-SLN metastases. The predictive model demonstrated excellent discriminatory power, with an area under the receiver operating characteristic curve (AUC) of 0.91. Conclusion. Specific clinical and histopathological variables reliably predict non-SLN involvement in SLN-positive breast cancer patients. Incorporation of these predictors into clinical practice may enhance individualized axillary management and reduce unnecessary ALND procedures. Further validation through larger prospective studies is warranted. Key words: Breast Neoplasms, Sentinel Lymph Node Biopsy, Axillary Lymph Nodes, Lymph Node Dissection, Neoplasm Staging.

Background Adjuvant chemotherapy decisions in early-stage, hormone receptor-positive, HER2-negative breast cancer traditionally rely on clinicopathological features such as tumor size, grade, and lymph node status. However, multigene expression assays like MammaPrint offer additional prognostic information that may alter treatment recommendations. This study aimed to assess the level of agreement between MammaPrint-based genomic risk classification and chemotherapy recommendations derived from National Comprehensive Cancer Network (NCCN)-based clinical criteria in a cohort of Bosnia and Herzegovina breast cancer patients. Methods We retrospectively analyzed 66 patients with HR+/HER2-, node-negative early breast cancer treated between 2023 and 2024. All patients underwent MammaPrint testing, which classified tumors as either low risk or high risk for distant recurrence. Clinical risk was assessed using a simplified NCCN-guided algorithm, in which chemotherapy was recommended for tumors >2 cm and/or grade three histology. The primary outcome was the rate of concordance between genomic and clinical risk classifications. Statistical analysis included descriptive summaries, cross-tabulation, and Cohen’s kappa to evaluate agreement. Results Of the 66 patients analyzed, MammaPrint classified 27 (40.9%) as high risk and 39 (59.1%) as low risk. Based on NCCN criteria, 36 patients (54.5%) were considered clinically high-risk and recommended for chemotherapy, while 30 (45.5%) were not. Concordance between genomic and clinical classifications was observed in 37 patients (56.1%), while 29 patients (43.9%) showed discordant results. The most common discordance pattern was a clinically high-risk but genomically low-risk classification, observed in 19 cases (65.5% of discordant pairs). Cohen’s kappa for agreement between methods was 0.136, indicating slight agreement beyond chance. McNemar’s test yielded a χ² value of 10.0 (p = 0.036), suggesting significant asymmetry in discordance patterns. Conclusion This study highlights a substantial rate of discordance between MammaPrint genomic risk and NCCN-based clinical risk assessment. In our cohort, reliance on clinicopathological features alone would have led to different chemotherapy recommendations in over half of the cases. These findings support the clinical utility of multigene assays in refining adjuvant treatment decisions and reducing potential overtreatment in early breast cancer.

Introduction. Colon cancer is one of the most common forms of cancer, affecting both sexes equally. The objective tumor response rate (ORR) is an important parameter that proves the effectiveness of treatment in oncology; one of the ways to evaluate ORR is the response evaluation criteria in solid tumors Response evaluation criteria in solid tumors (RECIST). The aim of the research is to determine and compare the impact of the objective response rate in patients with metastatic colorectal cancer and the impact on overall survival (OS) and progression-free survival (PFS). Methods. The work is based on a retrospective (2014-2020) clinical study, with follow-up of patients over a period of 5 years. The research included a total of n=101 patients diagnosed with colorectal cancer (stages II and III according to the American Joint Committee of Cancer -AJCC). Research included n=101 patients, 52% male, 48% female. The youngest patient is 18 years old, and the oldest patient is 80 years old. Results. The average age is 59.69 years. The obtained data show that the largest percentage of Colorectal Cancer-CRC patients are in the third age. Adenocarcinoma is the most common pathohistological verification of colon cancer (77.23%). Overall survival and progression-free time in relation to objective response to therapy (ORR) according to RECIST criteria did not show statistical significance. One patient had a complete response (CR) to therapy, six patients (5.94%) had a partial response (PR) to therapy. Stable disease (SD) was verified in 32.67%, and disease progression (PD) was confirmed in 60.39% of subjects. Conclusion. The extent of objective response to therapy has no influence on overall survival and survival without disease progression in patients with metastatic colorectal disease. Key words: colorectal, cancer, response evaluation criteria in solid tumors.

