Impact of Neoadjuvant Chemotherapy (NAC) on Biomarker Expression in Breast Cancer.

Background and Objectives: This study aimed to explore biomarker change after NAC (neoadjuvant chemotherapy) and to investigate biomarker expression as a prognostic factor in patients with residual disease (RD) after NAC. Materials and Methods: We retrospectively evaluated 104 patients with invasive breast cancer, who underwent NAC and surgery at Pusan National University Hospital from 2015 to July 2022. The expression of the biomarker was assessed, and the overall survival (OS) and disease-free survival (DFS) were investigated. Results: After NAC, 24 patients (23.1%) out of 104 total patients had a pathological complete response (pCR). We found that changes in at least one biomarker were observed in 41 patients (51.2%), among 80 patients with RD. In patients with RD after NAC (n = 80), a subtype change was identified in 20 patients (25.0%). Any kind of change in the HER2 status was present 19 (23.7%) patients. The hormone receptor (HR)+/HER2+ subtype was significantly associated with better disease-free survival (DFS) (HR, 0.13; 95% CI, 0.02-0.99; p = 0.049). No change in p53 was associated with better DFS, and negative-to-positive change in p53 expression after NAC was correlated with worse DFS (p < 0.001). Negative-to-positive change in p53 was an independent, worse DFS factor in the multivariate analysis (HR,18.44; 95% CI, 1.86-182.97; p = 0.013). Conclusions: Biomarker change and subtype change after NAC were not infrequent, which can affect the further treatment strategy after surgery. The expression change of p53 might have a prognostic role. Overall, we suggest that the re-evaluation of biomarkers after NAC can provide a prognostic role and is needed for the best decision to be made on further treatment.

Tumor budding as a predictor of disease-free survival in patients with cholangiocarcinoma.

Background: Tumor budding is considered a prognostic factor in several solid cancer types. However, we lack comprehensive information on the importance of tumor budding in cholangiocarcinoma. Therefore, we aimed to assess the prognostic value of tumor budding in intrahepatic and extrahepatic cholangiocarcinomas and to evaluate its correlations with other clinicopathological parameters. Methods: We monitored 219 patients who underwent surgery for intrahepatic or extrahepatic cholangiocarcinoma at the Pusan National University Hospital between 2012 and 2021. Tumor budding was evaluated using the International Tumor Budding Consensus Conference scoring system. Tumor budding was classified into low (0-4), intermediate (5-9), and high (≥10). For statistical analysis, tumor budding was divided into two groups based on the cut-off value of 10 (lower: 0-9 vs. higher: ≥10). The correlations between clinicopathological parameters were examined using the chi-square and Fisher's exact test. The prognostic values of the variables were analyzed using the log-rank test and Cox regression analysis. Results: Low, intermediate, and high tumor buddings were identified in 135 (61.6%), 63 (28.8), and 21 (9.6%), patients, respectively. Higher tumor budding was related to the presence of lymphatic invasion (p = 0.017), higher tumor grade (p = 0.001), higher N category (p = 0.034). In the univariable and multivariable analyses, higher tumor budding was associated with shorter disease-free survival in 97 (44.3%) patients who underwent R0 resection (p < 0.001 and p = 0.011). Tumor budding did not significantly correlate with disease-specific survival in entire patients. Conclusion: Tumor budding may serve as a prognostic factor for intrahepatic and extrahepatic cholangiocarcinomas treated with R0 resection.

Factors affecting satisfaction in patients with a rotator cuff retear: CT arthrography-based study.

PURPOSE: The relationship between retear that may occur after rotator cuff repair and patient satisfaction is not well established. This study aimed to determine whether the types and size of the retear evaluated by computed tomography arthrography (CTA) influenced patient satisfaction. We also analyzed the patient factors that could affect patient satisfaction. PATIENTS AND METHODS: A total of 50 patients who were diagnosed with rotator cuff retear after undergoing arthroscopic rotator cuff repair were included in this study. All the patients were dichotomously classified into the satisfactory or dissatisfactory groups according to the patients' self-classifications. CTA was used to assess the attachment status of the footprint, detect retear on the medial side of the footprint of the repaired cuff, and determine the retear size. Demographic factors, including sex, age, occupation, dominant upper extremity, duration of pain, presence of diabetes mellitus, trauma history, history of ipsilateral shoulder surgery, repair technique, worker's compensation status, and functional shoulder score, were investigated. RESULTS: Thirty-nine patients were classified into the satisfactory group and 11 patients were classified into the dissatisfactory group. There were no differences in age, sex, occupation, dominant hand, duration of pain, presence of diabetes mellitus, trauma history, history of ipsilateral shoulder surgery, repair technique, worker's compensation, and duration of follow-up between the two groups. However, the postoperative American Shoulder and Elbow Surgeon (ASES) score (P < 0.01), visual analog scale (VAS) pain level (P < 0.01), anteroposterior (AP) length (P < 0.01), and area of the retear site (P < 0.01) were significantly different. CONCLUSION: The AP length and area of the retear site estimated using CTA were confirmed as the significant risk factors for dissatisfaction. However, the type of repaired rotator cuff judged by the attachment status of the footprint did not correlate with patient satisfaction. In addition, the postoperative VAS pain scale and ASES score was correlated with patient satisfaction.

