1.A unified framework for postoperative complications after gastrectomy for gastric cancer: insights from the Korean Quality Improvement Platform in Surgery program
Jeong Ho SONG ; Chang Seok KO ; Han Hong LEE ; Hong Man YOON ; Hyoung-Il KIM ; In Gyu KWON ; Ji Yeon PARK ; Ji Yeong AN ; Jong Won KIM ; Mi Ran JUNG ; Sang-Il LEE ; Seong Ho KONG ; Sun-Hwi HWANG ; Yun-Suhk SUH ; Sang-Yong SON ; Sang-Uk HAN
Annals of Surgical Treatment and Research 2026;110(5):290-298
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.
2.Current status of treatment for esophagojejunostomy leakage after total gastrectomy in patients with gastric cancer: a multicenter retrospective study in Korea
Min-Chan KIM ; Mi Ran JUNG ; Jeong Ju NOH ; Sunghwa KANG ; Jae Hun CHUNG ; Ji-Ho PARK ; Tae-Han KIM ; Jae Kyun PARK ; Yoonhong KIM ; Sang Hyuk SEO ; Sung Eun KIM ; Oh Kyung KWON ; Ji Yeon PARK ; Ki Bum PARK ; Sun-Hwi HWANG ; SI-Hak LEE ; Young-Joon LEE ; Sang-Ho JEONG ; Tae-Yong JEON ; Dae Hwan KIM ; Chang In CHOI ; Ki Young YOON ; Kyung Won SEO ; Ki Hyun KIM ; Sang Hoon OH ; Kwang Hee KIM
Journal of Minimally Invasive Surgery 2025;28(4):184-192
Purpose:
Esophagojejunostomy leakage (EJL) remains one of the most critical complications following total gastrectomy for gastric cancer. This study aimed to evaluate the evolving therapeutic approaches and clinical outcomes of EJL using data from a large-scale multicenter retrospective cohort.
Methods:
Among 6,577 patients who underwent total gastrectomy or proximal gastrectomy with double tract reconstruction at nine institutions from 2003 to 2024, 196 (3.0%) developed EJL. Of these, 162 patients with comprehensive clinical data were included in the final analysis. The study examined treatment modalities, changes in management over time, patient characteristics, surgical variables, and clinical outcomes. Four groups were defined according to treatment approach: conservative, endoscopic, reoperation, and multimodal (combined) therapy.
Results:
Endoscopic therapy was first introduced in 2011 and has progressively supplanted reoperation, now comprising 32.5% of cases. The average time to EJL diagnosis was 8.4 days after surgery. Overall in-hospital mortality was 6.1% (10/162). When conservative management was excluded, endoscopic treatment demonstrated the highest rate of therapeutic success (94.3%, p = 0.004). Both the duration until diet resumption and length of hospital stay were notably reduced in the endoscopic and conservative groups compared with reoperation and multimodal therapy (p < 0.001). Moreover, although the highest post-leakage hospitalization costs were observed with multimodal treatment (p < 0.001), overall hospitalization expenses were significantly lower for patients managed conservatively or with endoscopic intervention (p < 0.001).
Conclusion
Over the past two decades, management of EJL has shifted toward endoscopic approaches. Endoscopic therapies yield superior clinical outcomes and should be considered a primary option for appropriate candidates.
3.Short-term Efficacy and Safety of Faricimab Switching in Neovascular Age-related Macular Degeneration Previously Treated with Anti-vascular Endothelial Growth Factor
Jun Sung LEE ; Chang Ryong KIM ; Sun Taek LIM ; Yung-Hwi KIM
Journal of Retina 2025;10(1):20-30
Purpose:
To evaluate the short-term efficacy and safety of intravitreal faricimab injection (IFI) in patients with neovascular age-related macular degeneration (nAMD) previously treated with another anti-vascular endothelial growth factor (anti-VEGF).
Methods:
We retrospectively reviewed the medical records of patients with nAMD refractory to previous anti-VEGF treatment who were switched to faricimab from June 2023 to July 2024. A good responder was defined as a case with complete absence of subretinal fluid (SRF) or intraretinal fluid (IRF) 8 weeks after IFI, whereas a poor responder was defined as having residual SRF or IRF 8 weeks after IFI. We evaluated best-corrected visual acuity (BCVA), central subfield retinal thickness (CST), sub-foveal choroidal thickness (SFCT), maximum height of pigment epithelial detachment (PED) and the presence of SRF or IRF, and the presence of optical coherence tomography parameters of nAMD at baseline (before the injection of faricimab) and 8 weeks and 16 weeks after faricimab switching. All adverse events following faricimab injection were analyzed.
Results:
Seventy-two eyes of 69 patients were included. There was no significant BCVA change after IFI. CST, SFCT and maximum PED height were significantly decreased 8 weeks and 16 weeks after faricimab switching compared to baseline (all p < 0.05). A fluid-free state was reached in 39% at 16 weeks. The poor responder group had a higher number of brolucizumab injections before switching compared to the good responder group (1.1 ± 1.9 vs. 2.4 ± 3.3, p = 0.04). The good responder group had more cases without SRF before switching and lower baseline CST than the poor responder group (all p < 0.05). There were no severe adverse events after IFI.
