Purpose: Enhanced Recovery After Surgery (ERAS) protocols have demonstrated significant benefits, but their safety and effectiveness in high-risk patients remain unclear. This study evaluated clinical postoperative outcomes in elderly patients and those with comorbidities undergoing colon cancer surgery. Methods: This retrospective cohort study included 1,035 patients who underwent elective colon cancer surgery from 2017 to 2022. A standardized 25-element ERAS protocol was implemented across all groups. Patients were categorized into a control group (aged <70 years without comorbidities, n = 534) and high-risk groups including elderly patients (≥70 years, n = 312) and those with cardiac (n = 60), pulmonary (n = 81), renal (n = 24), or hepatic disease (n = 24). Results: ERAS compliance rates were significantly lower in all high-risk groups compared to controls (79.39% ± 10.9%), with renal disease patients showing the most pronounced reduction (69.69% ± 17.0%). Post-hoc analysis revealed that only renal disease patients demonstrated significantly higher complication rates (45.8% vs. 18.9%, P < 0.01). Despite lower compliance, multivariate analysis revealed ERAS compliance ≥70% as the strongest independent predictor of both length of stay (odds ratio [OR], 0.139; P < 0.001) and complications (OR, 0.298; P < 0.001), substantially outweighing patient risk factors. After adjusting for treatment factors, patient comorbidity groups showed no independent association with clinical outcomes. Conclusion ERAS protocols can be successfully implemented in high-risk patients with appropriate attention to compliance optimization. Treatment factors, particularly ERAS adherence, consistently outweigh patient risk factors in determining outcomes, and well-tailored ERAS implementation should be considered with high-risk patients for perioperative care.

Purpose: Due to its rarity, treatment guidelines for appendiceal cancer have traditionally followed those established for colorectal cancer, despite showing distinct histologic and clinical features. This study aimed to compare the clinicopathologic characteristics and long-term oncologic outcomes of appendiceal cancer with those of right-sided colon cancers. Methods: We retrospectively reviewed the records of patients with stage I–III appendiceal, cecal, or ascending colon cancer who underwent curative resection between 2010 and 2020 at our center. A 1:3:3 exact matching for age, sex, TNM stage, and adjuvant chemotherapy was performed. Survival outcomes were analyzed using the Kaplan-Meier and Cox regression methods. Results: Overall, 245 patients with appendiceal cancer (n = 35), ascending colon cancer (n = 105), and cecal cancer (n = 105) were analyzed. Appendiceal cancer exhibited a higher proportion of T4 tumors and fewer harvested lymph nodes compared with ascending or cecal cancers. The mean follow-up duration was 9.5 years. The 5- and 10-year overall survival rates were lower in appendiceal cancer (66.2% and 52.9%) than in ascending (91.2% and 78.4%) or cecal cancer (88.5% and 78.3%). Similarly, the 10-year disease-free survival rate was lower in appendiceal cancer (59.2%) compared with ascending (83.1%) and cecal cancers (78.4%). Cox regression analysis identified age (≥65 years), perforation, nodal metastasis, and lymphovascular invasion as independent predictors of poor prognosis. Conclusion Appendiceal cancer exhibited significantly worse long-term survival compared to cecal or ascending colon cancer. Tumor perforation, nodal metastasis, and lymphovascular invasion were adverse prognostic factors for overall and disease-free survival.

Phyllodes tumors are rare biphasic fibroepithelial breast neoplasms classified as benign, borderline, or malignant. Despite their rarity, malignant variants carry higher risks of recurrence and metastasis. This review synthesizes current evidence on their clinical, histopathological, and molecular characteristics, including treatment strategies and prognostic factors, emphasizing tailored management. We performed a comprehensive literature review to summarize knowledge on clinical presentation, imaging, histopathological features, surgical treatment, adjuvant therapy, and outcomes. Recent genomic and molecular research was also evaluated to identify future directions. Persistent challenges include a lack of consensus on optimal surgical margins, adjuvant radiotherapy, and follow-up protocols, highlighting the need for larger, high-quality studies. Advances in molecular profiling suggest potential for targeted therapies, especially in aggressive or metastatic cases. Due to clinical heterogeneity and the limited accuracy of core biopsies, definitive grading based on surgical histopathology remains essential for treatment planning. This review offers an updated perspective on phyllodes tumor management, identifies critical gaps, and suggests priorities for future research.