Inverse Propensity Score-Weighted Analysis of Entecavir and Tenofovir Disoproxil Fumarate in Patients with Chronic Hepatitis B: A Large-Scale Multicenter Study.

Tenofovir disoproxil fumarate (TDF) is reportedly superior or at least comparable to entecavir (ETV) in preventing hepatocellular carcinoma (HCC) among chronic hepatitis B (CHB) patients; however, it remains controversial. This study aimed to conduct comprehensive comparisons between the two antivirals. CHB patients initially treated with ETV or TDF between 2012 and 2015 at 20 referral centers in Korea were included. The primary outcome was the cumulative incidence of HCC. The secondary outcomes included death or liver transplantation, liver-related outcome, extrahepatic malignancy, development of cirrhosis, decompensation events, complete virologic response (CVR), seroconversion rate, and safety. Baseline characteristics were balanced using the inverse probability of treatment weighting (IPTW). Overall, 4210 patients were enrolled: 1019 received ETV and 3191 received TDF. During the median follow-ups of 5.6 and 5.5 years, 86 and 232 cases of HCC were confirmed in the ETV and TDF groups, respectively. There was no difference in HCC incidence between the groups both before (p = 0.36) and after IPTW was applied (p = 0.81). Although the incidence of extrahepatic malignancy was significantly higher in the ETV group than in the TDF group before weighting (p = 0.02), no difference was confirmed after IPTW (p = 0.29). The cumulative incidence rates of death or liver transplantation, liver-related outcome, new cirrhosis development, and decompensation events were also comparable in the crude population (p = 0.24-0.91) and in the IPTW-adjusted population (p = 0.39-0.80). Both groups exhibited similar rates of CVR (ETV vs. TDF: 95.1% vs. 95.8%, p = 0.38), and negative conversion of hepatitis B e antigen (41.6% vs. 37.2%, p = 0.09) or surface antigen (2.8% vs. 1.9%, p = 0.10). Compared to the ETV group, more patients in the TDF group changed initial antivirals due to side effects, including decreased kidney function (n = 17), hypophosphatemia (n = 20), and osteoporosis (n = 18). In this large-scale multicenter study, ETV and TDF demonstrated comparable effectiveness across a broad range of outcomes in patients with treatment-naïve CHB during similar follow-up periods.

BRAF V600E Mutation of Non-Small Cell Lung Cancer in Korean Patients.

Background and Objectives: BRAF mutational status in resected non-small cell lung cancer (NSCLC) in the Korean population is poorly understood. We explored BRAF (particularly BRAF V600E) mutational status among Korean patients with NSCLC. Materials and Methods: This study included 378 patients with resected primary NSCLC who were enrolled from January 2015 to December 2017. The authors obtained formalin-fixed paraffin-embedded (FFPE) tissue blocks and performed peptide nucleic acid (PNA)-clamping polymerase chain reaction (PCR) for detecting BRAF V600, real-time PCR for detecting BRAF V600E, and immunohistochemical analyses using the mutation-specific Ventana VE1 monoclonal antibody. For positive cases in any methods mentioned above, direct Sanger sequencing was additionally performed. Results: The PNA-clamping method revealed the BRAF V600 mutation in 5 (1.3%) of the 378 patients. Among these five patients, real-time PCR, direct Sanger sequencing detected BRAF V600E mutations in three (0.8%) patients. Thus, two cases showed differences in their PNA-clamping and the others. Direct Sanger sequencing of PNA-clamping PCR product was performed for two cases showing negative results on direct Sanger sequencing; both contained BRAF mutations other than V600E. All patients harboring BRAF mutations had adenocarcinomas, and all patients with V600E mutation exhibited minor micropapillary components. Conclusions: Despite the low incidence of the BRAF mutation among Korean patients with NSCLC, lung adenocarcinoma patients with micropapillary components should be prioritized in terms of BRAF mutation testing. Immunohistochemical staining using Ventana VE1 antibody may serve as a screening examination for BRAF V600E.

