Rectal cancer, which accounts for approximately 40% of colorectal cancers, remains a major clinical concern. Recent advances in diagnostic imaging, surgical techniques, radiotherapy, and systemic treatment have steadily improved rectal cancer outcomes. Considering this, the Korean Rectal Cancer Multidisciplinary (KRCM) Committee has aimed to provide clinicians and policymakers with up-to-date, evidence-based clinical practice guidelines to support optimal decision-making, reflecting current evidence, the Korean healthcare context, and patient values and preferences. The Clinical Practice Guidelines for Rectal Cancer version 2.0 were developed through multidisciplinary collaboration with related academic societies, building upon and updating the KRCM Clinical Practice Guidelines version 1.0 (titled “Multidisciplinary guidelines for the management of rectal cancer”). These consensus guidelines of the KRCM were established based on a comprehensive literature review, evidence synthesis, with recommendation development guided by the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology, and consideration of applicability in real-world clinical practice under the national health insurance system. Each recommendation has been presented with its strength and level of evidence.

Background: A systematic evaluation of potential living liver donors is essential to ensure donor safety and optimize recipient outcomes in living donor liver transplantation (LDLT). This study aimed to assess donor acceptance rates and reasons for disqualification among individuals evaluated for LDLT at a high-volume transplant center over a one-year period. Methods: We retrospectively reviewed 1,087 potential living liver donors who presented for LDLT evaluation in 2023. Of these, 991 candidates advanced beyond the initial screening (Stage 1) and underwent comprehensive clinical, imaging, and pathological assessments (Stages 2 and 3). Candidates who discontinued after Stage 1 were excluded due to the absence of documented reasons for non-progression. Results: Among the 991 candidates who proceeded beyond initial screening, 473 (47.7%) completed the full donor evaluation, of whom 466 were judged to be suitable donors. Among suitable donors, 384 (82.4%) proceeded to donor hepatectomy, whereas 82 did not, primarily due to recipient-related factors such as clinical deterioration or withdrawal of consent. Donor ineligibility was determined in 422 candidates (42.6%), most commonly due to inadequate remnant liver volume (52.8%), hepatic steatosis (20.6%), and insufficient graft size (10.2%). Among candidates undergoing Stage 2 evaluation, 162 (16.3%) failed to meet steatosis criteria; 126 were excluded solely for steatosis and advised weight reduction, and 39 subsequently became eligible and successfully donated. Conclusion In this high-volume LDLT center, donor disqualification was primarily driven by remnant liver volume and hepatic steatosis. Targeted interventions such as weight reduction enabled successful donation in a subset of initially ineligible candidates, underscoring the importance of individualized donor evaluation and pre-donation optimization.

Purpose: Huge (≥10 cm) hepatocellular carcinoma (HCC) poses significant treatment and prognosis challenges. This study aimed to determine whether preoperative transarterial chemoembolization (TACE) for huge HCC is necessary. Methods: This single-center, retrospective cohort study evaluated 435 patients with huge HCC who underwent upfront hepatectomy or hepatectomy after preoperative TACE from January 2009 to December 2018. TACE’s impact on survival and prognostic factors, including microvascular invasion (MVI) and satellite nodules (SNs), was analyzed. Results: The preoperative TACE group (n = 33) had a lower incidence of MVI (P = 0.009) and higher postoperative morbidity (P = 0.001), particularly pleural effusion (P = 0.004) and Clavien-Dindo class III–IV complications (P = 0.033), compared with the upfront hepatectomy group (n = 402). Short-term mortality (P = 0.828) and recurrence within 6 months (P = 0.654) were comparable between groups. The 1-, 3-, and 5-year survival curves showed no significant between-group differences in recurrence-free survival (RFS) (P = 0.172) and overall survival (OS) (P = 0.450). Local regional therapy for intrahepatic recurrences and surgical resection for extrahepatic recurrences were associated with better OS. MVI, SN, and hepatic vein tumor thrombosis were identified as significant risk factors for poorer RFS and OS. In patients without SN, preoperative TACE improved RFS (P = 0.039) but not OS. Conclusion Preoperative TACE for huge HCC was associated with reduced MVI but did not improve RFS and OS. Survival outcomes were more significantly influenced by SN, suggesting that upfront hepatectomy without TACE should be prioritized.