Purpose: This study aimed to evaluate the outcomes and learning curve of laparoscopic duodenal atresia repair performed by a single pediatric surgeon over 10 years and compare it with traditional open repair. Methods: This retrospective study included 28 neonates who underwent surgical repair for congenital duodenal atresia between 2010 and 2024 at a tertiary center. In total, 20 patients underwent laparoscopic repair by a single surgeon between 2013 and 2024, whereas 8 underwent open repair between 2010 and 2014. Clinical characteristics, operative times, feeding milestones, and complications were compared. To assess the effect of surgical experience, the laparoscopic cohort was divided into early and late phases. Results: The median operative time was longer in the laparoscopic group than in the open group (124 minutes vs. 80 minutes, P < 0.05). However, laparoscopic patients achieved earlier oral intake (5 days vs. 9 days, P = 0.021) and full enteral feeding (8 days vs. 13 days, P = 0.028). No significant differences were observed in complication rates. The operative time improved significantly throughout the laparoscopic series, decreasing from 155 minutes in early cases to 110 minutes in later cases (P = 0.039). No conversions or anastomotic leaks were observed in the late laparoscopic group. Conclusion Laparoscopic duodenal atresia repair performed by a single surgeon is safe and effective, allowing for faster postoperative recovery than open repair. With accumulated experience, operative efficiency improves significantly, supporting its broader adoption in neonatal surgery.

The operating room remains a paradox: it is one of the most sensor-rich environments in the hospital, yet it produces largely underutilized data. While surgical artificial intelligence (AI) has achieved remarkable progress in recent years, the day-to-day practice of surgery has changed little, with most systems confined to passive decision support. This narrative review traces the evolution of surgical AI from perception to cognition to early forms of action, arguing that the next paradigm shift requires “physical AI”—systems capable of meaningful physical interaction and autonomous execution. The clinical motivation for pursuing physical AI is clear: surgical outcomes vary substantially across surgeons, access is constrained by workforce shortages, and high-quality care remains tied to the scarcity of human expertise. If reliable autonomous systems can be developed, surgery could become more standardized, scalable, and reproducible.However, a critical bottleneck persists: the scarcity of synchronized, multimodal training data. The fundamental barrier is environmental rather than algorithmic, as most operating rooms are not configured to measure surgical practice objectively. We propose reconceptualizing the operating room as a “Surgical Data Factory”—a closed-loop ecosystem designed to capture multimodal signals, structure them via consensus taxonomies linked to outcomes, and utilize them for training, validation, and monitoring. Surgeons must transition from passive users to active architects of this infrastructure.Investing in systematic data governance is the prerequisite for responsibly developing, validating, and scaling physical AI in surgery.

Purpose: In the past decade, advancements in robotic surgery have significantly expanded its application into diverse fields, including urological, gastrointestinal, hepatobiliary, and gynecological procedures. However, comparative outcome data between robotic and laparoscopic cholecystectomy (LC) in pediatric patients are scarce. Therefore, this study aims to evaluate the clinical utility of robotic cholecystectomy (RC) by comparing its outcomes with those of LC. Methods: A retrospective study was conducted using patient records from a single institution involving individuals who underwent RC or LC. Patients who had undergone open cholecystectomy or previous open abdominal surgeries were excluded. Matching criteria included operative age, body mass index, and total bilirubin levels. Baseline and outcome variables were compared using appropriate statistical tests to assess significance. Results: Groups were well-matched for demographic variables. Regression-adjusted analysis showed no significant difference in operative time between RC and LC and hospital stay length (P > 0.05). Complication rates were higher in the RC group (25.0% vs. 3.4%, P = 0.040) and analgesic use was significantly higher in the RC group (adjusted odds ratio, ∞; P < 0.001), as all RC patients received postoperative analgesics. Conclusion The baseline characteristics between the 2 groups were well-matched. While most outcomes showed no statistically significant differences, the RC group had significantly higher postoperative analgesic use and complication rates. These findings highlight the need for careful patient selection and further studies to evaluate the safety profile of RC in pediatric patients.

Purpose: Postoperative complications following gastric cancer surgery significantly impact patient outcomes, yet standardized definitions for these events have not been consistently applied across institutions in Korea. This study aimed to develop a consensus-based, standardized complication classification system specific to gastrectomy for gastric cancer as part of the Korean Quality Improvement Platform in Surgery (K-QIPS) initiative. Methods: As part of K-QIPS, a dedicated task force team (TFT) was formed with surgical experts from fourteen high-volume hospitals across Korea. The TFT conducted ten formal meetings to review existing literature and international guidelines, and incorporated findings from randomized controlled trials. The final complication list was developed through expert consensus and structured into a standardized framework. A Data Entry Manual was created to support consistent data collection by surgical clinical reviewers. Results: The TFT defined specific postoperative complications following gastrectomy for gastric cancer, including anastomotic leakage, duodenal stump leakage, pancreatic fistula, intra-abdominal and luminal bleeding, delayed gastric emptying, and internal hernia. Notably, internal hernia was described in standardized form for the first time. General complications were developed first and overlapped in part with the gastric cancer-specific list. The task force also produced a Data Entry Manual that provides practical instructions to ensure consistency and accuracy in complication reporting. Conclusion This nationwide consensus initiative established the first standardized complication classification system for gastric cancer surgery in Korea. The proposed definitions and data entry system are expected to improve complication reporting, enable multicenter research, support surgical quality benchmarking, and ultimately enhance patient outcomes.

