Background: To identify the optimal surgical technique for single-level anterior cervical discectomy and fusion (ACDF), this study compared surgical outcomes and incidence of adjacent segment degeneration (ASD) in patients undergoing single-level ACDF using cage alone single-level fusion and plate fixation techniques. Methods: This single-center retrospective study (2003–2018) included patients who underwent single-level ACDF with either plate fixation (PLATE) or cage (CAGE) alone. The radiologic and clinical outcomes between the 2 surgical groups were compared over a 4-year follow-up period. Outcomes of interest included parameters related to range of motion, sagittal alignment, as well as fusion, subsidence, and ASD rates. Clinical outcomes were evaluated using the Neck Disability Index (NDI) and visual analog scale (VAS) for pain. Dysphagia and hoarseness rates were estimated based on medical records. Results: Forty-seven patients were included (n=17 in CAGE group). In the CAGE group, 94.1% of the patients had Bridwell grade 1 or 2, compared to 83.3% in the PLATE group (p = 0.396). Subsidence occurred in 12.5% and 3.6% of the CAGE and PLATE cases, respectively (p = 0.543). Segmental kyphosis progressed in the CAGE group compared to the PLATE group at 12, 24, and 48 months (p < 0.001). Radiographic ASD was observed in 41.2% and 30.0% of patients in the CAGE and PLATE groups, respectively, with a higher incidence in the upper segments for both groups. Preoperative NDI scores were similar between the groups; however, postoperatively, the CAGE group had significantly lower NDI scores (3.50 ± 2.74 vs. 8.00 ± 5.81) at 4 years (p = 0.020). Neck pain VAS scores also showed significant improvement in the CAGE group (2.33 ± 2.94) compared with that in the PLATE group (3.07 ± 2.31) at 4 years (p = 0.045). Both groups showed comparable arm pain VAS scores at 2 and 4 years postoperatively. Postoperative dysphagia occurred in 1 patient in the PLATE group, resolving almost completely by 1 year. Conclusions Single-level ACDF using a cage alone technique demonstrated favorable radiologic and clinical outcomes overall compared to plate-augmented ACDF. However, plate augmentation is recommended for patients with severe cervical kyphosis or those at high risk of subsidence.

Gastric cancer is one of the most common cancers in both Korea and worldwide. Since 2004, the Korean Practice Guidelines for Gastric Cancer have been regularly updated, with the 4th edition published in 2022. The 4th edition was the result of a collaborative work by an interdisciplinary team, including experts in gastric surgery, gastroenterology, endoscopy, medical oncology, abdominal radiology, pathology, nuclear medicine, radiation oncology, and guideline development methodology. The current guideline is the 5th version, an updated version of the 4th edition. In this guideline, 6 key questions (KQs) were updated or proposed after a collaborative review by the working group, and 7 statements were developed, or revised, or discussed based on a systematic review using the MEDLINE, Embase, Cochrane Library, and KoreaMed database. Over the past 2 years, there have been significant changes in systemic treatment, leading to major updates and revisions focused on this area.Additionally, minor modifications have been made in other sections, incorporating recent research findings. The level of evidence and grading of recommendations were categorized according to the Grading of Recommendations, Assessment, Development and Evaluation system. Key factors for recommendation included the level of evidence, benefit, harm, and clinical applicability. The working group reviewed and discussed the recommendations to reach a consensus. The structure of this guideline remains similar to the 2022 version.Earlier sections cover general considerations, such as screening, diagnosis, and staging of endoscopy, pathology, radiology, and nuclear medicine. In the latter sections, statements are provided for each KQ based on clinical evidence, with flowcharts supporting these statements through meta-analysis and references. This multidisciplinary, evidence-based gastric cancer guideline aims to support clinicians in providing optimal care for gastric cancer patients.

