The present study supports the hypothesis that NAC administration alleviates the negative effects of radiotherapy on anastomotic healing. Nevertheless, the underlying mechanisms responsible for this protective effect is unknown today.

The findings of the present study indicate that EPO contributes to wound healing and the strength of colon anastomosis following radiation due to its antioxidant and anti-inflammatory effects, but further studies are needed to explore the significance of these effects.

We found detrimental effects of RT on systolic and diastolic cardiac functions and the electrical conduction system of the heart. Maximal prevention should be provided for the patients during RT.

Pancreatic cancer is one of the most resistant cancers to conventional treatment modalities and is generally in the locally advanced or metastatic stage at the time of initial diagnosis. Approximately only 20% of patients are diagnosed as potentially resectable but 5-year survival rate is no more than 20-25% even in these resectable ones.Realizing the poor prognosis with a single-modality approach, several studies that used the combination of chemotherapy and radiotherapy with surgery are performed in order to improve local control and survival.This review evaluates the existing data and future aspects about the combined modality treatment in locally advanced pancreatic cancer regarding both the efficiency and toxicity of these combinations and novel agents.

Margin status is one of the significant prognostic factors for recurrence in breastconserving surgery (BCS). The issue that merits consideration for oncologic safety and cost-effectiveness about the modalities to assure clear margins at initial surgical intervention remains controversial after neo-adjuvant chemotherapy (NAC). The presented study aimed to assess the impact of intraoperative ultrasound (IOUS)-guided surgery on accurate localization of tumor site, adequacy of excision with clear margins, and healthy tissue sacrifice in BCS after NAC. Patients who had IOUS-guided BCS ater NAC were reviewed. No patient had preoperative localization with wire or radiotracer. Intraoperative real-time sonographic localization, sonographic margin assessment during resection, macroscopic and sonographic examination of specimen, and cavity shavings (CS) were done as the standard procedure. No frozen assessment was performed. One hundred ninety-four patients were included, in which 42.5% had pCR. IOUS-guided surgery accomplished successful localization of the targeted lesions in all patients. Per protocol, all inked margins on CS specimens were reported to be tumor-free in permanent histopathology. No re-excision or mastectomy was required. For a setting without CS, the negative predictive value (NPV) of IOUS rate was 96%. IOUS was found to over and underestimate tumor response to NAC both in 2% of patients. IOUS-guided surgery seems to be an efficient modality to perform adequate BCS after NAC with no additional localization method. Especially, when CS is integrated as a standard to BCS, IOUS seems to provide safe surgery for patients with no false negativity and a high rate of NPV. K E Y W O R D S breast-conserving surgery, intraoperative ultrasonography, neo-adjuvant chemotherapy 1 | INTRODUC TI ON With the evidence-based overwhelming data confirming the importance of tumor biology on breast cancer (BC) recurrence and prognosis, upfront systemic therapies gained enthusiasm, while surgeons stepped back in terms of radical surgery. 1 Since then, breast-conserving surgery (BCS) has become the preferred surgical option with improved cosmetic and psychologic consequences. How to cite this article: Tasdöven I, Karadeniz Çakmak G, Emre AU, et al. Intraoperative ultrasonography-guided surgery: An effective modality for breast conservation after neo-adjuvant chemotherapy.