Conclusions
Faricimab was safe and anatomically effective, though it did not produce functional improvements. IFI could serve as another option in the treatment of patients with nAMD treated with previous anti-VEGF.
4.Klebsiella pneumoniae-Induced Emphysematous Prostatic Abscess Accompanied by a Spinal Cord Infarction: Case Report
Seong Uk JEH ; Min Sung CHOI ; Chang Seok KANG ; Dae Hyun KIM ; Jae Hwi CHOI ; See Min CHOI ; Sung Chul KAM ; Jeong Seok HWA ; Jae Seog HYUN
Urogenital Tract Infection 2024;19(3):104-108
Various strains can be found in emphysematous prostatic abscesses (EPAs), but the most frequent causative organism is Klebsiella pneumoniae . Hypervirulent K. pneumoniae can disseminate to distant sites by forming a muco-polysaccharide network outside the capsule. Here, we present the first case of K. pneumoniae in an EPA accompanied by a spinal cord infarction. A 65-year-old man was referred to our hospital due to sudden-onset paraplegia after a 5-day history of fever, myalgia, and voiding difficulty. Abdominal computed tomography revealed a collection of air pockets in the prostate, and diffusion-weighted magnetic resonance imaging showed high signal intensity in the thoracic spinal cord. The patient was initially treated with antibiotics and surgical drainage. On the third hospital day, therapeutic heparin was added after discussion with a neurologist. The patient had no inflammatory symptoms, experienced some improvement in paraplegia, and was discharged on the 14th hospital day. This study adhered to the case report guidelines.
5.Klebsiella pneumoniae-Induced Emphysematous Prostatic Abscess Accompanied by a Spinal Cord Infarction: Case Report
Seong Uk JEH ; Min Sung CHOI ; Chang Seok KANG ; Dae Hyun KIM ; Jae Hwi CHOI ; See Min CHOI ; Sung Chul KAM ; Jeong Seok HWA ; Jae Seog HYUN
Urogenital Tract Infection 2024;19(3):104-108
Various strains can be found in emphysematous prostatic abscesses (EPAs), but the most frequent causative organism is Klebsiella pneumoniae . Hypervirulent K. pneumoniae can disseminate to distant sites by forming a muco-polysaccharide network outside the capsule. Here, we present the first case of K. pneumoniae in an EPA accompanied by a spinal cord infarction. A 65-year-old man was referred to our hospital due to sudden-onset paraplegia after a 5-day history of fever, myalgia, and voiding difficulty. Abdominal computed tomography revealed a collection of air pockets in the prostate, and diffusion-weighted magnetic resonance imaging showed high signal intensity in the thoracic spinal cord. The patient was initially treated with antibiotics and surgical drainage. On the third hospital day, therapeutic heparin was added after discussion with a neurologist. The patient had no inflammatory symptoms, experienced some improvement in paraplegia, and was discharged on the 14th hospital day. This study adhered to the case report guidelines.
6.Clinical outcome and safety of holmium laser prostate enucleation after transrectal prostate biopsies for benign prostatic hyperplasia
See Min CHOI ; Chang Seok KANG ; Dae Hyun KIM ; Jae Hwi CHOI ; Chunwoo LEE ; Seong Uk JEH ; Sung Chul KAM ; Jeong Seok HWA ; Jae Seog HYUN
Investigative and Clinical Urology 2024;65(2):148-156
Purpose:
This study aimed to assess the clinical outcome and safety of holmium laser enucleation of the prostate (HoLEP) following transrectal ultrasound-guided prostate biopsy (TR biopsy) in the treatment of benign prostate hyperplasia.
Materials and Methods:
We retrospectively analyzed data from 556 patients who underwent HoLEP between 2014 and 2021. The patients were categorized into six groups: Group 1-A (n=45) underwent HoLEP within four months post TR biopsy. Group 1-B (n=94) underwent HoLEP more than four months post TR biopsy. Group 1-C (n=120) underwent HoLEP after a single TR biopsy. Group 1-D (n=19) underwent HoLEP after two or more TR biopsies. Group 1-total (n=139, group 1-A+group 1-B or group 1-C+group 1-D) underwent HoLEP post TR biopsy. Group 2 (control group, n=417) underwent HoLEP without prior TR biopsy. We examined perioperative parameters, safety, and functional outcomes.
Results:
The age, body mass index, International Prostate Symptom Score (IPSS), uroflowmetry, and comorbid diseases between group 1-total and group 2 were comparable. However, group 1-total exhibited significantly elevated prostate-specific antigen levels and larger prostate volumes (p<0.01). Perioperative factors like enucleation time, enucleation weight, and catheterization duration were notably higher in group 1-total (p<0.01). All groups showed significant improvements in IPSS, postvoid residual urine, and maximum flow rate during the 1-year postoperative period (p<0.05). The rates of postoperative complications were similar between group 1-total and group 2.
Conclusions
Enucleation time and catheterization duration were significantly longer in the TR biopsy group. However, postoperative complications were not significantly different between TR biopsy and non-TR biopsy groups.