Core indicators related to the elimination of hepatitis B and C virus infection in South Korea: A nationwide study.

BACKGROUND/AIMS: To eliminate hepatitis B virus (HBV) and hepatitis C virus (HCV) according to the World Health Organization (WHO) criteria in 2021, this study investigated the national core indicators representing the current status of viral hepatitis B and C in South Korea. METHODS: We analyzed the incidence, linkage-to-care, treatment, and mortality rates of HBV and HCV infection using the integrated nationwide big data of South Korea. RESULTS: According to data from 2018-2020, the incidence of acute HBV infection in South Korea was 0.71 cases per 100,000 population; tthe linkage-to-care rate was only 39.4%. Among those who need hepatitis B treatment, the treatment rate was 67.3%, which was less than 80% reported in the WHO program index. The annual liver-related mortality due to HBV was 18.85 cases per 100,000 population, exceeding the WHO target of four; the most frequent cause of death was liver cancer (54.1%). The annual incidence of newly diagnosed HCV infection was 11.9 cases per 100,000 population, which was higher than the WHO impact target of five. Among HCV-infected patients, the linkage-to-care rate was 65.5% while the treatment rate was 56.8%, which were below the targets of 90% and 80%, respectively. The liver-related annual mortality rate due to HCV infection was 2.02 cases per 100,000 population. CONCLUSION: Many of the current indicators identified in the Korean population did not satisfy the WHO criteria for validation of viral hepatitis elimination. Hence, a comprehensive national strategy should be urgently developed with continuous monitoring of the targets in South Korea.

CAGE-B and SAGE-B models better predict the hepatitis B virus-related hepatocellular carcinoma after 5-year entecavir treatment than PAGE-B.

OBJECTIVES: The PAGE-B model consists of variables at the initiation of antiviral therapy (AVT), whereas the SAGE-B and CAGE-B models consist of variables after 5 years of AVT. We aimed to compare the predictive accuracy of three risk prediction models for hepatocellular carcinoma (HCC) development after 5 years of AVT in patients with chronic hepatitis B (CHB). METHODS: A total of 1335 patients who initiated entecavir (ETV) treatment between 2006 and 2011 and were followed up for more than 5 years were enrolled in the study. RESULTS: At ETV initiation, the median age was 49 years and the median score of the PAGE-B model was 14. After 5 years of ETV treatment, the median SAGE-B and CAGE-B scores were 6 and 6. During the study period, 93 (7.0%) patients developed HCC after 5-year treatment. In multivariate analysis, PAGE-B (hazard ratio [HR] 1.151, 95% confidence interval [CI] 1.087-1.219), SAGE-B (HR 1.340, 95% CI 1.228-1.463), and CAGE-B (HR 1.327, 95% CI 1.223-1.440) models independently predicted HCC development after 5 years of treatment (all P < 0.001). The high-risk groups of the three risk prediction models showed a significantly higher risk of HCC development compared to the medium- and low-risk groups (both P < 0.05). The AUROC of the SAGE-B (0.772-0.844) and CAGE-B (0.785-0.838) models was significantly higher than those of the PAGE-B model (0.696-0.745) in predicting HCC development after 5 years of treatment (both P < 0.05). CONCLUSION: The SAGE-B and CAGE-B models might be better than the PAGE-B model in predicting HCC development after 5 years of ETV treatment.

Initial treatment response and short-term mortality of spontaneous bacterial peritonitis in cirrhotic patients with hepatocellular carcinoma.

