Purpose: Pancreatic cancer has a poor prognosis; however, the implementation of neoadjuvant treatment enables borderline resectable cases to undergo curative resection and improves the overall survival rate. Attempts have been made to expand the eligibility criteria for neoadjuvant treatment, even in resectable cases. Some studies have suggested a correlation between vein abutment and poor prognosis or that the abutment angle may affect prognosis. This study investigated the anatomical factors affecting the vessel abutment angle and its prognostic value in pancreatic cancer. Methods: Patients with pancreatic ductal adenocarcinoma who underwent surgery between 2012 and 2017 were included in this study. Patients who underwent neoadjuvant treatment were excluded. Data from only the intent-to-treat pancreaticoduodenectomy group were included in the analysis. Clinicopathological characteristics; preoperative factors such as CA 19-9, preoperative biliary drainage, American Society of Anesthesiologists physical status classification, portal vein/superior mesenteric vein contact angle measured via CT scan; and intraoperative factors were collected for analysis. Results: A total of 365 patients were included in this study, and the abutment group included 92 patients (25.2%). The abutment and no-contact groups did not show any significant differences in terms of the overall survival or diseasefree survival rate. Among the abutment groups, patients with less than 90° and 90°–180° did not show any significant differences. In the multivariate analysis, the only preoperative factor that had a prognostic effect was CA 19-9, a biological factor. Conclusion When there is no vessel invasion in the abutment group, upfront surgery should be considered because the angle does not affect the overall prognosis.

Purpose: Pancreatic cancer has a poor prognosis; however, the implementation of neoadjuvant treatment enables borderline resectable cases to undergo curative resection and improves the overall survival rate. Attempts have been made to expand the eligibility criteria for neoadjuvant treatment, even in resectable cases. Some studies have suggested a correlation between vein abutment and poor prognosis or that the abutment angle may affect prognosis. This study investigated the anatomical factors affecting the vessel abutment angle and its prognostic value in pancreatic cancer. Methods: Patients with pancreatic ductal adenocarcinoma who underwent surgery between 2012 and 2017 were included in this study. Patients who underwent neoadjuvant treatment were excluded. Data from only the intent-to-treat pancreaticoduodenectomy group were included in the analysis. Clinicopathological characteristics; preoperative factors such as CA 19-9, preoperative biliary drainage, American Society of Anesthesiologists physical status classification, portal vein/superior mesenteric vein contact angle measured via CT scan; and intraoperative factors were collected for analysis. Results: A total of 365 patients were included in this study, and the abutment group included 92 patients (25.2%). The abutment and no-contact groups did not show any significant differences in terms of the overall survival or diseasefree survival rate. Among the abutment groups, patients with less than 90° and 90°–180° did not show any significant differences. In the multivariate analysis, the only preoperative factor that had a prognostic effect was CA 19-9, a biological factor. Conclusion When there is no vessel invasion in the abutment group, upfront surgery should be considered because the angle does not affect the overall prognosis.

Purpose: Pancreatic cancer has a poor prognosis; however, the implementation of neoadjuvant treatment enables borderline resectable cases to undergo curative resection and improves the overall survival rate. Attempts have been made to expand the eligibility criteria for neoadjuvant treatment, even in resectable cases. Some studies have suggested a correlation between vein abutment and poor prognosis or that the abutment angle may affect prognosis. This study investigated the anatomical factors affecting the vessel abutment angle and its prognostic value in pancreatic cancer. Methods: Patients with pancreatic ductal adenocarcinoma who underwent surgery between 2012 and 2017 were included in this study. Patients who underwent neoadjuvant treatment were excluded. Data from only the intent-to-treat pancreaticoduodenectomy group were included in the analysis. Clinicopathological characteristics; preoperative factors such as CA 19-9, preoperative biliary drainage, American Society of Anesthesiologists physical status classification, portal vein/superior mesenteric vein contact angle measured via CT scan; and intraoperative factors were collected for analysis. Results: A total of 365 patients were included in this study, and the abutment group included 92 patients (25.2%). The abutment and no-contact groups did not show any significant differences in terms of the overall survival or diseasefree survival rate. Among the abutment groups, patients with less than 90° and 90°–180° did not show any significant differences. In the multivariate analysis, the only preoperative factor that had a prognostic effect was CA 19-9, a biological factor. Conclusion When there is no vessel invasion in the abutment group, upfront surgery should be considered because the angle does not affect the overall prognosis.