Background: To identify the optimal surgical technique for single-level anterior cervical discectomy and fusion (ACDF), this study compared surgical outcomes and incidence of adjacent segment degeneration (ASD) in patients undergoing single-level ACDF using cage alone single-level fusion and plate fixation techniques. Methods: This single-center retrospective study (2003–2018) included patients who underwent single-level ACDF with either plate fixation (PLATE) or cage (CAGE) alone. The radiologic and clinical outcomes between the 2 surgical groups were compared over a 4-year follow-up period. Outcomes of interest included parameters related to range of motion, sagittal alignment, as well as fusion, subsidence, and ASD rates. Clinical outcomes were evaluated using the Neck Disability Index (NDI) and visual analog scale (VAS) for pain. Dysphagia and hoarseness rates were estimated based on medical records. Results: Forty-seven patients were included (n=17 in CAGE group). In the CAGE group, 94.1% of the patients had Bridwell grade 1 or 2, compared to 83.3% in the PLATE group (p = 0.396). Subsidence occurred in 12.5% and 3.6% of the CAGE and PLATE cases, respectively (p = 0.543). Segmental kyphosis progressed in the CAGE group compared to the PLATE group at 12, 24, and 48 months (p < 0.001). Radiographic ASD was observed in 41.2% and 30.0% of patients in the CAGE and PLATE groups, respectively, with a higher incidence in the upper segments for both groups. Preoperative NDI scores were similar between the groups; however, postoperatively, the CAGE group had significantly lower NDI scores (3.50 ± 2.74 vs. 8.00 ± 5.81) at 4 years (p = 0.020). Neck pain VAS scores also showed significant improvement in the CAGE group (2.33 ± 2.94) compared with that in the PLATE group (3.07 ± 2.31) at 4 years (p = 0.045). Both groups showed comparable arm pain VAS scores at 2 and 4 years postoperatively. Postoperative dysphagia occurred in 1 patient in the PLATE group, resolving almost completely by 1 year. Conclusions Single-level ACDF using a cage alone technique demonstrated favorable radiologic and clinical outcomes overall compared to plate-augmented ACDF. However, plate augmentation is recommended for patients with severe cervical kyphosis or those at high risk of subsidence.

Background: To identify the optimal surgical technique for single-level anterior cervical discectomy and fusion (ACDF), this study compared surgical outcomes and incidence of adjacent segment degeneration (ASD) in patients undergoing single-level ACDF using cage alone single-level fusion and plate fixation techniques. Methods: This single-center retrospective study (2003–2018) included patients who underwent single-level ACDF with either plate fixation (PLATE) or cage (CAGE) alone. The radiologic and clinical outcomes between the 2 surgical groups were compared over a 4-year follow-up period. Outcomes of interest included parameters related to range of motion, sagittal alignment, as well as fusion, subsidence, and ASD rates. Clinical outcomes were evaluated using the Neck Disability Index (NDI) and visual analog scale (VAS) for pain. Dysphagia and hoarseness rates were estimated based on medical records. Results: Forty-seven patients were included (n=17 in CAGE group). In the CAGE group, 94.1% of the patients had Bridwell grade 1 or 2, compared to 83.3% in the PLATE group (p = 0.396). Subsidence occurred in 12.5% and 3.6% of the CAGE and PLATE cases, respectively (p = 0.543). Segmental kyphosis progressed in the CAGE group compared to the PLATE group at 12, 24, and 48 months (p < 0.001). Radiographic ASD was observed in 41.2% and 30.0% of patients in the CAGE and PLATE groups, respectively, with a higher incidence in the upper segments for both groups. Preoperative NDI scores were similar between the groups; however, postoperatively, the CAGE group had significantly lower NDI scores (3.50 ± 2.74 vs. 8.00 ± 5.81) at 4 years (p = 0.020). Neck pain VAS scores also showed significant improvement in the CAGE group (2.33 ± 2.94) compared with that in the PLATE group (3.07 ± 2.31) at 4 years (p = 0.045). Both groups showed comparable arm pain VAS scores at 2 and 4 years postoperatively. Postoperative dysphagia occurred in 1 patient in the PLATE group, resolving almost completely by 1 year. Conclusions Single-level ACDF using a cage alone technique demonstrated favorable radiologic and clinical outcomes overall compared to plate-augmented ACDF. However, plate augmentation is recommended for patients with severe cervical kyphosis or those at high risk of subsidence.

