Medicinal, Psychological, and Health Research Journal (MPHRJ)

Abstract Background: Acute intracranial hypertension requiring emergency neurosurgical intervention is associated with substantial risks of neurological deterioration, cerebral hypo perfusion, and perioperative mortality. Anesthetic management in this setting is particularly challenging because induction, airway manipulation, ventilation, hemodynamic instability, and anesthetic drug selection may influence intracranial pressure (ICP), cerebral perfusion pressure (CPP), and neurological outcomes. However, evidence regarding the optimal perioperative anesthetic strategy remains heterogeneous.

Objective: This systematic review and meta-analysis aimed to evaluate perioperative anesthetic strategies and their associations with physiological and clinical outcomes in patients undergoing emergency neurosurgery for acute intracranial hypertension.

Methods: A systematic literature search designed to identify clinical studies evaluating anesthetic management during emergency or urgent craniotomy or craniectomy for intracranial hypertension or brain herniation. Relevant outcomes included ICP, CPP, arterial blood pressure, hemodynamic instability, brain swelling, extubation status, neurological outcomes, and mortality. Evidence concerning intravenous and volatile anesthetic techniques, induction strategies, and adjunctive perioperative interventions critically assessed. Risk of bias, clinical, and methodological heterogeneity considered before quantitative synthesis.

Results: Available evidence suggests that perioperative anesthetic management can influence cerebral and systemic physiology, although the certainty of evidence remains limited. Propofol-based anesthesia has been associated with lower ICP and reduced risk of brain swelling compared with volatile anesthetics in broader craniotomy populations, although this benefit not consistently demonstrated in emergency craniotomy subgroups. Contemporary evidence also challenges the historical concern that ketamine invariably increases ICP; systematic reviews have reported no consistent adverse effect on ICP, CPP, or mortality in patients with acute brain injury. Nevertheless, heterogeneity in patient populations, anesthetic regimens, concomitant therapies, and outcome definitions limits definitive comparisons.

Conclusions: Current evidence does not establish a single superior anesthetic regimen for emergency neurosurgery complicated by acute intracranial hypertension. Individualized, physiology-guided management emphasizing preservation of cerebral perfusion and avoidance of secondary physiological insults appears most appropriate.

Abstract Introduction: In the present study, the evaluation of cardiopulmonary problems in cancer patients suffering from embolism has been investigated with clinical and radio-oncological points. Having cancer as well as its treatment can bring many complications for the patient. Cancer treatments such as radiotherapy, surgery and chemotherapy are very complicated and may have significant side effects in the short term or even after several years. People who have previously suffered from this disease and are currently treated are at a higher risk of contracting and dying from cardiovascular diseases compared to normal people in the society.

Methodology: Various studies have been conducted in this field and its various aspects have been investigated. A study published in 2021 looked at the increased risk of cardiovascular disease within 3 years of cancer patients finishing treatment. The present study investigated the issue by reviewing more than 60 articles with keywords including " Cardiopulmonary Problem”, “Cancer”, “Clinical and Radio Ecological Points” and “Patient”.

Results: This study showed that the probability of cardiovascular disease in people with cancer was higher than in healthy people. Among the existing cancers, those who were diagnosed with bladder, kidney, prostate, colon, rectal, lung, melanoma, and testicular cancers, compared to those who were diagnosed with other cancers, had a higher probability of developing cardiovascular disease.

Conclusion: The results obtained from this study showed that in people who were between the ages of 60 and 69, the probability of developing cardiovascular disorders within 3 years after the completion of cancer treatment was 1.24 times the normal state. This study showed that people with a history of cancer have a higher chance of developing cardiovascular disease after treatment.

Abstract Introduction: Geriatric femoral fractures frequently precipitate severe acute postoperative complications, yet early risk stratification remains suboptimal. Given the potential of systemic inflammatory markers to reflect perioperative stress, identifying reliable biomarkers is clinically critical. Therefore, this study aimed to evaluate the predictive value of the systemic immune-inflammation index for acute postoperative complications in elderly patients undergoing femoral fracture surgery.