This study aimed to investigate the initial treatment response and short-term mortality of spontaneous bacterial peritonitis (SBP) in cirrhotic patients with hepatocellular carcinoma (HCC) compared with those without HCC. A total of 245 patients with liver cirrhosis diagnosed with SBP between January 2004 and December 2020 were included. Of these, 107 (43.7%) were diagnosed with HCC. Overall, the rates of initial treatment failure, 7-day and 30-day mortality were 91 (37.1%), 42 (17.1%), and 89 (36.3%), respectively. While the baseline CTP score, MELD score, culture-positive rate, and rates of antibiotic resistance did not differ between both groups, patients with HCC had a higher rate of initial treatment failure than those without HCC patients (52.3% vs. 25.4%, P < 0.001). Similarly, 30-day mortality was also significantly higher in patients with HCC (53.3% vs. 23.2%, P < 0.001). In the multivariate analysis, HCC, renal impairment, CTP grade C, and antibiotic resistance were independent factors for initial treatment failure. Furthermore, HCC, hepatic encephalopathy, MELD score, and initial treatment failure were independent risk factors for 30-day mortality, with statistically significant poor survival outcomes in patients with HCC (P < 0.001). In conclusion, HCC is an independent risk factor for initial treatment failure and high short-term mortality in patients with cirrhosis with SBP. It has been suggested that more attentive therapeutic strategies are required to improve the prognosis of patients with HCC and SBP.

Ataxia-Telangiectasia Mutated Is Involved in Autolysosome Formation.

Ataxia-telangiectasia mutated (ATM), a master kinase of the DNA damage response (DDR), phosphorylates a multitude of substrates to activate signaling pathways after DNA double-strand breaks (DSBs). ATM inhibitors have been evaluated as anticancer drugs to potentiate the cytotoxicity of DNA damage-based cancer therapy. ATM is also involved in autophagy, a conserved cellular process that maintains homeostasis by degrading unnecessary proteins and dysfunctional organelles. In this study, we report that ATM inhibitors (KU-55933 and KU-60019) provoked accumulation of autophagosomes and p62 and restrained autolysosome formation. Under autophagy-inducing conditions, the ATM inhibitors caused excessive autophagosome accumulation and cell death. This new function of ATM in autophagy was also observed in numerous cell lines. Repression of ATM expression using an siRNA inhibited autophagic flux at the autolysosome formation step and induced cell death under autophagy-inducing conditions. Taken together, our results suggest that ATM is involved in autolysosome formation and that the use of ATM inhibitors in cancer therapy may be expanded.

Risk factors of loss of reduction after acromioclavicular joint dislocation treated with a hook plate.

BACKGROUND: Acromioclavicular joint fixation using a hook plate is effective for the treatment of acute acromioclavicular joint dislocation. However, several studies have reported some complications including loss of reduction after surgery for acromioclavicular joint dislocation. This study aimed to identify the risk factors associated with the loss of reduction after acromioclavicular joint dislocation surgery using a hook plate. METHODS: This was a retrospective study that assessed 118 patients with acromioclavicular joint dislocation, who were diagnosed between March 2013 and January 2019 and underwent surgical treatment using the hook plate (reduction loss group: n = 38; maintenance group: n = 80). The mean follow-up period was 29.9 months (range, 24-40 months). We assessed the range of motion, the American Shoulder and Elbow Surgeons score (ASES), visual analog scale score for pain, and a subjective shoulder value. Radiological assessment of coracoid clavicular distance was performed. The risk factors of reduction loss were analyzed using multivariable logistic regression analysis. RESULTS: Age (p = 0.049), sex (female, p = 0.03, odds ratio OR = 4.81), Rockwood type V (p = 0.049, OR = 2.20), and time from injury to surgery > 7 days (p = 0.018, OR = 2.59) were statistically significant factors in the reduction loss group. There were no significant differences in the clinical outcomes for range of motion, ASES, subjective shoulder value, and visual analog scale scores between the two groups. In the radiological results, preoperative coracoid clavicular distance (p = 0.039) and ratio (p = 0.001), and over-reduction (p = 0.023, OR = 0.40) were significantly different between the two groups. The multivariate logistic regression analysis identified the female sex (p = 0.037, OR = 5.88), a time from injury to surgery > 7 days (p = 0.019, OR = 3.36), and the preoperative coracoid clavicular displacement ratio of the injured shoulder (p < 0.001, OR = 1.03) as risk factors associated with reduction loss following surgery using a hook plate for acromioclavicular dislocation. CONCLUSION: A delayed timing of surgery > 7 days, preoperative coracoid clavicular displacement ratio of the injured shoulder, and female sex were identified as risk factors for loss of reduction after surgery using a hook plate for acromioclavicular joint dislocation. LEVEL OF EVIDENCE: Level IV; retrospective comparison; treatment study.

Complications and outcomes of operative treatment for acute perilunate injuries: a systematic review.