Aim To investigate prognostic significance of preoperative levels of the Carbohydrate anti-gen 19-9 (CA 19-9) in patients with stage III rectal adenocarcinoma who underwent a treatment at the Clinical Centre of the University of Sarajevo. Materials A retrospective cohort study included 84 patients who underwent radical anterior rectal resection due to grade III rectal adenocarcinoma, followed by adjuvant chemotherapy according to the FOLFOX protocol (Oxaliplatin, Leucovorin, 5-Fluorouracil (5-FU)). The patients were divided into two groups according to CA 19-9 values (≥27 U/mL and <27 U/mL, respectively). Results High pre-operative CA 19-9 values predicted an increased probability of postoperative metastases, especially liver, lung and abdominopelvic metastases, as well as three-year disease-free survival (3Y-DFS) and three-year overall survival (3Y-OS). The 3Y-DFS rate for patients with high CA 19-9 was 64.5%, while for those with low CA 19-9 it was 87.2%. The 3Y-OS rate for patients with high CA 19-9 was 89.8%, while for those with low CA 19-9 it was 65.7%. Univariate and multivariate regression analysis confirmed that a high level of CA 19-9 is an independent predictor for DFS and OS shorter than three years. Conclusion Pre-operatively elevated values of CA 19-9 in rectal adenocarcinoma have a significant role in predicting the outcome in patients with stage III rectal adenocarcinoma.

Abstract: Surgical correction of inguinal hernias is the most commonly used surgical procedure in the world. Currently only three surgical techniques have been validated, that is the Shouldice technique, the Lichtenstein technique, and laparoscopic techniques such as transabdominal preperitoneal (TAPP) hernioplasty and totally extraperitoneal endoscopic hernioplasty (TEP).The aim of the study: The aim of this study is to show the results in terms of postoperative recovery, complications, length of hospitalization after inguinal hernia surgery in patients who underwent the Lichtenstein and the laparoscopic (TAPP) methods.Material and methods: This is a monocentric, retrospective cohort study, conducted in the period from 2019 to 2023. The research period covered 70 patients who underwent surgery at the Clinic for General and Abdominal Surgery with Glandular Surgery, of the University Clinical Center, Sarajevo. The patients were divided into two groups: Group 1: 20 patients who underwent the TAPP method and Group 2: 50 patients who underwent the Lichtenstein method. All patients underwent surgery performed by two doctors.Results: One woman (1.4%) and 69 men (98.6%) participated in the research. Of the total number, 50 patients (72.5%) were treated with the Lichtenstein technique, and 19 (27.5%) were treated with the TAPP technique (p=0.539). The statistical results did not show a significant difference in the average age between patients who underwent the Lichtenstein and the TAPP technique (T=0.759; p=0.450).Discussion: There was no significant difference in relation to age and type of surgery (T=0.759; p=0.450). There was no statistical difference in the choice of surgical approach in relation to the laterality of the hernia (P<0.001), nor any statistically significant difference between the TAPP and Lichtenstein surgical procedures in relation to BMI T=0.613; p=0.542. Our analyses showed that patients treated with the TAPP technique had a statisticallysignificantly higher probability of shorter postoperative hospitalization compared to those treated with the Lichtenstein technique (B=0.245; p=0.019). Two patients in the study had complications within 30 days (Clavien-Dindo Grade I and Grade IIIB).Conclusion: Using an individual approach for each patient, surgical treatment of hernia using laparoscopic TAPP can be the first choice in patients without comorbidities, without previous pelvic surgery, bilaterality or recurrence of previous surgery (anterior approach). Patients treated with the laparoscopic technique (TAPP) have a shorter hospitalization time, which ultimately affects the economic aspect.