Material and methods: This descriptive cross-sectional study at Shohada Hospital, Tabriz, enrolled 118 elderly patients with femoral fractures, determined by Cochran’s formula. Preoperative systemic immune-inflammation index (SII) values were calculated from complete blood counts. Participants were prospectively evaluated to assess the association between admission SII and acute postoperative complications, with statistical models utilized to determine the index’s prognostic accuracy in predicting adverse surgical outcomes.

Results: This study comprehensively analyzed preoperative inflammatory biomarkers for predicting acute postoperative complications in elderly patients with femoral fractures. Key findings indicate that elevated SII (AUC=0.865), NLR (AUC=0.782), and PLR (AUC=0.714) are significantly associated with increased complication risk. The multivariable model demonstrated superior predictive accuracy (AUC=0.912), highlighting the clinical utility of these indices for early risk stratification and tailored perioperative management.

Conclusion: Preoperative assessment of systemic inflammatory indices, particularly SII, offers valuable insights into the risk of acute postoperative complications in elderly hip fracture patients, enabling targeted interventions for improved outcomes.

Abstract Introduction: Post mastectomy radiotherapy significantly improves locoregional control and survival in breast cancer patients but may lead to late complications such as fibrosis, cardiopulmonary toxicity, and lymphedema, which adversely affect long term quality of life. Identifying patients at higher risk is essential for personalized survivorship care. This study aims to determine predictive factors for late radiotherapy induced complications in post mastectomy breast cancer survivors.

Material and methods: This cross-sectional analytical study was conducted in 2025 at hospitals affiliated with Tabriz University of Medical Sciences and included 73 post-mastectomy breast cancer survivors. The study evaluated predictive factors for late radiotherapy-induced complications using demographic, clinical, surgical, oncologic, and dosimetric variables, along with treatment-related characteristics and late toxicity outcomes.

Results: Among 73 post mastectomy survivors, late complications were common, particularly skin fibrosis (30.14%) and shoulder limitation (28.77%). Severe toxicity (CTCAE ≥2) occurred in 35.62% and was associated with higher BMI (P = 0.004), smoking (P = 0.037), mean heart dose (P = 0.001), and lung V20 (P = 0.002). Lung V20 predicted severe events (AUC = 0.84; cut off = 20.57%; sensitivity = 84.62%; specificity = 72.34%).

Conclusion: Late radiotherapy induced complications remain prevalent in post mastectomy breast cancer survivors. Elevated BMI, smoking, and higher cardiopulmonary dose parameters—particularly lung V20—were associated with severe toxicity. These findings highlight the importance of optimizing radiation planning and addressing modifiable risk factors to reduce long term morbidity and improve survivorship outcomes.

Abstract Introduction: Colorectal cancer surgery outcomes are influenced not only by tumor characteristics but also by the patient’s nutritional and inflammatory status. Serum albumin, a widely available biomarker, reflects both physiological reserve and systemic inflammation and has been linked to postoperative prognosis. This study aimed to evaluate the clinical significance of preoperative serum albumin levels in predicting survival after colorectal cancer surgery.

Material and methods: This observational analytical study was conducted in 2025 at hospitals affiliated with Tabriz University of Medical Sciences. A total of 85 colorectal cancer patients undergoing surgical resection were enrolled using convenience sampling. Demographic characteristics, clinical variables, tumor features, preoperative serum albumin levels, and postoperative survival outcomes were collected and analyzed to evaluate the prognostic value of albumin.

Results: Among 85 patients undergoing colorectal cancer surgery, hypoalbuminemia (<3.5 g/dL) was present in 36.47%. Lower albumin was associated with higher BMI (P = 0.041) and advanced tumor stage (P = 0.032). Patients with low albumin had shorter survival (24.83 ± 9.71 vs 33.47 ± 11.26 months; P = 0.006) and higher mortality (35.48% vs 16.67%; P = 0.047). Hypoalbuminemia independently predicted mortality (HR = 2.47, 95% CI: 1.29–4.73; P = 0.006) with good ROC performance (AUC = 0.80).

