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.

This video demonstrates the surgical technique of percutaneous endoscopic debridement and drainage (PEDD) for infectious spondylodiscitis performed under local anesthesia. Two representative cases are presented. The first case underwent transforaminal PEDD for L2–3 infectious spondylodiscitis, and the second case underwent combined transforaminal PEDD and drainage of a psoas abscess. In both cases, needle insertion was guided by C-arm fluoroscopy, followed by root block, discography, serial dilation, and insertion of a 3.7-mm endoscope. Under endoscopic visualization, necrotic disc material and infected granulation tissue were removed, and samples were collected for culture and biopsy. The procedure also enabled safe placement of a drainage catheter into the abscess cavity. Postoperatively, one patient improved with intravenous antibiotics after identification of Streptococcus constellatus, while the other was diagnosed with tuberculous spondylodiscitis and treated with antituberculosis therapy. Both patients showed gradual improvement in back pain and normalization of inflammatory markers. This video provides a detailed step-by-step guide to PEDD, highlighting its diagnostic and therapeutic advantages in infectious spondylodiscitis, as well as its educational value for surgeons learning full-endoscopic spine surgery.

Objective: : This study aimed to identify risk factors predicting the loss of cervical lordosis (LCL) in patients with multilevel ossification of the posterior longitudinal ligament (OPLL) after laminoplasty. Additionally, we evaluated the impact of these factors on health-related quality of life (HRQOL). Methods: : We retrospectively analyzed data from patients who underwent laminoplasty at Chonnam National University Hospital between January 2013 and December 2022. A range of radiological parameters and clinical outcome measures were collected perioperatively. Patients were divided into two groups based on the severity of LCL. We then evaluated preoperative radiological parameters associated with LCL and clinical outcomes, including HRQOL. Results: : A total of 110 patients (93 men and 17 women; mean age, 61.31±10.80 years) were included in the analysis. A higher T1 slope (T1S) (β=-0.412; p=0.004) and a lower extension ratio (β=0.107; p=0.006) were associated with an increased risk of LCL. T1S proved to be an excellent predictor of LCL, with a cutoff value of 28° (p<0.001; area under the curve, 0.918). Furthermore, T1S was the only factor significantly correlated with HRQOL after laminoplasty (r=-0.330; p<0.001). Conclusion : T1S was significantly associated not only with LCL but also with HRQOL among patients with multilevel OPLL after laminoplasty. With a T1S cutoff of 28°, a T1S exceeding this threshold can be considered an important prognostic factor when planning laminoplasty in these patients.

Purpose: The extent of seminal vesicle invasion (SVI) in prostate cancer can be classified into muscle layer invasion (SVI-muscle) and mucosal layer invasion (SVI-mucosa). This study aimed to evaluate the prognostic significance of the extent of SVI after radical prostatectomy. Materials and Methods: SVI-mucosa data were prospectively collected since 2014. Among 1,659 radical prostatectomy specimens from 2014 to 2023, 259 cases (15.6%) with extraprostatic SVI were enrolled. A total of 252 cases with available follow-up data were included in the final analysis. Results: SVI-mucosa was identified in 63 cases (25.0%), and SVI-muscle was identified in all 252 cases. Extracapsular extension was present in nearly all SVI cases (99.6%). The mean tumor volume percentage in final specimens was significantly higher in patients with SVI-mucosa (50%) compared to those without it (35%) (p<0.001). A high Gleason score (≥8) was more common in men with SVI-mucosa (p=0.021). Only 10 (5.3%) and 4 patients (6.3%) with and without SVI-mucosa, respectively, received adjuvant therapy (p=0.544). Biochemical recurrence-free survival did not significantly differ between men with SVI-mucosa and those with SVI-muscle alone (log-rank test, p=0.309). The 5-year metastasis-free survival and prostate cancerspecific survival rates were 86.0% vs. 91.6% (p=0.654) and 99.5% vs. 100% (p=0.865) in patients with and without SVI-mucosa, respectively. Conclusion The prognosis of patients with SVI is not uniformly poor. SVI-mucosa was associated with more aggressive pathological features. In most cases, SVI-muscle appears to develop first following extracapsular extension, with subsequent progression to SVI-mucosa. However, the presence of SVI-mucosa, an advanced status of SVI, did not significantly impact biochemical recurrence and metastasis-free survival rates.

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 investigated the efficacy of intravesical gemcitabine as an alternative to bacillus Calmette–Guérin (BCG) therapy. Materials and Methods: Data were retrospectively collected across seven institutions from February 1999 to May 2023. Inclusion criteria included patients with intermediate- or high-risk non-muscle invasive bladder cancer (NMIBC) who underwent transurethral resection of bladder tumors (TURBT) and received at least four sessions of intravesical gemcitabine or BCG induction therapy. Patient characteristics, complete remission (CR), occurrence, and progression rates were compared. Results: In total, 149 patients were included in this study (gemcitabine, 63; BCG, 86). No differences were apparent between the two groups in baseline characteristics, except for the follow-up period (gemcitabine, 9.2±5.9 months vs. BCG, 43.9±41.4 months, p<0.001). There were no consistent significant differences observed between the two groups in the 3-month (gemcitabine, 98.4% vs. BCG, 95.3%; p=0.848), 6-month (94.9% vs. 90.0%, respectively; p=0.793) and 1-year CR rates (84.2% vs. 83.3%, respectively;p=0.950). Also, there was no significant statistical difference in progression-free survival between the two groups (p=0.953). The occurrence rates of adverse events were similar between the groups (22.2% vs. 22.1%; p=0.989); however, the rate of Clavien– Dindo grade 2 or higher was significantly higher in the BCG group (1.6% vs. 16.3%, respectively; p<0.001). Conclusions Intravesical gemcitabine demonstrated efficacy comparable to BCG therapy for the first year in patients with intermediate- and high-risk NMIBC. However, long-term follow-up studies are warranted.