Gastric cancer is one of the most common cancers in both Korea and worldwide. Since 2004, the Korean Practice Guidelines for Gastric Cancer have been regularly updated, with the 4th edition published in 2022. The 4th edition was the result of a collaborative work by an interdisciplinary team, including experts in gastric surgery, gastroenterology, endoscopy, medical oncology, abdominal radiology, pathology, nuclear medicine, radiation oncology, and guideline development methodology. The current guideline is the 5th version, an updated version of the 4th edition. In this guideline, 6 key questions (KQs) were updated or proposed after a collaborative review by the working group, and 7 statements were developed, or revised, or discussed based on a systematic review using the MEDLINE, Embase, Cochrane Library, and KoreaMed database. Over the past 2 years, there have been significant changes in systemic treatment, leading to major updates and revisions focused on this area.Additionally, minor modifications have been made in other sections, incorporating recent research findings. The level of evidence and grading of recommendations were categorized according to the Grading of Recommendations, Assessment, Development and Evaluation system. Key factors for recommendation included the level of evidence, benefit, harm, and clinical applicability. The working group reviewed and discussed the recommendations to reach a consensus. The structure of this guideline remains similar to the 2022 version.Earlier sections cover general considerations, such as screening, diagnosis, and staging of endoscopy, pathology, radiology, and nuclear medicine. In the latter sections, statements are provided for each KQ based on clinical evidence, with flowcharts supporting these statements through meta-analysis and references. This multidisciplinary, evidence-based gastric cancer guideline aims to support clinicians in providing optimal care for gastric cancer patients.

Background: To identify the optimal surgical technique for single-level anterior cervical discectomy and fusion (ACDF), this study compared surgical outcomes and incidence of adjacent segment degeneration (ASD) in patients undergoing single-level ACDF using cage alone single-level fusion and plate fixation techniques. Methods: This single-center retrospective study (2003–2018) included patients who underwent single-level ACDF with either plate fixation (PLATE) or cage (CAGE) alone. The radiologic and clinical outcomes between the 2 surgical groups were compared over a 4-year follow-up period. Outcomes of interest included parameters related to range of motion, sagittal alignment, as well as fusion, subsidence, and ASD rates. Clinical outcomes were evaluated using the Neck Disability Index (NDI) and visual analog scale (VAS) for pain. Dysphagia and hoarseness rates were estimated based on medical records. Results: Forty-seven patients were included (n=17 in CAGE group). In the CAGE group, 94.1% of the patients had Bridwell grade 1 or 2, compared to 83.3% in the PLATE group (p = 0.396). Subsidence occurred in 12.5% and 3.6% of the CAGE and PLATE cases, respectively (p = 0.543). Segmental kyphosis progressed in the CAGE group compared to the PLATE group at 12, 24, and 48 months (p < 0.001). Radiographic ASD was observed in 41.2% and 30.0% of patients in the CAGE and PLATE groups, respectively, with a higher incidence in the upper segments for both groups. Preoperative NDI scores were similar between the groups; however, postoperatively, the CAGE group had significantly lower NDI scores (3.50 ± 2.74 vs. 8.00 ± 5.81) at 4 years (p = 0.020). Neck pain VAS scores also showed significant improvement in the CAGE group (2.33 ± 2.94) compared with that in the PLATE group (3.07 ± 2.31) at 4 years (p = 0.045). Both groups showed comparable arm pain VAS scores at 2 and 4 years postoperatively. Postoperative dysphagia occurred in 1 patient in the PLATE group, resolving almost completely by 1 year. Conclusions Single-level ACDF using a cage alone technique demonstrated favorable radiologic and clinical outcomes overall compared to plate-augmented ACDF. However, plate augmentation is recommended for patients with severe cervical kyphosis or those at high risk of subsidence.