Conclusion: Preoperative hypoalbuminemia was significantly associated with poorer survival after colorectal cancer surgery and remained an independent predictor of mortality. These findings highlight the importance of assessing nutritional and inflammatory status before surgery. Serum albumin, as a simple and accessible biomarker, may assist clinicians in identifying high risk patients and improving preoperative risk stratification.

Abstract Introduction: Conventional agents such as opioids and benzodiazepines may control symptoms but can impair recovery and pose airway-related risks. Dexmedetomidine offers sedative, analgesic, and sympatholytic benefits with minimal respiratory depression. The aim of this trial was to evaluate intraoperative dexmedetomidine for reducing emergence agitation and postoperative pain after traumatic nasal surgery.

Material and methods: This prospective, double-blind randomized controlled trial at Imam Reza Hospital included 60 patients undergoing traumatic nasal surgery, randomized equally to receive either intraoperative dexmedetomidine or saline placebo. Dexmedetomidine was administered as a 1 µg/kg loading dose followed by a 0.5 µg/kg/h infusion. Primary outcomes were postoperative agitation and pain severity, while secondary outcomes included hemodynamic changes, recovery duration, rescue analgesic use, and adverse events.

Results: Dexmedetomidine significantly reduced postoperative emergence agitation and pain scores at all assessed time points compared with placebo. It also attenuated heart rate and mean arterial pressure during early recovery without affecting oxygen saturation. Although dexmedetomidine prolonged extubation time and PACU stay, it did not significantly increase major adverse events and was associated with a lower incidence of postoperative shivering.

Conclusion: In conclusion, intraoperative infusion of dexmedetomidine during traumatic nasal surgery significantly attenuates emergence agitation and mitigates postoperative pain severity, while ensuring superior hemodynamic stability in the early recovery phase.

Abstract Introduction: Breast cancer outcomes vary widely, creating a need for accessible biomarkers that reflect tumor burden and systemic inflammation during chemotherapy. CA15 3 and CRP may provide complementary prognostic and predictive information. This study aims to evaluate the prognostic value and predictive utility of CA15 3 and CRP in patients with breast cancer undergoing chemotherapy.

Material and methods: This descriptive cross-sectional study will be conducted at Shahid Madani Hospital, Tabriz University of Medical Sciences, using convenience sampling to enroll 70 breast cancer patients undergoing chemotherapy. Demographic, clinicopathological, and treatment data, along with serum CA15-3 and CRP levels, will be collected and analyzed using appropriate descriptive and inferential statistics.

Results: In 70 patients with breast cancer undergoing chemotherapy, the mean age was 49.8 ± 10.7 years; 80.0% had invasive ductal carcinoma, 70.0% had lymph node involvement, and 18.6% had metastasis. Median CA15-3 and CRP levels were 31.5 U/mL and 8.9 mg/L, respectively.

Conclusion: These findings indicate that CA15-3 and CRP reflect related but non-identical biological dimensions in patients with breast cancer undergoing chemotherapy. While CA15-3 appears to represent tumor-associated activity, CRP likely captures the accompanying systemic inflammatory response.

