Purpose: This study evaluated the clinical outcomes and prognostic factors in patients with borderline resectable pancreatic cancer (BRPC) and locally advanced pancreatic cancer (LAPC) treated with upfront FOLFIRINOX followed by local-regional therapy (LRT), surgical resection (SR), and radiotherapy (RT). We aimed to identify specific patient subgroups for which RT may serve as a reasonable alternative to SR for local tumor control. Methods: We retrospectively analyzed 116 patients (SR group, n= 70; RT group, n= 46) at a single center between 2015 and 2020. Survival outcomes were compared based on LRT modalities, focusing on identifying subgroups in which RT provided an efficacy comparable to that of SR. Results: Among 116 patients, the SR group achieved a significantly higher 5-year overall survival (OS) than the RT group (27.1% vs. 8.7%, P< 0.0001), despite similar progression-free survival (P= 0.23). Significant prognostic factors for OS included carbohydrate antigen 19-9 (CA19-9) response in BRPC (P= 0.02) and radiologic partial response in LAPC (P= 0.05). Subgroup analysis revealed that, while SR provided a survival advantage in CA19-9 responders, no significant difference in OS was observed between SR and RT in CA19-9 non-responders (P= 0.37). Conclusion Although surgery remains the gold standard, RT may be considered a justifiable local alternative for CA19-9 non-responders and surgically ineligible patients with LAPC, yielding comparable outcomes in these specific, biologically unfavorable subgroups.

Objectives: Endoscopic submucosal dissection (ESD) has become a standard minimally invasive treatment for selected patients with early gastric cancer (EGC). This study presents the first nationwide survey of patients with EGC treated with ESD in 2023, conducted by the Korean College of Helicobacter and Upper Gastrointestinal Research. Methods: Data were retrospectively collected from participating referral centers across Korea using a standardized case report form covering patient characteristics, tumor features, procedural details, histopathological findings, and clinical outcomes. Descriptive and comparative analyses were conducted to summarize nationwide ESD practice patterns and outcomes. Results: Data from 5460 ESD cases from 5250 patients across 27 institutions were analyzed. The mean age was 67.4 years, with 74.1% males. Multiple synchronous lesions were identified in 3.7%. Most lesions were located in the lower third of the stomach (64.0%), and differentiated-type adenocarcinomas accounted for 87.8%. The en bloc and complete resection rates were 99.2% and 91.4%, respectively. Curative resection was achieved in 80.5%, whereas local non-curative resection (L-NCR) and surgical non-curative resection (S-NCR) were identified in 2.8% and 16.7%, respectively. Additional surgery was performed more frequently in patients with S-NCR than in those with L-NCR (59.3% vs. 24.7%). The bleeding and perforation rates were 3.6% and 0.9%, respectively, and were mostly managed conservatively or endoscopically. The median length of hospitalization was 4.0 days. Conclusions This first nationwide survey provides a comprehensive overview of the current practice of EGC treatment using ESD in Korea, demonstrating high technical success and safety, and establishing a baseline dataset for future longitudinal research.

Purpose: Endoscopic submucosal dissection (ESD) has become a standard minimally invasive treatment for selected patients with early gastric cancer (EGC). This study presents the first nationwide survey of patients with EGC treated with ESD in 2023, conducted by the Korean College of Helicobacter and Upper Gastrointestinal Research. Materials and Methods: Data were retrospectively collected from participating referral centers across Korea using a standardized case report form covering patient characteristics, tumor features, procedural details, histopathological findings, and clinical outcomes.Descriptive and comparative analyses were conducted to summarize nationwide ESD practice patterns and outcomes. Results: Data from 5,460 ESD cases from 5,250 patients across 27 institutions were analyzed. The mean age was 67.4 years, with 74.1% males. Multiple synchronous lesions were identified in 3.7%. Most lesions were located in the lower third of the stomach (64.0%), and differentiated-type adenocarcinomas accounted for 87.8%. The en bloc and complete resection rates were 99.2% and 91.4%, respectively. Curative resection was achieved in 80.5%, whereas local non-curative resection (L-NCR) and surgical non-curative resection (S-NCR) were identified in 2.8% and 16.7%, respectively. Additional surgery was performed more frequently in patients with S-NCR than in those with L-NCR (59.3% vs. 24.7%). The bleeding and perforation rates were 3.6% and 0.9%, respectively, and were mostly managed conservatively or endoscopically. The median length of hospitalization was 4.0 days. Conclusions This first nationwide survey provides a comprehensive overview of the current practice of EGC treatment using ESD in Korea, demonstrating high technical success and safety, and establishing a baseline dataset for future longitudinal research.