Gastric cancer is one of the most common cancers in both Korea and worldwide. Since 2004, the Korean Practice Guidelines for Gastric Cancer have been regularly updated, with the 4th edition published in 2022. The 4th edition was the result of a collaborative work by an interdisciplinary team, including experts in gastric surgery, gastroenterology, endoscopy, medical oncology, abdominal radiology, pathology, nuclear medicine, radiation oncology, and guideline development methodology. The current guideline is the 5th version, an updated version of the 4th edition. In this guideline, 6 key questions (KQs) were updated or proposed after a collaborative review by the working group, and 7 statements were developed, or revised, or discussed based on a systematic review using the MEDLINE, Embase, Cochrane Library, and KoreaMed database. Over the past 2 years, there have been significant changes in systemic treatment, leading to major updates and revisions focused on this area.Additionally, minor modifications have been made in other sections, incorporating recent research findings. The level of evidence and grading of recommendations were categorized according to the Grading of Recommendations, Assessment, Development and Evaluation system. Key factors for recommendation included the level of evidence, benefit, harm, and clinical applicability. The working group reviewed and discussed the recommendations to reach a consensus. The structure of this guideline remains similar to the 2022 version.Earlier sections cover general considerations, such as screening, diagnosis, and staging of endoscopy, pathology, radiology, and nuclear medicine. In the latter sections, statements are provided for each KQ based on clinical evidence, with flowcharts supporting these statements through meta-analysis and references. This multidisciplinary, evidence-based gastric cancer guideline aims to support clinicians in providing optimal care for gastric cancer patients.

Purpose: Osteosynthesis of a clavicular fracture can obtain good clinical results even with conservative treatment. The development of surgical techniques and improvements in internal fixation have led to the use of metal plates and screws. Although there are intramedullary nails or minimally invasive plate osteosynthesis that can reduce soft tissue damage, these techniques are not used often because most require a skin incision about the length of the metal plate to be inserted. This study compared the postoperative pain to determine the appropriate injection depth. Materials and Methods: A prospective, single-institute, single-blind, randomized study was designed. The patients in the study had clavicular fractures and who underwent the removal of implant. The patients judged to have difficulty indicating pain were excluded.Ropivacaine was injected between plate fixation and muscle suturing. The visual analog scale (VAS) pain score, patient-controlled analgesia (PCA) use, and additional pain medication usage were measured after surgery and every 4 hours. Results: Thirty-four clavicle shaft fracture patients were classified into 16 patients in the subcutaneous injection group and 18 in the muscle injection group. Seventeen implant removal patients were divided into eight patients in the subcutaneous injection group and another nine in the muscle injection group. In the fracture group, the mean VAS for the subcutaneous injection group was 4.20±2.68 immediately after surgery, 4.47±1.85 at 4 hours, 1.93±1.44 at 24 hours, and 1.60±1.35 at 48 hours. The mean VAS for the muscle injection group was 4.23±1.59 immediately after surgery, 3.00±1.47 at 4 hours, 1.69±1.03 at 24 hours, and 1.31±1.11 at 48 hours; the mean VAS score was not statistically significant in the two groups (p=0.332). In the implant removal group, the mean VAS for the subcutaneous injection group was 4.75±1.58 immediately after surgery, 3.75±1.04 at 4 hours, 1.75±0.89 at 24 hours, and 1.75±0.89 at 48 hours. The mean VAS for the muscle injection group was 3.78±1.20 immediately after surgery, 3.22±0.83 at 4 hours, 1.89±1.17 at 24 hours, and 1.11±1.01 at 48 hours; the mean VAS score was not statistically significant in the two groups (p=0.181). Conclusion The postoperative VAS pain score and PCA usage were not statistically significant regardless of the ropivacaine injection site in clavicular surgery, but each group had significantly different VAS pain scores and PCA usage according to time after surgery. In addition, the muscle injection group tended to have a lower average VAS than the subcutaneous injection group in the implant removal patient group.