Abstract Dysphagia is a frequent and clinically significant complication following esophageal surgery, particularly esophagectomy, and it poses substantial challenges in the postoperative management of critically ill patients. Impaired swallowing after surgery may arise from multiple mechanisms, including anatomical alterations, neural injury, postoperative inflammation, motility disorders, and anastomotic strictures. These factors can disrupt the coordinated physiological process of swallowing and increase the risk of serious complications. In the intensive care unit (ICU), early identification and appropriate management of dysphagia are essential to prevent adverse outcomes such as aspiration pneumonia, malnutrition, dehydration, and prolonged hospitalization. Comprehensive evaluation strategies—including bedside clinical assessment, standardized screening tests, and instrumental diagnostic methods such as videofluoroscopic swallow study and fiberoptic endoscopic evaluation of swallowing—play a crucial role in detecting swallowing dysfunction and guiding clinical decisions. Nutritional management is another key component of postoperative care, as patients with dysphagia often experience inadequate oral intake during the early recovery phase. Early initiation of nutritional support, preferably through enteral routes, helps maintain metabolic stability and supports tissue healing. Multidisciplinary collaboration among intensivists, surgeons, dietitians, and speech language pathologists is fundamental for optimizing patient outcomes. Rehabilitation strategies, including swallowing therapy, postural adjustments, and targeted muscle exercises, can facilitate functional recovery and reduce aspiration risk. In addition, structured ICU protocols and enhanced recovery pathways may contribute to improved postoperative outcomes by promoting safe nutritional progression and coordinated care.

Abstract Enhanced Recovery After Surgery (ERAS) has emerged as an important perioperative framework for improving outcomes after thoracotomy, particularly in patients requiring intensive postoperative care. This review examines current evidence and practical strategies for applying ERAS principles in the intensive care unit after thoracic surgery. Key components include preoperative optimization through patient education, pulmonary assessment, smoking cessation, nutritional support, and anesthetic planning; intraoperative measures such as appropriate surgical technique selection, goal-directed fluid therapy, targeted anesthesia, multimodal analgesia, and tissue-sparing practice; and postoperative ICU management focused on hemodynamic monitoring, ventilatory support, pain control, chest tube care, mobilization, respiratory physiotherapy, and early nutritional intervention. Collectively, these measures aim to reduce pulmonary complications, shorten ICU and hospital stay, improve functional recovery, and enhance quality of life. The review also highlights important barriers to implementation, including protocol variability, limited resources, and the complexity of critically ill thoracic patients. Overall, ERAS provides a structured and multidisciplinary approach that aligns perioperative care with modern goals of safety, efficiency, and patient-centered recovery after thoracotomy.

Abstract Introduction: Laparoscopic hysterectomy is widely performed due to its minimally invasive nature and faster recovery compared with open surgery; however, acute postoperative pain remains a common clinical challenge that may affect recovery and patient satisfaction. Various patient-related factors may influence pain perception. Therefore, this study aimed to investigate the association between age and the incidence of acute postoperative pain following laparoscopic hysterectomy.

Material and methods: This cross sectional study was conducted in 2025 at hospitals affiliated with Tabriz University of Medical Sciences and included 73 patients undergoing laparoscopic hysterectomy, with sample size determined using the single proportion prevalence formula. Variables assessed included age, BMI, comorbidities, surgical duration, anesthesia type, and acute postoperative pain severity measured by the Visual Analog Scale within 24 hours after surgery.

Results: Postoperative pain was common, with a mean VAS score of 4.28 ± 1.86 and an incidence of 76.71%. Moderate pain was most frequent, and younger patients reported significantly higher pain levels, while pain decreased progressively with age (ANOVA p = 0.018). Age showed a strong negative correlation with VAS scores (r = −0.711, p = 0.001), indicating markedly lower pain intensity in older patients.

Conclusion: Age demonstrated a clear inverse relationship with acute postoperative pain following laparoscopic hysterectomy, with younger patients reporting higher pain intensity and greater analgesic needs. These findings highlight the importance of age responsive pain management protocols to ensure individualized postoperative care and optimized recovery outcomes.

Abstract Introduction: Pediatric abdominal surgery is associated with significant postoperative morbidity, influenced not only by surgical factors but also by perioperative anesthetic management. Variations in anesthetic techniques may affect pain control, recovery, and complication rates in children. Therefore, this study aims to evaluate the impact of different anesthetic techniques on postoperative outcomes in pediatric abdominal surgery.

Material and methods: This study was designed as a systematic review and meta analysis to evaluate anesthetic techniques in pediatric abdominal surgery. A comprehensive literature search was conducted in PubMed, Scopus, Web of Science, and Embase to synthesize available evidence on postoperative outcomes in children.