South Korea’s current healthcare system stands at a critical crossroads that will determine whether it can progress in a better direction over the next decade. Behind the relatively stable level of population health that has been maintained until now, it has become clear that the deterioration of patient experiences, the risk of collapse in critical emergency medical services, the burnout of healthcare providers, and the crisis in the sustainability of healthcare finances have all accumulated simultaneously. This crisis can no longer be overcome by partial fixes or short-term measures alone. The answer to what needs to change first must begin with a reaffirmation of what the healthcare system should aim for. Ultimately, what needs to be changed now is not an individual policy, but the criteria and priorities through which we view healthcare. The focus must shift from what to provide more of, to questioning what holds greater social value. If such a shift does not begin now, in ten years we won’t face a better healthcare system, but care enmeshed in a deeper crisis. Now is precisely the time to fundamentally define the direction of the healthcare system.

Objective: To evaluate the diagnostic performance of the “probable hepatocellular carcinoma (HCC)” category in the Korean Liver Cancer Association-National Cancer Center (KLCA-NCC) v2022 guidelines. Materials and Methods: This multicenter retrospective study included patients at risk of HCC who underwent gadoxetic acid-enhanced MRI between January 2015 and June 2018; a subgroup of these patients also underwent liver CT. Eligible patients had at least one non-cystic lesion (≥10 mm) with a reference standard. Four radiologists interpreted the images independently and the results were pooled. The performance of “definite HCC” and “probable HCC” together and “probable HCC” alone were compared between v2018 and v2022. Results: A total of 2,237 patients (1,666 men; mean age, 59 ± 11 years) with 2,445 lesions were included. In v2022, 1.5% (143/9,780) of the lesions were additionally categorized as “probable HCC” by four reviewers on MRI; among these, 104 lesions were not HCCs. Focal nodular hyperplasia (FNH) or FNH-like nodules constituted 90.4% (94/104) of the false positives. When “definite HCC” and “probable HCC” were combined, v2022 showed higher sensitivity (83.7% [5,670/6,776] vs. 83.1% [5,631/6,776]) but lower specificity (77.1% [2,316/3,004] vs. 80.6% [2,420/3,004]) than v2018 (P < 0.001). For “probable HCC” alone, v2022 showed a lower positive predictive value (PPV) than v2018 (64.1% [373/582] vs. 76.1% [334/439], P < 0.001). In v2022, lesions with non-rim arterial-phase hyperenhancement (APHE) showed a lower PPV than those without APHE (42.3% [91/215] vs. 76.8% [282/367], P < 0.001). In the CT subgroup (n = 1,590), 1.6% (99/6,360) of the lesions were reassessed as “probable HCC,” and its PPV was 83.8% (83/99) in v2022 whereas no lesions were classified as “probable HCC” under v2018. Conclusion The revised “probable HCC” category in the KLCA-NCC v2022 aligns with updates in the diagnostic flow, demonstrating acceptable performance on MRI and CT. Notably, FNH or FNH-like nodules can be misclassified as “probable HCC” when MRI is used.