Colonoscopic polypectomy is effective in decreasing the incidence and mortality of colorectal cancer (CRC). Premalignant polyps discovered during colonoscopy are associated with the risk of metachronous advanced neoplasia. Postpolypectomy surveillance is the most important method for managing advanced metachronous neoplasia. A more efficient and evidence-based guideline for postpolypectomy surveillance is required because of the limited medical resources and concerns regarding colonoscopy complications. In these consensus guidelines, an analytic approach was used to address all reliable evidence to interpret the predictors of CRC or advanced neoplasia during surveillance colonoscopy. The key recommendations state that the high-risk findings for metachronous CRC following polypectomy are as follows: adenoma ≥10 mm in size; 3 to 5 (or more) adenomas; tubulovillous or villous adenoma; adenoma containing high-grade dysplasia; traditional serrated adenoma; sessile serrated lesion containing any grade of dysplasia; serrated polyp of at least 10 mm in size; and 3 to 5 (or more) sessile serrated lesions. More studies are needed to fully comprehend the patients who are most likely to benefit from surveillance colonoscopy and the ideal surveillance interval to prevent metachronous CRC.

Purpose: Persistent levels of prostate-specific antigen (PSA) is a poor prognostic factor for recurrence after radical prostatectomy (RP). We investigated the impact of the percentage of residual PSA (%rPSA) [(post-/preoperative PSA)×100], representing a biochemical residual tumor, and the first postoperative PSA (fPSA) level on metastasis-free survival (MFS) in men with persistent levels of PSA after RP. Materials and Methods: We retrospectively identified male patients within a single tertiary referral hospital database who harbored persistent (≥0.1 ng/mL) vs. undetectable (<0.1 ng/mL) PSA levels 4 to 8 weeks after RP. Kaplan–Meier analyses and Cox regression models were used to test the effect of persistent PSA levels, the fPSA level, and %rPSA on MFS. Results: Of 1,205 patients, 178 patients with persistent PSA levels were enrolled. Seven-year MFS rates were 60.5% vs. 84.3% (p<0.001) for patients with a %rPSA ≥6% and <6%, respectively. Multivariable Cox regression models of the overall cohort revealed that persistent PSA levels (hazard ratio [HR], 3.94; p=0.010), extracapsular extension (HR, 4.17; 95% confidence interval [CI], 1.06–16.41; p=0.041), and pathological Gleason grade group (pGGG) (HR, 3.69; 95% CI, 1.32–10.27; p=0.013) were independent predictors of metastasis. Multivariable Cox regression models in men with persistent PSA levels revealed that the %rPSA (HR, 8.92; 95% CI, 1.74–45.71; p=0.009) and pGGG 4–5 (HR, 4.13; 95% CI, 1.22–13.96; p=0.022) were independent predictors of distant metastasis, but not the fPSA level after surgery. Conclusions Persistent levels of PSA were associated with worse MFS after RP. In men with persistent PSA levels after RP, the %rPSA is a valuable predictor of MFS unlike the fPSA level.

Purpose: To evaluate the impact of paired transrectal ultrasonography (TRUS) findings of index lesions identified by multiparametric magnetic resonance imaging (mpMRI) on the detection rate of clinically significant prostate cancer (csPCa, Gleason score ≥7) during MRI/US fusion-targeted biopsies. Materials and Methods: From 2019 to 2021, TRUS findings of paired index lesions were prospectively collected from MRI/US cognitive (cTB, n=299) or program-assisted (pTB, n=294) fusion-targeted biopsies. csPCa detection rates according to the presence of a paired hypoechoic lesion (HoEL) and predictive factors for csPCa detection by targeted biopsy were evaluated. Results: Among 593 patients with visible lesions on upfront mpMRI (Prostate Imaging-Reporting and Data System score ≥3), 288 (48.6%) had paired HoELs on TRUS. The csPCa detection rates in targeted biopsy patients with and without paired HoELs were 56.3% and 10.5% (p<0.001), respectively. Detection rates in patients with and without paired HoELs in the peripheral zone were 65.0% and 14.5%, respectively, and in the transition zone, 37.4% and 8.2%, respectively. In the cTB cohort, a paired HoEL (OR=6.25; p<0.001) was an independent predictive factor for the detection of csPCa in the target core, but not in the pTB cohort (OR=1.92; p=0.107). Conclusions During MRI/US fusion-targeted biopsy, csPCa detection rate was higher in patients with paired HoELs on TRUS than in those without it. After adjustment of the zonal location and mpMRI findings, the presence of paired HoELs is an independent predictive factor for csPCa detection in cTB, but not in pTB. Therefore, paired HoELs improve only the targeting of visually estimated biopsies.