We systematically reviewed the incidence of complications and outcomes of different surgical methods for acute perilunate injury in the MEDLINE, Scopus, Embase and Cochrane Library databases. Forty-three articles with 880 patients were included. The most common complications were arthritis (30%), carpal instability (15%), avascular necrosis of the lunate (12%), complex regional pain syndrome (11%), and nonunion or avascular necrosis of the scaphoid (9%). In the meta-analysis, the mean scapholunate gap was 1.7 mm in the closed surgery group and 2.3 mm in the open surgery group, which was a statistically significant difference. The mean flexion-extension arc of the wrist and modified Mayo wrist score were better in the closed surgery group than in the open surgery group. However, these findings may relate to different cohorts in terms of injury severity. Therefore, the causal relationship between closed surgery and better outcomes may be uncertain as less severe subluxations are more likely to be treated closed.

Comparison of histological and molecular features of pediatric-type follicular lymphoma and pediatric nodal marginal zone lymphoma.

Pediatric-type follicular lymphoma and pediatric nodal marginal zone lymphoma are pediatric B cell lymphomas with similar clinical characteristics but distinct histological features. We investigated the differences between pediatric-type follicular lymphoma and pediatric nodal marginal zone lymphoma by comparing their histological and molecular characteristics. A total of 5 pediatric-type follicular lymphoma and 11 pediatric nodal marginal zone lymphoma patients were included in the study. In the histological review, 5 of the 16 cases showed overlapping morphological features of pediatric-type follicular lymphoma and pediatric nodal marginal zone lymphoma; hence, they were reclassified as "mixed type." In molecular analysis, using panel-based massively parallel sequencing, MAP2K1, TNFRSF14, and IRF8 mutations were found in 6, 3, and 2 of the 11 pediatric nodal marginal zone lymphoma patients, respectively, and IRF8 mutation was found in one of the five pediatric-type follicular lymphoma patients. There were no significant differences in genetic alterations established from the histologically reclassified diagnosis as well as the initial diagnosis. Pediatric-type follicular lymphoma and pediatric nodal marginal zone lymphoma showed morphological overlap in some cases, and no difference between the two was found upon molecular analysis. These findings suggest the possibility that pediatric-type follicular lymphoma and pediatric nodal marginal zone lymphoma are single entity pediatric B-cell lymphoma with broad morphological spectrum.

Assessment of the biofilm-forming ability on solid surfaces of periprosthetic infection-associated pathogens.

Biofilm formation is one of the leading causes of complications after surgery in clinical settings. In this study, we profiled the biofilm-forming ability of various periprosthetic infection-associated pathogens on medically relevant surfaces, polystyrene (PS) and titanium (Ti). We also explored how a specific environmental stressor, epigallocatechin gallate (EGCG), affected biofilm formation. First, Congo red tests revealed that all microorganisms formed biofilms within 72 h. Then, the amounts of biofilm formation on PS at 24, 48 and 72 h and also on a Ti plate for 72 h were determined. Some microbes preferred one surface over the other, whereas other microbes formed consistent levels of biofilm regardless of the surface material. Staphylococcus lugdunenensis was the most potent, while Enterococcus faecalis and Staphylococcus aureus were the weakest. Bacterial adhesion to hydrocarbon (BATH) tests indicated that the biofilm-forming abilities were not directly correlated with cell surface hydrophobicity (CSH). Finally, an external signal, EGCG, was applied to challenge the biofilm formation of each microorganism. EGCG regulated each microorganism's ability differently, though the change was consistent across surfaces for most pathogens. This study can help a better understanding of a broad spectrum of periprosthetic infection-associated pathogens by relative comparison of their biofilm-forming abilities.

Long-term clinical outcome of tendon transfer and tendon graft for extensor tendon ruptures in rheumatoid hands.