Results: Pooled analysis of five studies showed that regional or multimodal anesthetic techniques significantly improved postoperative outcomes compared with general anesthesia. These approaches reduced pain intensity (SMD = −0.82, 95% CI −1.15 to −0.49; I² = 42%) and shortened hospital stay (MD = −1.34 days, 95% CI −1.98 to −0.70; I² = 46%), indicating consistent clinical benefits.

Conclusion: the present systematic review and meta analysis provide compelling evidence that regional and multimodal anesthetic techniques offer significant advantages over general anesthesia alone in pediatric abdominal surgery.

Abstract Introduction: Gastroesophageal junction cancers show variable responses to chemo-induction, highlighting the need for predictive biomarkers. PD-L1, through its role in tumor–immune interactions, may help identify patients more likely to benefit from preoperative treatment. This study aimed to retrospectively evaluate chemo-induction outcomes in GEJ cancers with emphasis on PD-L1 as a predictive pathologic biomarker.

Material and methods: This retrospective cross-sectional study, approved by the Tabriz University of Medical Sciences Ethics Committee, evaluated 100 gastroesophageal junction cancer patients at Shahid Madani Hospital. Using accessible sampling, clinical data and PD-L1 expression were analyzed. Statistical analyses, including chi-square tests and logistic regression, were performed to identify predictors of pathological response.

Results: In 100 patients, baseline variables were comparable between the dexmedetomidine and lidocaine groups (all p > 0.05). Infusion duration, surgery time, anesthesia time, treatment completion, pathological findings, treatment response, and PD-L1 positivity did not differ significantly between groups. Only total study drug dose differed significantly (92.6 ± 18.4 µg vs. 248.3 ± 41.7 mg, p < 0.001).

Conclusion: These findings indicate that dexmedetomidine and lidocaine were associated with broadly similar perioperative, pathological, and immunohistochemical outcomes in this cohort. The absence of significant between-group differences in pathological response and PD-L1 expression suggests that neither intervention demonstrated clear superiority in influencing tumor-related postoperative characteristics.

Abstract Skin cancer is one of the most common malignancies worldwide, and its early detection remains essential for improving survival rates and reducing healthcare burdens. Dermoscopy has significantly enhanced the diagnostic accuracy of skin cancer by allowing detailed visualization of subsurface skin structures, but its interpretation depends heavily on clinical expertise and experience. In recent years, artificial intelligence (AI) has emerged as a transformative tool in medical imaging, particularly in dermatology, enabling automated, rapid, and highly accurate analysis of dermoscopic images. This study explores the integration of AI techniques—such as convolutional neural networks (CNNs), deep learning, and ensemble models—for the early detection and classification of skin lesions, including melanoma, basal cell carcinoma, and benign nevi. By leveraging large annotated datasets and advanced feature extraction algorithms, AI-based diagnostic systems can identify subtle visual patterns that may elude human observation. The paper reviews the main architectures applied to dermoscopy, discusses data preprocessing and augmentation strategies, and analyzes the performance of AI compared to dermatologists in clinical studies. Moreover, it highlights explainability, interpretability, and ethical considerations in AI-assisted diagnosis, ensuring transparency and trust in clinical applications. Results from recent research indicate that AI models achieve dermatologist-level accuracy and can serve as valuable decision-support systems, particularly in teledermatology and resource-limited settings. The findings suggest that AI-powered dermoscopic analysis represents a paradigm shift toward personalized, accessible, and efficient skin cancer screening, with significant implications for global public health and digital medicine.

