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Purpose@#Perioperative transfusion is reported to be an independent risk factor not only for postoperative complications but also for early recurrence of periampullary carcinoma after pancreaticoduodenectomy (PD). The purpose of this study was to evaluate the safety and efficacy of ferric carboxymaltose (FCM) in reducing the need for perioperative transfusion in iron deficiency anemia patients scheduled for PD. @*Methods@#Twenty-two male patients (hemoglobin [Hb] 7 to <13 g/dL) and 18 female patients (Hb 7 to <12 g/dL) were enrolled in the study group and administered FCM 1–3 weeks before PD. The perioperative transfusion rate was the primary endpoint; morbidity, length of postoperative hospital stay, change in hematological parameters after FCM injection, and adverse effects of FCM were also investigated. @*Results@#The perioperative transfusion rate of the study group was 22.5% (9 of 40). Hb level was significantly higher on the day of the operation compared to baseline (P < 0.001). Levels of Hb, transferrin saturation, and ferritin were higher at the follow-up compared to baseline (P = 0.008, P = 0.033, and P < 0.001, respectively). @*Conclusions@#FCM administration was associated with a reduced need for perioperative transfusion and can safely stabilize hematological parameters.
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Purpose@#This study evaluated real-world compliance with surgical treatment according to Korea's gastric cancer treatment guidelines. @*Materials and Methods@#The 2018 Korean Gastric Cancer Treatment Guidelines were evaluated using the 2019 national survey data for surgically treated gastric cancer based on postoperative pathological results in Korea. In addition, the changes in surgical treatments in 2019 were compared with those in the 2014 national survey data implemented before the publication of the guidelines in 2018. The compliance rate was evaluated according to the algorithm recommended in the 2018 Korean guidelines. @*Results@#The overall compliance rates in 2019 were 83% for gastric resection extent, 87% for lymph node dissection, 100% for surgical approach, and 83% for adjuvant chemotherapy, similar to 2014. Among patients with pathologic stages IB, II, and III disease who underwent total gastrectomy, the incidence of splenectomy was 8.08%, a practice not recommended by the guidelines. The survey findings revealed that 48.66% of the patients who underwent gastrectomy had pathological stage IV disease, which was not recommended by the 2019 guidelines. Compared to that in 2014, the rate of gastrectomy in stage IV patients was 54.53% in 2014. Compliance rates were similar across all regions of Korea, except for gastrectomy in patients with stage IV disease. @*Conclusions@#Real-world compliance with gastric cancer treatment guidelines was relatively high in Korea.
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Purpose@#This study aimed to compare the long-term functional and patient-reported outcomes between intra-corporeal delta-shaped gastroduodenostomy and gastrojejunostomy after laparoscopic distal gastrectomy for gastric cancer. @*Materials and Methods@#We retrospectively reviewed clinicopathological data from 616 patients who had undergone laparoscopic distal gastrectomy for stage I gastric cancer between January 2015 and September 2020. Among them, 232 patients who had undergone delta-shaped anastomosis and another 232 who had undergone Billroth II anastomosis were matched using propensity scores. Confounding variables included age, sex, body mass index, physical status classification, tumor location, and T classification. Postoperative complications, nutritional outcomes, endoscopic findings, and quality of life (QoL) were compared between the 2 groups. @*Results@#No significant differences in postoperative complications or nutritional parameters between the two groups were observed. Annual endoscopic findings revealed more residual food and less bile reflux in the delta group (P<0.001) than in the Billroth II group. Changes of QoL were significantly different regarding emotional function, insomnia, diarrhea, reflux symptoms, and dry mouth (P=0.007, P=0.002, P=0.013, P=0.001, and P=0.03, respectively).Among them, the delta group had worse insomnia, reflux symptoms, and dry mouth within three months postoperatively. @*Conclusions@#Long-term nutritional outcomes and QoL were comparable between the delta and Billroth II groups. However, more residual food and worse short-term QoL regarding insomnia, reflux symptoms, and dry mouth were observed in the delta group. Longer fasting time before endoscopic evaluation and short-term symptom management would have been helpful for the delta group.