PURPOSE: To evaluate the objective and subjective long-term clinical outcomes of tendon transfer and tendon graft for extensor tendon ruptures in rheumatoid hands. METHODS: We evaluated the long-term clinical outcomes of tendon transfer and tendon graft for extensor tendon ruptures in rheumatoid hands of 37 patients (43 hands) followed up for a mean of 14 years (range, 10-21 years). RESULTS: The mean time from rupture to surgery was 13.1 weeks (range, 3-48 weeks). The mean extension lag of the metacarpophalangeal joint was 8.7° (range, 0-40°), the mean pulp-to-palm distance was 0.4 cm (range, 0-3 cm), and the mean overall satisfaction rate was 86.5 (range, 70-100). There were no significant differences in clinical outcomes between tendon transfers and tendon grafts. There was a significant correlation between extension lag of the metacarpophalangeal joint and overall satisfaction rate (R2 = 0.155; p = 0.009). Time to surgery was significantly correlated with extension lag of the metacarpophalangeal joint (R2 = 0.437; p = 0.001) in the tendon graft group. CONCLUSIONS: Both tendon transfer and tendon graft for extensor tendon ruptures in rheumatoid hands achieve satisfactory results that are maintained for an average of 14 years. In cases of tendon graft, the time to surgery should be considered, and there is concern over extension lag of MP joint. LEVEL OF EVIDENCE: IV.

Tracheal Glomus Tumor: A Case Report with CT Imaging Features.

BACKGROUND AND OBJECTIVES: Glomus tumors are rare benign tumors. The majority of them affect the skin the most and are rarer in the trachea, where the glomus bodies may not be present. Only scarce reports of tracheal glomus tumors have been reported solely with case reports of relevant articles. MATERIALS AND METHODS: A 53-year-old man, with a free previous medial history, presented to our hospital with tracheal mass which was incidentally found. He did not complain of any specific symptoms associated with the tracheal tumor. The contrast-enhanced chest computed tomography (CT) revealed an avid enhancing nodular lesion, which is similar to blood vessels, in the trachea, 3 cm above the carina level without definite airway obstruction. RESULTS: Successful tracheal resection and end-to-end anastomosis were performed on the patients; therefore, the final post-operative pathologic findings revealed a benign tracheal glomus tumor. The follow-up CT scan four months after operation showed complete removal of the tumor. CONCLUSION: Tracheal glomus tumors, even rare entities, could be considered as a differential diagnosis if a highly enhancing mass appears on CT images.

PD-L1 Expression Correlated with Clinicopathological Factors and Akt/Stat3 Pathway in Oral SCC.

Programmed cell death ligand 1 (PD-L1) is an immune checkpoint molecule that inhibits immune responses. The physiological and prognostic role of the PD-L1 signaling pathway in the oral maxillofacial region is unclear. This study aimed to investigate the role of PD-L1 in the progression of oral squamous cell carcinoma (OSCC). Furthermore, clinicopathological factors related to PD-L1 expression were examined in patients with OSCC through immunohistochemistry (IHC) of tissue sections and through an in vitro study in OSCC cells. The medical records, radiographic findings, and mortality referrals of 81 patients obtained from the National Statistical Office were reviewed. IHC was performed on tissue specimens of these patients to determine the expression levels of PD-L1, which showed significant statistical differences based on age, tumor size, TNM stage, cervical lymph node metastasis, and locoregional recurrence. Patients with a high PD-L1 expression had significantly poorer survival rates. Multivariate analysis using the Cox proportional model confirmed the high relative risk ratio for high PD-L1 expression, TNM stage, and neck node metastasis, all of which were significantly associated with a poor prognosis in patients with OSCC. The in vitro study showed that SAS and YD38 cells transfected with PD-L1 siRNA had significantly increased apoptosis, reduced proliferative capacity, and tumorigenicity.

A Randomised Control Trial Comparing Opioid and Paracetamol for Pain Control after Carpal Tunnel Release.

Background: Opioids are frequently used for pain control after carpal tunnel release (CTR). However, few studies have examined whether the use of opioids is necessary for pain control after CTR. The aim of this study is to compare the effectiveness of codeine versus paracetamol for pain control after CTR. Methods: This is a prospective comparison of consecutive patients' subjective perception of pain after outpatient CTR. Patients were randomised to receive either codeine or paracetamol for pain control after CTR. Visual analogue scale for pain of both groups was compared on the day of surgery and the first three post-operative days (POD) using non-inferiority test. Results: In the codeine group, the mean pain score was 5.2, 4.0, 2.6 and 1.6 on the day of surgery and the first, second and third days after surgery, respectively. In the paracetamol group, the mean VAS score in the same period was 4.3, 3.5, 2.8 and 2.3. There was no significant difference in the mean visual analogue pain scores between the two groups from the day of surgery to the third POD. Conclusions: Paracetamol was as effective as codeine for relieving the pain after outpatient CTR. Our results suggest that the clinicians might avoid unnecessary prescription of the opioid after outpatient CTR. Level of Evidence: Level III (Therapeutic).