Abstract Persistent HPV infection drives carcinogenesis via E6/E7 targeting p53 and Rb inactivation; loss of the p16 gatekeeper amplifies cellular susceptibility to HPV integration, rapidly accelerating progression toward invasive disease, defining critical targets for therapeutic precision and risk stratification. This narrative review rigorously synthesized literature from PubMed, Scopus, and other databases using combined MeSH terms and keywords like “cervical cancer” AND “HPV” AND “p16 expression,” filtering for English-language, full-text articles indexed before January 2026, explicitly excluding editorials and non-human studies via initial screening followed by full-text assessment focused solely on molecular pathogenesis linking viral oncogenesis to host cell cycle control in precursor lesions. High-risk HPV infection drives cervical carcinogenesis through E6 and E7 oncogenes, which degrade p53 and inactivate Rb, leading to uncontrolled proliferation reflected by compensatory p16 overexpression, a robust biomarker for high-grade disease. Viral integration is a critical step, often disrupting host genes like CDKN2A while locking in high E6/E7 expression, creating genomic instability. Clinically, p16 status helps triage positive HPV tests to identify high-risk lesions; while CDK4/6 inhibitors offer therapeutic avenues, primary vaccination remains the definitive strategy by eliminating the initiating oncogenic stimulus.

Abstract Introduction: Cancer patients receiving chemotherapy are particularly vulnerable to COVID 19–associated thrombotic complications. The coexistence of SARS CoV 2 infection, malignancy related hypercoagulability, and treatment induced immunosuppression may adversely affect mechanical thrombectomy outcomes. Understanding this interaction is essential for optimizing acute stroke management and improving neurological and survival outcomes in this high risk population.

Material and methods: Following ethical approval, data were prospectively collected at Imam Reza Hospital using standardized forms. Demographic characteristics, comorbidities, cancer type, laboratory findings, thrombotic sites, anticoagulant use, ICU course, and clinical outcomes were systematically recorded for eligible cancer patients with COVID‑19. Statistical analyses were conducted to evaluate associations between clinical variables and patient outcomes.

Results: Critically ill cancer patients with concurrent COVID‑19 exhibited marked inflammatory and hypercoagulable profiles, with frequent multisite thrombosis, predominantly pulmonary and cerebral. Clinical outcomes were poor, characterized by prolonged ICU stays, high mechanical ventilation use, and substantial mortality. Active chemotherapy was associated with significantly reduced overall survival, underscoring its prognostic relevance in this high‑risk population.

Conclusion: the findings of this study support the concept that COVID 19 and malignancy act synergistically to create a uniquely severe thromboinflammatory state with profound clinical consequences. The combination of systemic inflammation, diffuse thrombosis, prolonged critical illness, and reduced survival—particularly among patients receiving chemotherapy—highlights the need for heightened vigilance, early identification of thrombotic complications, and tailored management strategies in this population.

Abstract Introduction: Rapid molecular diagnostic techniques have emerged as critical tools for optimizing targeted antimicrobial therapy in critically ill ICU patients with multidrug‑resistant bacterial infections. By enabling early pathogen identification and resistance detection, these methods support timely therapeutic decision‑making, improve clinical outcomes, and strengthen antimicrobial stewardship in high‑risk critical care settings.

Material and methods: This systematic review synthesized evidence from major international databases using a comprehensive, unrestricted search strategy to evaluate rapid molecular diagnostics and their clinical impact on targeted antimicrobial therapy in critically ill patients.

Results: Across included studies, PCR‑based molecular diagnostics predominated, reflecting their clinical feasibility in ICU settings. Rapid molecular testing significantly shortened time to targeted therapy, reduced empirical broad‑spectrum antibiotic use, and improved ICU length of stay. Stewardship decisions were frequently optimized through de‑escalation, targeted escalation, or antibiotic discontinuation, collectively supporting more precise and evidence‑based antimicrobial management.

Conclusion: The proportion of cases in which no change in therapy was made following molecular testing likely reflects scenarios where empirical management was already appropriate. Rather than diminishing the value of molecular diagnostics, this finding reinforces their role in validating clinical judgment and providing reassurance regarding therapeutic adequacy.