Background: Melanoma, though less common than other cutaneous malignancies, remains clinically significant. In Asia, acral and nailunit melanoma—less related to ultraviolet exposure—pose diagnostic and reconstructive challenges. Clarifying temporal and anatomic trends in melanoma within plastic surgery practice may enhance early recognition and guide standardized reconstruction. Methods: We retrospectively reviewed 960 surgically treated cutaneous malignancies (2000–2022) in a tertiary plastic surgery department, classifying tumors as basal cell carcinoma (BCC), squamous cell carcinoma (SCC), malignant melanoma (MM), or others. For MM, we analyzed anatomic site (headeck, trunk, non-acral extremity, acral), sex, age, comorbidities, and lifestyle factors, comparing period A (2000–2017) with period B (2018–2022). Group comparisons used the chi-square or Fisher exact test and the Mann-Whitney test. Incidence rates were calculated with Poisson confidence intervals; between-period differences were evaluated using exact binomial tests and rate ratios. Results: Of 960 tumors, BCC, SCC, MM, and others comprised 47.4%, 44.3%, 5.8%, and 2.5%. MM site distribution was heterogeneous: headeck 14.3%, trunk 30.4%, non-acral extremity 21.4%, acral 33.9%. Distribution shifted significantly (chi-square p= 0.043), with headeck lesions decreasing from 28.0% to 3.2% and trunk and acral lesions each increasing to 38.7%. Annual MM incidence rose from 1.39 to 6.20 cases per year (rate ratio, 4.46; p< 0.001). Hypertension (64.5%) and diabetes (35.5%) were more frequent in period B. Conclusion Recent years showed a sharply increased MM caseload and redistribution toward trunk and acral sites with greater metabolic comorbidity, reflecting both epidemiologic change and evolving detection or referral patterns.

Meningioma arises from arachnoid cap cells and is a common intracranial neoplasm; however, primary extracranial meningioma is rare, accounting for only 1%–2% of cases and is therefore frequently misdiagnosed. We report a case of primary extracranial meningioma arising in the temporal region without intracranial or dural involvement. A 66-year-old woman presented with a slowly enlarging mass in the left temporal region for approximately 10 years, without pain or limitation of mouth opening. Computed tomography revealed a 2.1× 2.7× 4.6 cm mass between the temporalis muscle and the skull, with no intracranial extension. Fine-needle aspiration suggested a spindle-cell neoplasm, and complete excision was performed via a coronal scalp incision for diagnosis and treatment. Histopathologic and immunohistochemical examination confirmed a World Health Organization grade II extracranial meningioma. The patient recovered without complications. Postoperative magnetic resonance imaging showed no residual tumor, and adjuvant radiotherapy was not administered. Surveillance imaging every 6 months demonstrated no recurrence over 3.5 years. This case highlights the importance of including extracranial meningioma in the differential diagnosis of temporal masses and supports complete excision as effective management. A brief literature review is included.

Full-thickness skin grafting (FTSG) is frequently used to reconstruct facial soft tissue defects because it provides favorable color and texture matching. Secondary cystic lesions, including milia or epidermal cysts, that develop after FTSG are rare. A 29-year-old woman sustained a dog-bite injury resulting in a 4.5× 2.5 cm defect involving the philtrum and upper lip. The philtrum was reconstructed using a full-thickness skin graft harvested from the retroauricular area, while the upper lip was repaired using a mucosal V-Y advancement flap. Ten months later, hypertrophic scarring developed, and a second FTSG was performed using contralateral retroauricular skin. Despite repeated intralesional triamcinolone injections, the grafted area became tender and pruritic, with the appearance of multiple milia-like lesions. Over the subsequent 9 months, three recurrent cystic nodules developed within the scar tissue and were serially excised. Histopathological examination confirmed the diagnosis of secondary milia. After complete excision, no recurrence was observed for over 3 years. We discuss possible contributing mechanisms, including adnexal survival within grafts and the role of remnant epidermis or ductal obstruction. Awareness of this complication may help guide donor-site selection and wound-bed preparation in perioral reconstruction.