Purpose: Hilar cholangiocarcinoma is known for its poor prognosis due to late diagnosis. To achieve long-term survival, curative resection often is necessary. However, after surgical resection, the 5-year survival rates vary from 14% to 48%.The aim of this study is to evaluate the prognostic factors for long-term survival in hilar cholangiocarcinoma. Methods: Patients who underwent curative resection for hilar cholangiocarcinoma at Samsung Medical Center from January 2000 to December 2020 were included. Demographics, surgical and oncological outcomes, short-term complications, recurrence, pathologic results, and survival were analyzed. Prognostic factors were analyzed with Cox proportional hazards models. Results: A total of 449 patients diagnosed with hilar cholangiocarcinoma who underwent intent-to-treat resection at Samsung Medical Center from 2000 to 2020 were included in this study. The median disease-free survival was 19 months, and the median survival was 40 months. One-, 3-, and 5-year survival rates were 82.8%, 53.7%, and 35.8%, respectively. Conclusion The 5-year survival rate of patients with hilar cholangiocarcinoma was 35.8% at Samsung Medical Center.Median survival was 40 months. N2 stage and tumor biology were factors affecting 5-year survival.

The increasing detection of papillary thyroid microcarcinoma (PTMC) has raised concerns about overtreatment.For low-risk PTMC, either immediate surgery or active surveillance (AS) can be considered. To support AS implementation, the Korean Thyroid Association convened a multidisciplinary panel and developed the first Korean guideline. AS is recommended to adults with pathologically proven Bethesda V-VI PTMC without clinical evidence of lymph node or distant metastasis, gross extrathyroidal extension, tracheal or recurrent laryngeal nerve invasion, or aggressive histology. Baseline assessment requires high‑resolution cervical ultrasound by experienced operators to rule out extrathyroidal extension, tracheal or recurrent laryngeal nerve invasion, and lymph node metastasis;contrast‑enhanced neck computed tomography is optional. Patient characteristics such as age, comorbidities, and capacity for long-term follow-up should be assessed. Shared decision-making should weigh the benefits and risks of surgery and AS, expected oncologic outcomes, complications, quality of life, anxiety, medical cost, and patient preference. Follow-up includes cervical ultrasound and thyroid function test every six months for two years, then annually. Disease progression, defined as significant tumor growth or newly detected nodal or distant metastasis, warrants surgery. Despite remaining uncertainties, this guideline offers a framework to ensure oncologic safety and support patient-centered active surveillance.

Objective: To survey experts’ opinions in abdominal radiology (radiologists) and pancreas-specialized gastroenterology (pancreatologists) in South Korea regarding diagnosing and managing pancreatic cystic neoplasms (PCNs). Materials and Methods: Between August 25, 2023, and October 5, 2023, an online survey was conducted among members of the Korean Society of Abdominal Radiology and the Korean Pancreatobiliary Association via email invitation. Results: The responses from 100 radiologists and 41 pancreatologists were analyzed. Of the respondents, 55.3% (78/141) reported seeing more than 50 patients or reading more than 50 exams related to PCN each month. The most common and preferred diagnostic modality for PCN was contrast-enhanced computed tomography (CECT), favored by 87.8% (36/41) of pancreatologists. When discrepancies arose between CECT or magnetic resonance imaging (MRI) and endoscopic ultrasound, 31.2% (44/141) of the respondents opted for multidisciplinary team discussion, whereas 29.1% (41/141) chose short-term follow-up using CECT or MRI. A total of 88.7% (125/141) of the respondents adhered to the 2017 International Association of Pancreatology (IAP) guidelines in their practice. Among the radiologists, 51.0% (51/100) endorsed a cut-off value of 5 mm for enhancing mural nodules, and 22.0% (22/100) supported a 5 mm/2 yr growth rate in the IAP guidelines v.2017.Additionally, 73.0% (73/100) of radiologists favored discontinuing surveillance, whereas 41.5% (17/41) of pancreatologists disagreed with stopping surveillance. Conclusion The survey underscores the clinical burden PCN poses and identifies CECT as the foremost diagnostic tool.Variability was noted in the terminology, differential diagnosis, approaches for resolving discrepancies between imaging examinations, and opinions on surveillance discontinuation among the respondents as a whole, as well as between radiologists and pancreatologists. Although the 2017 IAP guidelines are primarily followed, there remains a level of dissatisfaction with risk stratification among radiologists. This highlights the need for more standardized diagnostic algorithms and improved consensus among specialists to address these challenges.