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Background@#Although most studies focused on the alignment or union of the tibia in same-level distal third tibiofibular fractures, the outcome of a concomitant fibular fracture is generally regarded as being of secondary importance in the literature. This study aimed to assess the outcomes of fibular fractures in same-level distal third tibiofibular fractures. @*Methods@#In this retrospective study, we enrolled 111 patients with same-level distal third tibiofibular fractures treated at our institute between January 2016 and August 2020. Tibial fractures were stabilized with intramedullary nailing, and the cases were divided into two groups based on whether they additionally underwent fibular fixation (group 1, 57 cases) or not (group 2, 54 cases). Clinical and radiographic outcomes were used for the evaluation of tibial and fibular alignments, union of the tibia and fibula, number of interlocking screws in the distal tibial fragment, range of motion of the ankle joint, and complications. @*Results@#No statistically significant differences in the tibial union rate or mean tibial alignment were observed between the two groups on either the immediate postoperative or final radiographs. The fibular union rate in group 1 was significantly higher than that in group 2 (fibular nonunion, 0 vs. 15; p < 0.001). Statistically significant differences in fibular displacement were observed on immediate postoperative radiographs between patients with fibular union and those without it. At the final follow-up, the mean range of ankle motion and lower extremity functional scale scores did not differ between the two groups. @*Conclusions@#Regardless of whether fibular fixation was performed, the overall tibial alignment with intramedullary nailing was well restored and the union rate of the tibia was comparable in the two groups. Fibular nonunion is not uncommon in unfixed fibula fractures. Displacement of the fibula as seen on immediate postoperative radiographs was related to fibular nonunion.
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Background@#This study aimed to evaluate the co-administration effect of atelocollagen combined with hyaluronic acid (HA) injections fortreatment of full-thickness rotator cuff tear (RCT). @*Methods@#Eighty patients who underwent arthroscopic rotator cuff repair for full-thickness RCT from March 2018 to November 2019 wereenrolled. The patients were randomly allocated to the following groups: combined atelocollagen and HA injection (group I, n=28), only HAinjection (group II, n=26), and no injection (group III, n=26). Clinical outcomes were assessed at 3, 6, and 12 months after surgery usingthe American Shoulder and Elbow Surgeons score, visual analog scale pain score, functional scores (pain visual analog scale, function visualanalog score), and range of motion. Magnetic resonance imaging was performed 12 months after surgery to evaluate rotator cuff integrity. @*Results@#Preoperative demographic data and postoperative clinical outcomes did not differ significantly among the three groups (p>0.05).However, in group I, the number of steroid injections after surgery was significantly lower than that in the other groups (p=0.011). The retear rate on follow-up magnetic resonance imaging was significantly higher in group II (9.5%, n=2) and group III (13.6%, n=3) than ingroup I (0%, p=0.021). @*Conclusions@#Co-administration of atelocollagen and HA improves healing of the rotator cuff and increases the integrity of the rotator cuffrepair site. This study provides encouraging evidence for use of combined atelocollagen-HA injections to treat patients with full-thicknessRCT.
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Purpose@#Patients who have undergone gastrectomy have unique symptoms that are not appropriately assessed using currently available tools. This study developed and validated a symptom-focused quality of life (QoL) questionnaire for patients who have received gastrectomy for gastric cancer. Materials and Methods Based on a literature review, patient interviews, and expert consultation by the KOrean QUality of life in Stomach cancer patients Study group (KOQUSS), the initial item pool was developed. Two large-scale developmental studies were then sequentially conducted for exploratory factor analyses for content validity and item reduction. The final item pool was validated in a separate cohort of patients and assessed for internal consistency, test-retest reliability, construct validity, and clinical validity. @*Results@#The initial questionnaire consisted of 46-items in 12 domains. Data from 465 patients at 11 institutions, followed by 499 patients at 13 institutions, were used to conduct item reduction and exploratory factor analyses. The final questionnaire (KOQUSS-40) comprised 40 items within 11 domains. Validation of KOQUSS-40 was conducted on 413 patients from 12 hospitals. KOQUSS-40 was found to have good model fit. The mean summary score of the KOQUSS-40 was correlated with the EORTC QLQ-C30 and STO22 (correlation coefficients, 0.821 and 0.778, respectively). The KOQUSS-40 score was also correlated with clinical factors, and had acceptable internal consistency (> 0.7). Test-retest reliability was greater than 0.8. Conclusion The KOQUSS-40 can be used to assess QoL of gastric cancer patients after gastrectomy and allows for a robust comparison of surgical techniques in clinical trials.