Objectives: Pediatric and adolescent oral and maxillofacial trauma and infections differ significantly from adults in anatomy, development, and immunity, making diagnosis and treatment challenging. This study retrospectively evaluated the etiology, clinical features, and management of oral and maxillofacial trauma and infections among patients aged 3 to 15 years. Materials and Methods: A retrospective review was conducted of 824 pediatric and adolescent patients who presented to the emergency department of Pusan National University Yangsan Hospital from January 2022 to December 2024. Patients were categorized based on chief complaints into trauma, infection, or other conditions. Primary analyses focused on trauma and infections, and secondary analyses included etiology, diagnosis, treatment, and outcomes. Results: Trauma accounted for 742 cases (90.0%) and infections for 44 cases (5.3%). Boys (65.7%) outnumbered girls (34.3%), and school-aged children (6-11 years) were most frequently affected (56.5%). Lacerations (49.2%) and abrasions (34.1%) were the most common traumas, followed by dental trauma (31.0%) and facial fractures (5.0%). Among fractures, the mandibular condyle (35.1%) was most commonly involved. Most fractures were managed non-surgically (54.0%), while 30.0% required surgery. Infections were mainly odontogenic abscesses (44.7%), cellulitis (36.4%), and sialadenitis (15.9%). Abscesses were treated with incision and drainage (57.1%) or antibiotics (19.1%), with 23.8% requiring hospitalization. Conclusion Trauma was the most frequent emergency cause in pediatric and adolescent patients, particularly among school-aged boys. Most cases were successfully managed with appropriate treatment. Early diagnosis and timely intervention are essential for favorable outcomes in pediatric maxillofacial emergencies.

Colorectal cancer is the third most common cancer in Korea and the third leading cause of death from cancer. Treatment outcomes for colon cancer are steadily improving due to national health screening programs with advances in diagnostic methods, surgical techniques, and therapeutic agents.. The Korea Colon Cancer Multidisciplinary (KCCM) Committee intends to provide professionals who treat colon cancer with the most up-to-date, evidence-based practice guidelines to improve outcomes and help them make decisions that reflect their patients’ values and preferences. These guidelines have been established by consensus reached by the KCCM Guideline Committee based on a systematic literature review and evidence synthesis and by considering the national health insurance system in real clinical practice settings. Each recommendation is presented with a recommendation strength and level of evidence based on the consensus of the committee.

Purpose: This study aimed to describe adult living donor liver transplantation (LDLT) for acute liver failure and evaluate its clinical significance by comparing its surgical and survival outcomes with those of deceased donor liver transplantation (DDLT). Methods: We retrospectively reviewed the medical records of 267 consecutive patients (161 LDLT recipients and 106 DDLT recipients) aged 18 years or older who underwent liver transplantation between January 2006 and December 2020. Results: The mean periods from hepatic encephalopathy to liver transplantation were 5.85 days and 8.35 days for LDLT and DDLT, respectively (P = 0.091). Among these patients, 121 (45.3%) had grade III or IV hepatic encephalopathy (living, 34.8% vs. deceased, 61.3%; P < 0.001), and 38 (14.2%) had brain edema (living, 16.1% vs. deceased, 11.3%; P = 0.269) before liver transplantation. There were no significant differences in in-hospital mortality (living, 11.8% vs. deceased, 15.1%; P = 0.435), 10-year overall survival (living, 90.8% vs. deceased, 84.0%; P = 0.096), and graft survival (living, 83.5% vs. deceased, 71.3%;P = 0.051). However, postoperatively, the mean intensive care unit stay was shorter in the LDLT group (5.0 days vs. 9.5 days, P < 0.001). In-hospital mortality was associated with vasopressor use (odds ratio [OR], 3.40; 95% confidence interval [CI], 1.45–7.96; P = 0.005) and brain edema (OR, 2.75; 95% CI, 1.16–6.52; P = 0.022) of recipient at the time of transplantation. However, LDLT (OR, 1.26; 95% CI, 0.59–2.66; P = 0.553) was not independently associated with in-hospital mortality. Conclusion LDLT is feasible for acute liver failure when organs from deceased donors are not available.

Background: An autologous abdominal flap can provide an aesthetically pleasing breast with a natural feel. However, contracted scars and hourglass contour deformities at the abdominal donor site can sometimes occur. These complications can reduce patient satisfaction and quality of life. Therefore, we performed different oblique plane closure of the abdominal donor site and evaluated the aesthetic scores in comparison with the conventional vertical single plane closure. Methods: The procedures begin with a beveled incision down to the fascia level during transverse rectus abdominis muscle flap elevation. At the time of donor site closure, Scarpa’s fascia and the subcutaneous layers are sutured while being pulled downward. Sixty patients were divided into two groups: group A (single vertical plane closure) and group B (different oblique plane closure). Abdominal scars were scored by five reviewers using the scar scale. Results: There were no significant differences in scores for vascularization, dog-ear presence, and umbilical shape of the scar between the two groups. However, group B showed marked improvements in flatness, contracture, and thickness of the scar surface. Notably, the different oblique plane closure in group B achieved much higher scores for the abdominal contour than group A. Conclusions The vertical single plane suture of the abdominal donor site may result in depressive contracture with poor cosmetic outcomes. The different oblique plane closure technique markedly improved the appearance of scars on the abdomen. This technique is likely to enhance patient satisfaction with both the breast and abdominal outcomes of breast reconstruction using an abdominal flap.