Objective: To survey experts’ opinions in abdominal radiology (radiologists) and pancreas-specialized gastroenterology (pancreatologists) in South Korea regarding diagnosing and managing pancreatic cystic neoplasms (PCNs). Materials and Methods: Between August 25, 2023, and October 5, 2023, an online survey was conducted among members of the Korean Society of Abdominal Radiology and the Korean Pancreatobiliary Association via email invitation. Results: The responses from 100 radiologists and 41 pancreatologists were analyzed. Of the respondents, 55.3% (78/141) reported seeing more than 50 patients or reading more than 50 exams related to PCN each month. The most common and preferred diagnostic modality for PCN was contrast-enhanced computed tomography (CECT), favored by 87.8% (36/41) of pancreatologists. When discrepancies arose between CECT or magnetic resonance imaging (MRI) and endoscopic ultrasound, 31.2% (44/141) of the respondents opted for multidisciplinary team discussion, whereas 29.1% (41/141) chose short-term follow-up using CECT or MRI. A total of 88.7% (125/141) of the respondents adhered to the 2017 International Association of Pancreatology (IAP) guidelines in their practice. Among the radiologists, 51.0% (51/100) endorsed a cut-off value of 5 mm for enhancing mural nodules, and 22.0% (22/100) supported a 5 mm/2 yr growth rate in the IAP guidelines v.2017.Additionally, 73.0% (73/100) of radiologists favored discontinuing surveillance, whereas 41.5% (17/41) of pancreatologists disagreed with stopping surveillance. Conclusion The survey underscores the clinical burden PCN poses and identifies CECT as the foremost diagnostic tool.Variability was noted in the terminology, differential diagnosis, approaches for resolving discrepancies between imaging examinations, and opinions on surveillance discontinuation among the respondents as a whole, as well as between radiologists and pancreatologists. Although the 2017 IAP guidelines are primarily followed, there remains a level of dissatisfaction with risk stratification among radiologists. This highlights the need for more standardized diagnostic algorithms and improved consensus among specialists to address these challenges.

Only a small percentage of patients (2-5%) with differentiated thyroid cancer (DTC) exhibit distant metastasis at the initial diagnosis or during the disease course. The most common metastatic sites of DTC are the lungs, followed by the bones. Radioactive iodine (RAI) therapy is considered the primary treatment for RAI-avid distant metastatic DTC. Depending on the characteristics of metastatic lesions, local treatment such as surgical resection, radiofrequency ablation, and external beam radiation therapy may be considered for some patients with metastatic DTC. Slowly growing and asymptomatic metastases can be monitored with follow-up while receiving thyroid-stimulating hormone (TSH) suppression therapy. In patients with a limited number of lung metastases and good performance status, surgical removal of the metastatic lesions may be considered. Systemic therapy should be considered for patients with progressive RAI refractory DTC. In this clinical guideline, we aim to outline the treatment principles for patients with lung, bone, and brain metastases of DTC.

Differentiated thyroid cancer demonstrates a wide range of clinical presentations, from very indolent cases to those with an aggressive prognosis. Therefore, diagnosing and treating each cancer appropriately based on its risk status is important. The Korean Thyroid Association (KTA) has provided and amended the clinical guidelines for thyroid cancer management since 2007. The main changes in this revised 2024 guideline include 1) individualization of surgical extent according to pathological tests and clinical findings, 2) application of active surveillance in low-risk papillary thyroid microcarcinoma, 3) indications for minimally invasive surgery, 4) adoption of World Health Organization pathological diagnostic criteria and definition of terminology in Korean, 5) update on literature evidence of recurrence risk for initial risk stratification, 6) addition of the role of molecular testing, 7) addition of definition of initial risk stratification and targeting thyroid stimulating hormone (TSH) concentrations according to ongoing risk stratification (ORS), 8) addition of treatment of perioperative hypoparathyroidism, 9) update on systemic chemotherapy, and 10) addition of treatment for pediatric patients with thyroid cancer.