Purpose: Technological advancements have enabled reduced-port robotic systems, enhancing the benefits of robotic surgery. This study compared the surgical outcomes of conventional multiport (5 ports), single-site (2 ports), and singleport (2 ports) robotic gastrectomy for gastric cancer. Methods: A prospectively collected database was retrospectively reviewed for patients who underwent robotic distal subtotal gastrectomy between January 2010 and August 2022 at Severance Hospital, Yonsei University Health System. The initial 20 cases from each group (multiport, single-site, and SP) were analyzed, focusing on demographics, surgical procedures, pathological results, and postoperative outcomes. The “textbook outcome” metric was employed to assess surgical quality. Results: The SP group showed lower visual analog pain scale compared to the multiport and single-site groups (3.5, 4.4, and 4.3, respectively, P = 0.017), faster time to first flatus (2.0, 2.7, and 2.8 days, respectively; P < 0.001), and shorter hospital stays (3.5, 6.2, and 5.5 days, respectively; P < 0.001). No significant differences were observed in major complications, unplanned intensive care unit care, readmission, or mortality between the groups. The rate of patients achieving textbook outcomes were 85.0% for the multiport group, 100% for the single-site group, and 95.0% for the SP group (P = 0.310). Conclusion Reduced-port robotic gastrectomy, including single-site and SP, has shown surgical safety with a high proportion of patients meeting textbook outcomes. The SP system demonstrated less pain and faster recovery, aligning with minimally invasive surgical goals. Therefore, the SP system could be a reliable and safe option for robotic gastrectomy, offering enhanced recovery without compromising surgical quality.

Minimally invasive surgery for gastric cancer has progressed from conventional laparoscopy to reduced-port and singleincision techniques, and further to robotic systems that address ergonomic and technical constraints. Reduced-port laparoscopic gastrectomy and single-incision laparoscopic gastrectomy demonstrated feasibility and cosmetic advantages but faced inherent limitations—restricted triangulation, instrument collisions, and unstable visualization—resulting in steep learning curves and selective adoption. Reduced-port robotic platforms, notably Single-Site (Intuitive Surgical)– based reduced-port totally robotic distal gastrectomy, mitigated some limitations and enabled complex tasks, including D2 lymphadenectomy and intracorporeal anastomosis, with acceptable short-term outcomes. The da Vinci Single-Port (SP) system (Intuitive Surgical) represents the latest step in this trajectory, introducing three fully-wristed instruments and a flexible 3-dimensional endoscope through a single multichannel cannula, restoring internal triangulation and reducing collisions. Early clinical experiences from high-volume centers report no or low conversion rates, minimal blood loss, adequate lymph node retrieval, and acceptable morbidity across distal and selected total gastrectomies. Practical considerations for safe adoption include optimized port placement, deliberate scope orientation, and close collaboration with an experienced bedside assistant. Nonetheless, the platform’s current lack of integrated robotic staplers and advanced energy or suction devices limits console autonomy; most cases still require an assistant port. Evidence remains confined largely to small series without head-to-head trials against reduced-port multi-arm robotic approaches.Future priorities include SP-dedicated energy and stapling tools, careful expansion to complex procedures, and robust multicenter studies assessing long-term oncologic outcomes. Taken together, the SP platform can be regarded as the present pinnacle of reduced-port gastrectomy and a promising path toward a reproducible, cosmetically favorable, and ergonomically enhanced approach for gastric cancer surgery.

Purpose: Non-operative management (NOM) has emerged as a promising organ-preserving strategy for patients with rectal cancer who achieve a clinical complete response (cCR) after neoadjuvant chemoradiotherapy (CRT). However, no standardized treatment protocol has been established for watch-and-wait strategies. Materials and Methods: This prospective study evaluated oncological outcomes of NOM combined with 4 months of adjuvant capecitabine. Patients with resectable rectal cancer (≤ 8 cm from the anal verge, cT2-4 or N+) underwent CRT (50-54 Gy in 25-27 fractions with capecitabine). Eight weeks post-CRT, a multidisciplinary team assessed cCR. Patients achieving cCR received six cycles of capecitabine (2 weeks on/1 week off) and were actively monitored. Results: Among 89 patients receiving CRT (2018-2023), 17 (19.1%) achieved cCR and were included. The median age was 65 years, and 64.7% were male. Eleven (64.7%) completed all six cycles of adjuvant therapy. After a median follow-up of 31.4 months, 11 patients (64.7%) remained disease-free. Local regrowth occurred in six patients (35.3%) with 2- and 4-year rates of 34.5% and 47.6%, respectively. Five underwent radical surgery, and one received transanal excision with systemic chemotherapy. At the time of assessment, 15 patients (88.2%) showed no evidence of disease, while two (11.8%) received palliative chemotherapy. All patients were alive. Conclusion NOM with adjuvant capecitabine showed promising oncological outcomes, offering an alternative to passive watch-and-wait approaches. Further refinement through multidisciplinary strategies is warranted.