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Background@#On February 2, 2017, the surgical team of ten board-certified hand specialists of W Hospital in Korea successfully performed the nation's first hand transplantation at Yeungnam University Medical Center (YUMC). This paper reports on the legal, financial, and cultural hurdles that were overcome to open the way for hand transplantation and its functional outcomes at 36 months after the operation. @*Methods@#W Hospital formed a memorandum of understanding with Daegu city and YUMC to comply with government regulations regarding hand transplantation. Campaigns were initiated in the media to increase public awareness and understanding. With the city's financial and legal support and the university's medical cooperation, a surgical team performed a left distal forearm hand transplantation from a brain-dead 48-year-old man to a 35-year-old left-handed man. @*Results@#With this successful allotransplantation, the Korean Act on Organ Transplantation has now been amended to include hand transplantation. Korean national health insurance has also begun covering hand transplantation. Functional outcome at 36 months after the operation showed satisfactory progress in both motor and sensory functions. The disabilities of the arm, shoulder, and hand score were 23. The final Hand Transplantation Score was 90 points. Functional brain magnetic resonance imaging shows significant cortical reorganization of the corticospinal tract, and reinnervation of intrinsic muscle is observed. @*Conclusions@#Hand transplantation at the distal forearm shows very satisfactory outcomes in functional, aesthetical, and psychological aspects. Legal and financial barriers against hand transplantation have long been the most burdensome issues. Despite this momentous success, there have been no other clinical applications of vascularized composite allotransplantation due to the limited acceptance by Korean doctors and people. Further public education campaigns for vascularized composite allotransplantation are needed to increase awareness and acceptance.
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Purpose@#Although there are several studies on the incidence and risk factors for incisional hernia (IH) after open surgery, data about IH after minimally invasive surgery (MIS) for gastric cancer is rare. This study aimed to identify the incidence and risk factors for IH after MIS in gastric cancer patients. @*Methods@#We analyzed the clinicopathologic data of patients who had laparoscopic or robotic gastric cancer surgeries between January 2006 and July 2019 at National Cancer Center, South Korea. Risk factors for development of IH were investigated with univariate and multivariate analyses. @*Results@#A total of 2,769 patients underwent laparoscopic-assisted or robot-assisted gastrectomy with extracorporeal gastric resection and reconstruction, while 1,469 underwent totally laparoscopic or totally robotic gastrectomy (TLRG) with intracorporeal gastric resection and reconstruction. IH repair was performed in 23 patients (0.5%) after gastric cancer surgery. In the multivariate analysis, female sex (odds ratio [OR], 5.23; 95% confidence interval [CI], 2.03–13.43; p = 0.001), high body mass index (BMI) of ≥25 kg/m2 (OR, 4.23; 95% CI, 1.73–10.35; p = 0.002), larger tumor size (OR, 21.67; 95% CI, 5.37–87.34; p < 0.001), and intracorporeal procedure (OR, 5.63; 95% CI, 2.15–14.61; p < 0.001) were independent significant risk factors for IH. @*Conclusion@#IH after MIS for gastric cancer is not common. Female sex, high BMI, large tumor size, and intracorporeal procedure were significant risk factors for it in this study. Therefore, in patients with risk factors, surgeons should cautiously close the abdominal wall access wound after MIS for gastric cancer, to prevent IH.
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Purpose@#Although there are several studies on the incidence and risk factors for incisional hernia (IH) after open surgery, data about IH after minimally invasive surgery (MIS) for gastric cancer is rare. This study aimed to identify the incidence and risk factors for IH after MIS in gastric cancer patients. @*Methods@#We analyzed the clinicopathologic data of patients who had laparoscopic or robotic gastric cancer surgeries between January 2006 and July 2019 at National Cancer Center, South Korea. Risk factors for development of IH were investigated with univariate and multivariate analyses. @*Results@#A total of 2,769 patients underwent laparoscopic-assisted or robot-assisted gastrectomy with extracorporeal gastric resection and reconstruction, while 1,469 underwent totally laparoscopic or totally robotic gastrectomy (TLRG) with intracorporeal gastric resection and reconstruction. IH repair was performed in 23 patients (0.5%) after gastric cancer surgery. In the multivariate analysis, female sex (odds ratio [OR], 5.23; 95% confidence interval [CI], 2.03–13.43; p = 0.001), high body mass index (BMI) of ≥25 kg/m2 (OR, 4.23; 95% CI, 1.73–10.35; p = 0.002), larger tumor size (OR, 21.67; 95% CI, 5.37–87.34; p < 0.001), and intracorporeal procedure (OR, 5.63; 95% CI, 2.15–14.61; p < 0.001) were independent significant risk factors for IH. @*Conclusion@#IH after MIS for gastric cancer is not common. Female sex, high BMI, large tumor size, and intracorporeal procedure were significant risk factors for it in this study. Therefore, in patients with risk factors, surgeons should cautiously close the abdominal wall access wound after MIS for gastric cancer, to prevent IH.