Background: As the prevalence of obesity and nonalcoholic fatty liver disease increases in recent years, the number of living donor liver transplantation from donor with high body mass index (BMI) is increasing. However, data on the effect of high BMI on outcomes in liver donors are lacking. This study aimed to investigate the influence of donor obesity (BMI ≥30 kg/m2 ) on and clinical outcomes after donor right liver resection (DRLR). Methods: Records of all living donors who underwent DRLR between January 2015 and December 2020 at Asan Medical Center were retrospectively reviewed. We divided donors into obese (BMI ≥30 kg/m2 , n=41) and normal-weight (BMI ≤25 kg/m2 , n=1,125) groups. To eliminate bias, matching was performed using the greedy method, and 34 donors involved in this study in each group. Results: After matching, preoperatively, the obese group had significantly higher preoperative levels of serum aspartate aminotransferase (p=0.021), alanine aminotransferase (p=0.003), and a larger celiac artery depth ratio (p<0.001) and graft volume (p<0.001) than the normal-weight group. When comparing perioperative outcomes of donor, the operation time was longer in the obese group (p=0.019), but no difference was observed in postoperative major complication rates (p=0.314), lengths of hospital stay (p=0.607), and readmission rate (p>0.999). Furthermore, both groups had similar major surgical outcomes of recipients including biliary (p=0.163) complications and lengths of hospital stay (p=0.445). Conclusion DRLR may be safely performed in a select group of high BMI donors with ≥30 kg/m2 without uncontrolled metabolic disease and significant liver steatosis in the absence of other suitable living donors.

Background: Numerous studies have investigated risk factors for unfavorable outcomes in prosthetic breast reconstruction, such as obesity, perioperative radiotherapy, and acellular dermal matrix use. However, no reports have explored whether the use of the dominant hand influences complications in breast reconstruction. To address this gap in the literature, analyzed complication rates between the dominant and non-dominant sides after reconstruction. Methods: We retrospectively reviewed the charts of 160 patients (170 breasts) who underwent breast reconstruction from February 2017 to March 2022. We analyzed the complications between beasts on the dominant and non-dominant sides according to the reconstruction method. Results: During prosthetic breast reconstruction, the drainage volume and duration on the dominant side exceeded those on the non-dominant side after reconstruction (duration: 9.79 days on the dominant side vs. 9.12 days on the non-dominant side, P=0.196; volume: 771.1 mL on the dominant side vs. 654.3 mL on the non-dominant side, P=0.027). The incidence of complications such as wound dehiscence, mastectomy flap necrosis, and infection was significantly higher in the dominant hand group (infection: 6 vs. 0, P=0.014; dehiscence: 15 vs. 4, P=0.009; flap necrosis: 13 vs. 4, P=0.024). Conclusions Complications including seroma, infection, and mastectomy skin flap necrosis following prosthetic reconstruction were common in breasts on the dominant-hand side. Therefore, meticulous management and restriction of shoulder movement can aid in preventing seroma-related complications in prosthetic breast reconstruction, especially on the side of the dominant hand.

Objectives: The purpose of this study was to evaluate risk factors and symptoms in cemento-osseous dysplasia (COD) patients. Materials and Methods: In this study, 62 patients who were diagnosed histologically with COD were investigated from 2010 to 2020 at the author’s institution. We compared clinical and radiological characteristics of symptomatic and asymptomatic patients. The factors were sex, age, lesion size, site, radiologic stage of lesion, apical involvement, sign of infection, and history of tooth extraction. Statistical analysis was performed using Fisher’s exact test and the chi-square test. Results: COD was more prevalent in female patients. With the exception of three cases, all were focal COD. The majority of patients presented with symptoms when the lesion was smaller than 1.5 cm in size. Symptoms were observed when the apex of the tooth was included in the lesion or there was a local infection around the lesion. The history of tooth extraction and previous endodontic treatment were evaluated, and history was not a significant predictor for the onset of symptoms. Conclusion In this study, risk factors associated with symptomatic patients were size of lesion, apical involvement, and local infection.