Purpose: This study analyzed nationwide trends in lung cancer surgery in South Korea over 14 years, focusing on surgical volume, patient demographics, surgical approaches, and outcomes. Materials and Methods: We performed a retrospective cohort study using nationwide health insurance claims data (124,334 cases) and robotic surgery data (1,740 cases) provided by the manufacturer. Patients who underwent lung cancer surgery between 2010 and 2023 were included. Annual trends were assessed using the annual percentage change (APC), and logistic as well as linear regression models were used to identify predictors of mortality and prolonged hospital stay. Results: The annual surgical volume increased from 4,557 in 2010 to 14,184 in 2023 (APC, 8.86%; p < 0.001). Video-assisted thoracoscopic surgery (VATS) became the predominant approach, rising from 52.9% to 94.8% (APC, 4.11%; p < 0.001). Sub-lobar resections increased, with wedge resections growing from 9.0% to 18.5% (APC, 5.72%; p < 0.001) and segmentectomies from 3.0% to 17.9% (APC, 14.63%; p < 0.001). The proportion of female patients increased from 32.0% to 44.7% (APC, 2.39%; p < 0.001), while patients aged 70-79 years increased from 26.3% to 32.3% (APC, 1.60%; p < 0.001) and those aged ≥ 80 years from 2.0% to 6.2% (APC, 9.63%; p < 0.001). The median hospital stay decreased from 13 to 7 days (APC, –4.34%; p < 0.001), and 30-day mortality declined from 2.45% to 0.76% (APC, –8.32%; p < 0.001). Conclusion Lung cancer surgery in Korea has increased substantially, with a notable shift toward minimally invasive and lung-sparing techniques that have improved outcomes. However, persistent disparities underscore the need for a national surgical registry.

Purpose: The aim of this study is to compare the detection ability of quality of life (QoL) changes and responsiveness of the KOrean QUality of life in Stomach cancer patients Study group (KOQUSS)-40 and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ). Materials and Methods: A multicenter prospective observational study was conducted to evaluate QoL changes after various gastrectomies between January 2021 and April 2022. Participants were instructed to complete the KOQUSS-40 and EORTC QLQ-C30/STO22 preoperatively and at 1, 3, 6, and 12 months postoperatively. QoL changes over time and QoL responsiveness were assessed for each questionnaire. Results: Data from 491 patients who underwent curative gastrectomy for gastric cancer at 22 institutions were analyzed. The summary scores of the KOQUSS-40 and EORTC QLQ-STO22 showed significant differences between the total and proximal gastrectomy groups (p=0.044 and p=0.038, respectively), but no difference was observed for the EORTC QLQ-C30. Dysphagia on the KOQUSS-40 was significantly different between the total and proximal gastrectomy groups (p=0.031); however, dysphagia on the EORTC QLQ-STO22 did not differ. The responsiveness of the KOQUSS-40 was similar to that of the EORTC QLQ in patients who experienced ≥ 10% body weight loss, but approximately 10% less in patients receiving adjuvant chemotherapy than the EORTC QLQ. Conclusion KOQUSS-40 has several advantages over EORTC QLQ-C30/STO22 when comparing QoL between the total and proximal gastrectomy groups. The findings provide information for researchers investigating the QoL of patients who have undergone curative gastrectomy for gastric cancer.