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Background@#This study aimed to evaluate the co-administration effect of atelocollagen combined with hyaluronic acid (HA) injections fortreatment of full-thickness rotator cuff tear (RCT). @*Methods@#Eighty patients who underwent arthroscopic rotator cuff repair for full-thickness RCT from March 2018 to November 2019 wereenrolled. The patients were randomly allocated to the following groups: combined atelocollagen and HA injection (group I, n=28), only HAinjection (group II, n=26), and no injection (group III, n=26). Clinical outcomes were assessed at 3, 6, and 12 months after surgery usingthe American Shoulder and Elbow Surgeons score, visual analog scale pain score, functional scores (pain visual analog scale, function visualanalog score), and range of motion. Magnetic resonance imaging was performed 12 months after surgery to evaluate rotator cuff integrity. @*Results@#Preoperative demographic data and postoperative clinical outcomes did not differ significantly among the three groups (p>0.05).However, in group I, the number of steroid injections after surgery was significantly lower than that in the other groups (p=0.011). The retear rate on follow-up magnetic resonance imaging was significantly higher in group II (9.5%, n=2) and group III (13.6%, n=3) than ingroup I (0%, p=0.021). @*Conclusions@#Co-administration of atelocollagen and HA improves healing of the rotator cuff and increases the integrity of the rotator cuffrepair site. This study provides encouraging evidence for use of combined atelocollagen-HA injections to treat patients with full-thicknessRCT.
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Purpose@#Patients who have undergone gastrectomy have unique symptoms that are not appropriately assessed using currently available tools. This study developed and validated a symptom-focused quality of life (QoL) questionnaire for patients who have received gastrectomy for gastric cancer. Materials and Methods Based on a literature review, patient interviews, and expert consultation by the KOrean QUality of life in Stomach cancer patients Study group (KOQUSS), the initial item pool was developed. Two large-scale developmental studies were then sequentially conducted for exploratory factor analyses for content validity and item reduction. The final item pool was validated in a separate cohort of patients and assessed for internal consistency, test-retest reliability, construct validity, and clinical validity. @*Results@#The initial questionnaire consisted of 46-items in 12 domains. Data from 465 patients at 11 institutions, followed by 499 patients at 13 institutions, were used to conduct item reduction and exploratory factor analyses. The final questionnaire (KOQUSS-40) comprised 40 items within 11 domains. Validation of KOQUSS-40 was conducted on 413 patients from 12 hospitals. KOQUSS-40 was found to have good model fit. The mean summary score of the KOQUSS-40 was correlated with the EORTC QLQ-C30 and STO22 (correlation coefficients, 0.821 and 0.778, respectively). The KOQUSS-40 score was also correlated with clinical factors, and had acceptable internal consistency (> 0.7). Test-retest reliability was greater than 0.8. Conclusion The KOQUSS-40 can be used to assess QoL of gastric cancer patients after gastrectomy and allows for a robust comparison of surgical techniques in clinical trials.