Purpose: Osteosynthesis of a clavicular fracture can obtain good clinical results even with conservative treatment. The development of surgical techniques and improvements in internal fixation have led to the use of metal plates and screws. Although there are intramedullary nails or minimally invasive plate osteosynthesis that can reduce soft tissue damage, these techniques are not used often because most require a skin incision about the length of the metal plate to be inserted. This study compared the postoperative pain to determine the appropriate injection depth. Materials and Methods: A prospective, single-institute, single-blind, randomized study was designed. The patients in the study had clavicular fractures and who underwent the removal of implant. The patients judged to have difficulty indicating pain were excluded.Ropivacaine was injected between plate fixation and muscle suturing. The visual analog scale (VAS) pain score, patient-controlled analgesia (PCA) use, and additional pain medication usage were measured after surgery and every 4 hours. Results: Thirty-four clavicle shaft fracture patients were classified into 16 patients in the subcutaneous injection group and 18 in the muscle injection group. Seventeen implant removal patients were divided into eight patients in the subcutaneous injection group and another nine in the muscle injection group. In the fracture group, the mean VAS for the subcutaneous injection group was 4.20±2.68 immediately after surgery, 4.47±1.85 at 4 hours, 1.93±1.44 at 24 hours, and 1.60±1.35 at 48 hours. The mean VAS for the muscle injection group was 4.23±1.59 immediately after surgery, 3.00±1.47 at 4 hours, 1.69±1.03 at 24 hours, and 1.31±1.11 at 48 hours; the mean VAS score was not statistically significant in the two groups (p=0.332). In the implant removal group, the mean VAS for the subcutaneous injection group was 4.75±1.58 immediately after surgery, 3.75±1.04 at 4 hours, 1.75±0.89 at 24 hours, and 1.75±0.89 at 48 hours. The mean VAS for the muscle injection group was 3.78±1.20 immediately after surgery, 3.22±0.83 at 4 hours, 1.89±1.17 at 24 hours, and 1.11±1.01 at 48 hours; the mean VAS score was not statistically significant in the two groups (p=0.181). Conclusion The postoperative VAS pain score and PCA usage were not statistically significant regardless of the ropivacaine injection site in clavicular surgery, but each group had significantly different VAS pain scores and PCA usage according to time after surgery. In addition, the muscle injection group tended to have a lower average VAS than the subcutaneous injection group in the implant removal patient group.

Purpose: Osteosynthesis of a clavicular fracture can obtain good clinical results even with conservative treatment. The development of surgical techniques and improvements in internal fixation have led to the use of metal plates and screws. Although there are intramedullary nails or minimally invasive plate osteosynthesis that can reduce soft tissue damage, these techniques are not used often because most require a skin incision about the length of the metal plate to be inserted. This study compared the postoperative pain to determine the appropriate injection depth. Materials and Methods: A prospective, single-institute, single-blind, randomized study was designed. The patients in the study had clavicular fractures and who underwent the removal of implant. The patients judged to have difficulty indicating pain were excluded.Ropivacaine was injected between plate fixation and muscle suturing. The visual analog scale (VAS) pain score, patient-controlled analgesia (PCA) use, and additional pain medication usage were measured after surgery and every 4 hours. Results: Thirty-four clavicle shaft fracture patients were classified into 16 patients in the subcutaneous injection group and 18 in the muscle injection group. Seventeen implant removal patients were divided into eight patients in the subcutaneous injection group and another nine in the muscle injection group. In the fracture group, the mean VAS for the subcutaneous injection group was 4.20±2.68 immediately after surgery, 4.47±1.85 at 4 hours, 1.93±1.44 at 24 hours, and 1.60±1.35 at 48 hours. The mean VAS for the muscle injection group was 4.23±1.59 immediately after surgery, 3.00±1.47 at 4 hours, 1.69±1.03 at 24 hours, and 1.31±1.11 at 48 hours; the mean VAS score was not statistically significant in the two groups (p=0.332). In the implant removal group, the mean VAS for the subcutaneous injection group was 4.75±1.58 immediately after surgery, 3.75±1.04 at 4 hours, 1.75±0.89 at 24 hours, and 1.75±0.89 at 48 hours. The mean VAS for the muscle injection group was 3.78±1.20 immediately after surgery, 3.22±0.83 at 4 hours, 1.89±1.17 at 24 hours, and 1.11±1.01 at 48 hours; the mean VAS score was not statistically significant in the two groups (p=0.181). Conclusion The postoperative VAS pain score and PCA usage were not statistically significant regardless of the ropivacaine injection site in clavicular surgery, but each group had significantly different VAS pain scores and PCA usage according to time after surgery. In addition, the muscle injection group tended to have a lower average VAS than the subcutaneous injection group in the implant removal patient group.