7.Klebsiella pneumoniae-Induced Emphysematous Prostatic Abscess Accompanied by a Spinal Cord Infarction: Case Report
Seong Uk JEH ; Min Sung CHOI ; Chang Seok KANG ; Dae Hyun KIM ; Jae Hwi CHOI ; See Min CHOI ; Sung Chul KAM ; Jeong Seok HWA ; Jae Seog HYUN
Urogenital Tract Infection 2024;19(3):104-108
Various strains can be found in emphysematous prostatic abscesses (EPAs), but the most frequent causative organism is Klebsiella pneumoniae . Hypervirulent K. pneumoniae can disseminate to distant sites by forming a muco-polysaccharide network outside the capsule. Here, we present the first case of K. pneumoniae in an EPA accompanied by a spinal cord infarction. A 65-year-old man was referred to our hospital due to sudden-onset paraplegia after a 5-day history of fever, myalgia, and voiding difficulty. Abdominal computed tomography revealed a collection of air pockets in the prostate, and diffusion-weighted magnetic resonance imaging showed high signal intensity in the thoracic spinal cord. The patient was initially treated with antibiotics and surgical drainage. On the third hospital day, therapeutic heparin was added after discussion with a neurologist. The patient had no inflammatory symptoms, experienced some improvement in paraplegia, and was discharged on the 14th hospital day. This study adhered to the case report guidelines.
8.Klebsiella pneumoniae-Induced Emphysematous Prostatic Abscess Accompanied by a Spinal Cord Infarction: Case Report
Seong Uk JEH ; Min Sung CHOI ; Chang Seok KANG ; Dae Hyun KIM ; Jae Hwi CHOI ; See Min CHOI ; Sung Chul KAM ; Jeong Seok HWA ; Jae Seog HYUN
Urogenital Tract Infection 2024;19(3):104-108
Various strains can be found in emphysematous prostatic abscesses (EPAs), but the most frequent causative organism is Klebsiella pneumoniae . Hypervirulent K. pneumoniae can disseminate to distant sites by forming a muco-polysaccharide network outside the capsule. Here, we present the first case of K. pneumoniae in an EPA accompanied by a spinal cord infarction. A 65-year-old man was referred to our hospital due to sudden-onset paraplegia after a 5-day history of fever, myalgia, and voiding difficulty. Abdominal computed tomography revealed a collection of air pockets in the prostate, and diffusion-weighted magnetic resonance imaging showed high signal intensity in the thoracic spinal cord. The patient was initially treated with antibiotics and surgical drainage. On the third hospital day, therapeutic heparin was added after discussion with a neurologist. The patient had no inflammatory symptoms, experienced some improvement in paraplegia, and was discharged on the 14th hospital day. This study adhered to the case report guidelines.
9.Klebsiella pneumoniae-Induced Emphysematous Prostatic Abscess Accompanied by a Spinal Cord Infarction: Case Report
Seong Uk JEH ; Min Sung CHOI ; Chang Seok KANG ; Dae Hyun KIM ; Jae Hwi CHOI ; See Min CHOI ; Sung Chul KAM ; Jeong Seok HWA ; Jae Seog HYUN
Urogenital Tract Infection 2024;19(3):104-108
Various strains can be found in emphysematous prostatic abscesses (EPAs), but the most frequent causative organism is Klebsiella pneumoniae . Hypervirulent K. pneumoniae can disseminate to distant sites by forming a muco-polysaccharide network outside the capsule. Here, we present the first case of K. pneumoniae in an EPA accompanied by a spinal cord infarction. A 65-year-old man was referred to our hospital due to sudden-onset paraplegia after a 5-day history of fever, myalgia, and voiding difficulty. Abdominal computed tomography revealed a collection of air pockets in the prostate, and diffusion-weighted magnetic resonance imaging showed high signal intensity in the thoracic spinal cord. The patient was initially treated with antibiotics and surgical drainage. On the third hospital day, therapeutic heparin was added after discussion with a neurologist. The patient had no inflammatory symptoms, experienced some improvement in paraplegia, and was discharged on the 14th hospital day. This study adhered to the case report guidelines.
10.Experimental infection of a porcine kidney cell line with hepatitis A virus
Dong-Hwi KIM ; Da-Yoon KIM ; Jae-Hyeong KIM ; Kyu-Beom LIM ; Joong-Bok LEE ; Seung-Yong PARK ; Chang-Seon SONG ; Sang-Won LEE ; In-Soo CHOI
Korean Journal of Veterinary Research 2023;63(2):e15-
The hepatitis A virus (HAV) induces severe acute liver injury and is adapted to human and monkey cell lines but not other cells. In this study, the HAV was inoculated into porcine kidney (PK-15) cells to determine its infectivity in porcine cells. The growth pattern of the HAV in PK-15 cells was compared with its growth pattern in fetal rhesus kidney (FRhK-4) cells. The growth of HAV was less efficient in PK-15 cells. In conclusion, HAV replication was verified in PK-15 cells for the first time. Further investigations will be needed to identify the HAV-restrictive mechanisms in PK-15 cells.

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