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Purpose@#Recovery from exercise is a vulnerable phase that has been linked to increased susceptibility to sudden cardiovascular events. Cigarette smoking increases the risk of cardiovascular mortality and morbidity. We tested the hypothesis that postexercise cigarette smoking would attenuate hemodynamics and vascular function during recovery from exercise in young men. @*Methods@#Thirteen habitual smokers (age, 22±3 years; body mass index, 25.1±3.6 kg/m 2 ) participated in (1) cigarette smoking (0.6 mg nicotine) and (2) sham smoking (SHAM) immediately postexercise (30 minutes on a treadmill;40% to 60% of heart rate [HR] reserve) in a randomized order. Assessments were hemodynamics (HR, rate-pressure product [RPP], brachial and central artery blood pressures) and vascular function (arterial stiffness via carotid-femoral pulse wave velocity [PWV]; conduit vessel function via brachial artery flow-mediated dilation [FMD]). All variables were assessed at baseline, 10 minutes, and 30 minutes postexercise, except for FMD (baseline and 30 minutes postexercise). @*Results@#Compared with the SHAM trial, cigarette smoking increased HR, RPP, and brachial and central blood pressures postexercise (interaction, p＜ 0.05). PWV reduced and FMD increased postexercise in the SHAM trial, while cigarette smoking attenuated exercise-induced improvements (interaction, p＜ 0.05). @*Conclusion@#Cigarette smoking attenuated hemodynamic recovery and an improvement in arterial stiffness and conduit vessel function in young habitual smokers, thereby providing evidence for the negative effects of cigarette smoking during recovery from exercise.
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Purpose@#Quality of life (QOL) has become important in the trend of emphasizing patient satisfaction. This study aimed to evaluate the QOL in patients who underwent laparoscopic or robotic gastrectomy for gastric cancer. @*Methods@#A prospective trial was performed involving patients who underwent laparoscopic or robotic gastrectomy for primary gastric cancer at 11 hospitals in Korea. Within this comparative trial, QOL, postoperative pain, and long-term complications were exanimated. The quality-of-life questionnaire (QLQ)-C30 and QLQ-STO22 developed by the European Organization for Research and Treatment of Cancer were used for the QOL survey. We compared the data after dividing it into several types of characteristics as follows; device (robotic or laparoscopic), operation type, pathological stage, and sex.Biased components were extracted by logistic regression analysis. Propensity score matching was applied to the data set with the biased components. @*Results@#In total, 434 patients (211 for laparoscopic surgery and 223 for robotic surgery) were enrolled, out of which 321 patients who responded to both preoperative and postoperative surveys were selected for analysis. Robotic gastrectomy was not different from laparoscopic gastrectomy with respect to postoperative QOL. Distal gastrectomy showed better scores than total gastrectomy in terms of role functioning, social functioning, fatigue, nausea/vomiting, pain, dyspnea, constipation, financial difficulties, dysphagia, eating restrictions, anxiety, taste, and body image. Male patients showed better scores on the 19 scales compared to female patients. @*Conclusion@#Robotic and laparoscopic approaches for gastric cancer surgery did not differ from each other with respect to QOL. Distal gastrectomy resulted in better QOL than total gastrectomy.
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Purpose@#Various reconstruction methods have been proposed to reduce reflux after proximal gastrectomy, and we report here a double shouldering technique. The purpose of this study is to compare the novel double shouldering technique with conventional esophagogastrostomy in terms of short term and 3-year clinical outcome. @*Methods@#A retrospective observational case control study was performed on 63 patients for cT1N0 upper third gastric cancer who underwent proximal gastrectomy from January 2012 to November 2016 at the National Cancer Center, Korea. There were 26 patients with conventional esophagogastrostomy, and 37 patients with novel double shouldering technique. The primary outcome was endoscopic reflux esophagitis findings one and three year after surgery according to Los Angeles classification. Secondary outcomes were short term surgical outcome and reflux symptom. @*Results@#There was no significant difference in reflux esophagitis on endoscopic findings at 1 and 3 years after surgery between the two group. The double shouldering (DS) technique group showed significantly better postoperative outcomes with bile reflux at one and three years via endoscopic findings versus conventional esophagogastrostomy (CEG). Operative time and hospital stay were significantly shorter in the CEG group than the DS group. There was no significant difference in terms of reflux symptoms and complications. @*Conclusion@#This novel DS technique is a reconstruction method for use after proximal gastrectomy. It did not show a significant clinical benefit. Development of surgical techniques and further study is needed to identify the optimal reconstruction method after proximal gastrectomy.