Background: Difficult cholecystectomy, often associated with a heightened risk of complications, poses a significant surgical dilemma. Risk factors, such as patient age, increased body weight, the presence of gallstones, acute cholecystitis, and prior abdominal surgeries, can complicate laparoscopic cholecystectomy and necessitate conver- sion to an open procedure for safety. The aim of our study was to assess the applicability of the Nassar scale in predicting the need for conversion from laparoscopic to open cholecystectomy.Material and methods: In our prospective cohort study, we included 85 patients who underwent either emergency or elective laparoscopic cholecystectomy between December 2021 and October 2023. The Nassar scale was used to assess the complexity of laparoscopic cholecystectomy, incorporating parameters such as ‘Gallbladder,’ ‘Cystic pedicle,’and ‘Adhesions’ to determine a final score ranging from 1 to 5. Statistical analysis involved descriptive and analytical methods, with the significance threshold set at p < 0.05.Results: ANOVA analysis revealed a statistically significant difference in the duration of operative procedures with different Nassar grades (p < 0.001). An increase in the Nassar grade by 1 was associated with a statistically significant6.23-fold increase in the odds of conversion to an open procedure (p < 0.001). Receiver Operating Characteristic (ROC) analysis demonstrated a highly significant association (p < 0.001) between the Nassar grade and the conversion event, with an Area Under the Curve (AUC) of 0.881 (95% CI 0.79,0.96). The optimal cutoff value, identified as >2.5, struck a balance between sensitivity (0.86) and 1-specificity (0.23). Conclusion: Our study underscores the utility of the Nassar scale in surgical practice. It provides valuable insights into assessing the severity of operations, facilitating informed decision-making, and optimizing treatment outcomes for patients undergoing laparoscopic cholecystectomy at our institution.

Background: Radical surgical resection for pancreatic head carcinoma offers a chance for cure but unfortunately is only available to a limited number of patients. For a significant number of patients, palliative surgery remains the only option. The question of the most effective approach for patients with borderline resectable pancreatic head carcinoma (BRPHC) remains unresolved. Objective: The aim of the study was to compare the morbidity and mortality following R1 duodenocephalic pancreatectomy and double palliative bypass to explore the most optimal surgical treatment for patients with BRPHC. Methods: Our retrospective cohort study included 64 patients with BRPHC who underwent surgery from 2012 to 2019, with postoperative follow-up for three years. Morbidity and mortality parameters were examined based on the type of surgical treatment: R1 duodenocephalic pancreatectomy or palliative double bypass. Chi-square test, univariate regression, and Kaplan-Meier analysis were used as basic statistical methods in the analysis of the results. Results: Patients undergoing R1 duodenocephalic pancreatectomy had a 3.69 times higher risk of developing biliary leak (p=0.039; 95%CI:1.066, 1.181) and shorter survival compared to those undergoing palliative double bypass (p=0.022). No statistically significant association was found between the type of surgical procedure and other postoperative complications. Conclusion: Our study suggests that the double palliative bypass procedure may be a better option than R1 resection for patients with BRPHC.

Introduction: Colorectal cancer (CRC) is one of the most common malignancies with significant global health and economic implications. Genetic mutations in genes such as TP53, APC, KRAS, and MMR play a crucial role in the development and progression of this cancer. This review paper analyzes current knowledge about the impact of these mutations on colorectal carcinogenesis, using available literature. Objective: To provide a comprehensive review of the role of genetic mutations in TP53, APC, KRAS, and MMR genes in the development of colorectal cancer and to consider their impact on diagnosis and treatment. Materials and Methods: This review examines peer-reviewed research articles and reports sourced from databases such as PubMed, Google Scholar, and other academic sources. The focus was on studies investigating genetic mutations, their prevalence, and their role in the pathogenesis of CRC. Results: Mutations in the TP53 gene, present in more than 50% of CRC cases, are critical for malignant cell transformations. KRAS mutations, found in about 50% of cases, lead to abnormal signaling contributing to unchecked proliferation. APC mutations are associated with hereditary predisposition to CRC, while MMR genes, such as MLH1 and MSH2, play a key role in DNA repair and are linked to hereditary nonpolyposis colorectal cancer. Conclusion: Genetic mutations in TP53, APC, KRAS, and MMR genes play a significant role in the development of colorectal cancer. A deeper understanding of these mutations may significantly enhance diagnostic and therapeutic strategies, guiding future research in this rapidly evolving field.