Abstract Introduction: This prospective study investigates the prognostic significance of routine liver and renal function tests in breast cancer patients undergoing chemotherapy. Given their central role in drug metabolism, systemic inflammation, and treatment tolerability, these readily available laboratory parameters may provide valuable prognostic information and support improved risk stratification and individualized clinical decision‑making in breast cancer management.

Material and methods: This prospective cohort study enrolled 150 patients with stage I–III breast cancer receiving adjuvant or neoadjuvant chemotherapy. Baseline and serial assessments of liver and renal function and related laboratory biomarkers were performed during treatment. Clinical response, chemotherapy related toxicity, overall survival, and progression free survival were prospectively evaluated across molecular subtypes.

Results: Multivariable analysis identified stage III disease as the strongest predictor of poorer overall survival compared with stages I–II (P < 0.001), a finding corroborated by Kaplan–Meier analysis. Older age (P = 0.014), HER2‑positive (P = 0.011) and basal‑like subtypes (P < 0.001), and neoadjuvant chemotherapy (P = 0.043) were associated with increased mortality, whereas higher serum albumin (P = 0.006) and eGFR (P = 0.017) independently predicted improved survival.

Conclusion: These results underscore that prognosis in breast cancer is shaped by both tumor related and host related factors. While tumor stage and molecular subtype remain the cornerstone of risk stratification, routinely available clinical parameters such as albumin and renal function provide meaningful complementary prognostic information.

Abstract Introduction: Bacterial sepsis remains a major challenge in intensive care units due to its nonspecific presentation and high mortality. Inflammatory biomarkers such as C‑reactive protein and procalcitonin are widely used to support early diagnosis and prognostication. However, variability in their diagnostic accuracy and prognostic performance necessitates a comprehensive evaluation of existing evidence.

Material and methods: This systematic review comprehensively searched major biomedical databases without time restrictions to evaluate the prognostic value of CRP and procalcitonin in bacterial sepsis among ICU patients.

Results: The review demonstrates a predominance of studies focusing on procalcitonin and combined biomarker strategies, with elevated CRP and procalcitonin consistently associated with adverse clinical outcomes in septic ICU patients. Procalcitonin showed superior prognostic precision, while overall methodological quality was acceptable despite residual bias concerns, underscoring the need for more rigorous prospective research.

Conclusion: Finally, the identified methodological gaps emphasize the need for rigorously designed prospective studies to clarify the independent prognostic value of inflammatory biomarkers. Future research should prioritize standardized biomarker measurement, robust adjustment for confounding, and evaluation of combined biomarker panels within well defined sepsis cohorts.

Abstract Breast-conserving surgery (BCS) is a standard treatment for early-stage breast cancer, often combined with adjuvant radiation therapy (RT) to reduce local recurrence. Despite strong evidence supporting RT, some patients undergo BCS without RT due to age, comorbidities, or preference. Radiological assessment, including preoperative imaging and intraoperative margin evaluation, plays a crucial role in optimizing outcomes and reducing recurrence. This systematic review synthesizes current literature on local recurrence rates following BCS with and without adjuvant RT, with a focus on the influence of radiological evaluation. A comprehensive search of PubMed, Scopus, Web of Science, and Cochrane Library from 2000 to 2025 was conducted, yielding 42 studies including randomized controlled trials, population-based cohorts, and meta-analyses. The findings consistently demonstrate that BCS without RT results in significantly higher local recurrence (10–35%) compared to BCS with RT (5–10%). Preoperative imaging with MRI or mammography improves tumor delineation and eligibility for BCS, while intraoperative margin assessment reduces positive margin rates and re-excision. Subgroup analyses indicate that selected low-risk patients (e.g., age >70, small low-grade tumors, hormone receptor-positive) may have acceptable recurrence rates without RT, though radiological guidance remains essential. The review concludes that adjuvant RT remains critical in preventing local recurrence after BCS, and radiological evaluation enhances surgical precision and long-term outcomes. Personalized treatment decisions should integrate tumor characteristics, patient risk profile, and imaging findings to optimize oncologic safety while preserving breast tissue.