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Purpose@#Various reconstruction methods have been proposed to reduce reflux after proximal gastrectomy, and we report here a double shouldering technique. The purpose of this study is to compare the novel double shouldering technique with conventional esophagogastrostomy in terms of short term and 3-year clinical outcome. @*Methods@#A retrospective observational case control study was performed on 63 patients for cT1N0 upper third gastric cancer who underwent proximal gastrectomy from January 2012 to November 2016 at the National Cancer Center, Korea. There were 26 patients with conventional esophagogastrostomy, and 37 patients with novel double shouldering technique. The primary outcome was endoscopic reflux esophagitis findings one and three year after surgery according to Los Angeles classification. Secondary outcomes were short term surgical outcome and reflux symptom. @*Results@#There was no significant difference in reflux esophagitis on endoscopic findings at 1 and 3 years after surgery between the two group. The double shouldering (DS) technique group showed significantly better postoperative outcomes with bile reflux at one and three years via endoscopic findings versus conventional esophagogastrostomy (CEG). Operative time and hospital stay were significantly shorter in the CEG group than the DS group. There was no significant difference in terms of reflux symptoms and complications. @*Conclusion@#This novel DS technique is a reconstruction method for use after proximal gastrectomy. It did not show a significant clinical benefit. Development of surgical techniques and further study is needed to identify the optimal reconstruction method after proximal gastrectomy.
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Purpose@#We devised omental free-shaped flap reinforcement on anastomosis and dissected area (OFFROAD) following reconstruction after gastrectomy. This study aimed to evaluate its safety and early clinical outcomes. @*Methods@#One hundred fifty-six patients who underwent totally laparoscopic distal gastrectomy with delta anastomosis from July 2016 to April 2018 were divided into the OFFROAD group (80 patients) and non-OFFROAD group (76 patients). Differences in short-term operative outcomes and surgical complications were compared between the groups. All patients’ inflammatory marker levels were measured to monitor flap necrotic change and inflammatory reactions. The clinical features of both groups in terms of anastomotic leakage were transcribed. @*Results@#Pain score in postoperative day1 was significantly lower in OFFROAD group. The serum WBC count on POD 1 was significantly lower in OG than in NOG. The mean duration of OFFROAD was shorter than five minutes. There were no statistical differences in short-term outcomes and surgical complications between two groups. Anastomotic leakage occurred in three patients in each group and there was no statistical difference in incidence. However, clinical features were notable when anastomotic leakage occurs. Unlike all three patients of non-OFFROAD group manifested every features of peritonitis, each patient of OFFROAD group just manifested only one of the three. @*Conclusion@#This study showed the safety and feasibility of OFFROAD procedure. It might mitigate septic complications when there is an anastomotic leakage. Additional large-scale study is needed to assess the versatile usefulness of OFFROAD aside from its role as a physical barrier.
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Purpose@#Recently, non-exposure simple suturing endoscopic full-thickness resection (NESSEFTR) was developed to prevent tumor exposure to the peritoneal cavity. This study aimed to evaluate the feasibility of NESS-EFTR with sentinel basin dissection for early gastric cancer (EGC). @*Materials and Methods@#This was the prospective SENORITA 3 pilot. From July 2017 to January 2018, 20 patients with EGC smaller than 3 cm without an absolute indication for endoscopic submucosal dissection were enrolled. The sentinel basin was detected using Tc 99m -phytate and indocyanine green, and the NESS-EFTR procedure was performed when all sentinel basin nodes were tumor-free on frozen pathologic examination. We evaluated the complete resection and intraoperative perforation rates as well as the incidence of postoperative complications. @*Results@#Among the 20 enrolled patients, one dropped out due to large tumor size, while another underwent conventional laparoscopic gastrectomy due to metastatic sentinel lymph nodes. All NESS-EFTR procedures were performed in 17 of the 18 other patients (94.4%) without conversion, and the complete resection rate was 83.3% (15/18). The intraoperative perforation rate was 27.8% (5/18), and endoscopic clipping or laparoscopic suturing or stapling was performed at the perforation site. There was one case of postoperative complications treated with endoscopic clipping; the others were discharged without any event. @*Conclusions@#NESS-EFTR with sentinel basin dissection is a technically challenging procedure that obtains safe margins, prevents intraoperative perforation, and may be a treatment option for EGC after additional experience.
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Purpose@#The guidelines for pathological evaluation of early gastric cancer (EGC) recommend wider section intervals for surgical specimens (5–7 mm) than those for endoscopically resected specimens (2–3 mm). Studies in surgically resected EGC specimens showed not negligible lymph node metastasis risks in EGCs meeting the expanded criteria for endoscopic submucosal dissection (ESD). @*Materials and Methods@#This retrospective study included 401 EGC lesions with an endoscopic size of ≤ 30 mm detected in 386 patients. Pathological specimens obtained by ESD or surgery were cut into 2-mm section intervals for reference. Submucosal or lymphovascular invasion (LVI) was evaluated arbitrarily in 4- or 6-mm section intervals. McNemar's tests compared the differences between submucosal and LVI. @*Results@#Submucosal invasion was detected in 29.2% (117/401) and LVI in 9.5% (38/401) at 2-mm interval. The submucosal invasion detection rates in 4-mm intervals decreased to 88.0% or 90.6% (both P<0.001), while the LVI detection rates decreased to 86.8% or 57.9% (P=0.025 and P<0.001, respectively). In 6-mm intervals, the submucosal and LVI detection rates decreased further to 72.7–80.3% (P<0.001 for all three sets) and 55.3–63.2% (P<0.001 for all three sets), respectively. Among 150 out-of-indication cases at 2-mm interval, 4–10 (2.7%–6.7%) at 4-mm intervals, and 10–17 (6.7%–11.3%) at 6-mm intervals were misclassified as lesions meeting the curative resection criteria due to the underestimation of submucosal or LVI. @*Conclusions@#After ESD, the 2-mm wide section interval was suitable for the pathological evaluation of focal submucosal or LVI. Thus, if an EGC lesion meets the expanded criteria for the ESD specimen pathological evaluation, it could be safely followed up.
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Three randomized control trials (RCTs), published in 2013, investigated efficacy of mechanical thrombectomy in large vessel occlusions and did not show better results compared to intravenous (IV) recombinant tissue-type plasminogen activator (tPA) alone. However, most clinicians treating stroke consider mechanical thrombectomy as the standard treatment rather than using IV tPA alone. This paradigm shift was based on five RCTs investigating efficacy of mechanical thrombectomy in acute ischemic stroke conducted from 2010 to 2015. They demonstrated that mechanical thrombectomy was effective and safe in acute ischemic stroke with anterior circulation occlusion when performed within 6 hours of stroke onset. There are four reasons underlying the different results observed between the trials conducted in 2013 and 2015. First, the three RCTs of 2013 used low-efficiency thrombectomy devices. Second, the three RCTs used insufficient image selection criteria. Third, following the initial presentation at the hospital, reperfusion treatment required a long time. Fourth, the three RCTs showed a low rate of successful recanalization. Time is the most important factor in the treatment of acute ischemic stroke. However, current trends utilize advanced imaging techniques, such as diffusion-weighted imaging and multi-channel computer tomographic perfusion, to facilitate the detection of core infarction, penumbra, and collateral flows. These efforts demonstrate that patient selection may overcome the barriers of time in specific cases.
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Objective@#: The purpose of this study is identify the operation status of the neurosurgical care units (NCUs) in neurosurgical residency training hospitals nationwide and determine needed changes by comparing findings with those obtained from the Korean Neurosurgical Society (KNS) and Korean Society of Neurointensive Care Medicine (KNIC) survey of 2010.Method : This survey was conducted over 1 year in 86 neurosurgical residency training hospitals and two neurosurgery specialist hospitals and focused on the following areas : 1) the current status of the infrastructure and operating systems of NCUs in Korea, 2) barriers to installing neurointensivist team systems, 3) future roles of the KNS and KNIC, and 4) a handbook for physicians and practitioners in NCUs. We compared and analyzed the results of this survey with those from a KNIC survey of 2010. @*Results@#: Seventy seven hospitals (87.5%) participated in the survey. Nineteen hospitals (24.7%) employed a neurointensivist or faculty member; Thirty seven hospitals (48.1%) reported high demand for neurointensivists, and 62 hospitals (80.5%) stated that the mandatory deployment of a neurointensivist improved the quality of patient care. Forty four hospitals (57.1%) believed that hiring neurointensivist would increase hospital costs, and in response to a question on potential earnings declines. In terms of potential solutions to these problems, 70 respondents (90.9%) maintained that additional fees were necessary for neurointensivists’ work, and 64 (83.1%) answered that direct support was needed of the personnel expenses for neurointensivists. @*Conclusion@#: We hope the results of this survey will guide successful implementation of neurointensivist systems across Korea.