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.Impact of single-port laparoscopic approach on scar assessment by patients and observers: a multicenter retrospective study
Sung Uk BAE ; Kyeong Eui KIM ; Chang-Woo KIM ; Ji-Hoon KIM ; Woon Kyung JEONG ; Yoon-Suk LEE ; Seong Kyu BAEK ; Suk-Hwan LEE ; Jun-Gi KIM
Annals of Coloproctology 2025;41(2):154-161
Purpose:
This study aimed to compare the wound cosmesis of a single-incision approach on scar assessment after laparoscopic surgery for colon cancer.
Methods:
This study included 32 patients undergoing single-port laparoscopic surgery (SPLS) and 61 patients undergoing multiport laparoscopic surgery (MPLS) for colon cancer at 3 tertiary referral hospitals between September 2011 and December 2019. We modified and applied the Korean version of the Patient and Observer Scar Assessment Scale (POSAS) to assess cosmetic outcomes. To assess the interobserver reliability using intraclass correlation coefficient values for the Observer Scar Assessment Scale (OSAS), the surgeons evaluated 5 images of postoperative scars.
Results:
No significant differences were observed in the time before the return of normal bowel function, time to sips of water and soft diet initiation, length of in-hospital stay, and postoperative complication rate. The SPLS group had a shorter total incision length than the MPLS group. The POSAS favored the SPLS approach, revealing significant differences in the Patient Scar Assessment Scale (PSAS), OSAS, and overall scores. The SPLS approach was an independent factor influencing the POSAS, PSAS, and OSAS scores. Eleven colorectal surgeons had a significantly substantial intraclass coefficient.
Conclusion
The cosmetic outcomes of SPLS as assessed by the patients and surgeons were superior to those of MPLS in colon cancer. Reducing the number of ports is an independent factor affecting scar assessment by patients and observers.
3.Impact of single-port laparoscopic approach on scar assessment by patients and observers: a multicenter retrospective study
Sung Uk BAE ; Kyeong Eui KIM ; Chang-Woo KIM ; Ji-Hoon KIM ; Woon Kyung JEONG ; Yoon-Suk LEE ; Seong Kyu BAEK ; Suk-Hwan LEE ; Jun-Gi KIM
Annals of Coloproctology 2025;41(2):154-161
Purpose:
This study aimed to compare the wound cosmesis of a single-incision approach on scar assessment after laparoscopic surgery for colon cancer.
Methods:
This study included 32 patients undergoing single-port laparoscopic surgery (SPLS) and 61 patients undergoing multiport laparoscopic surgery (MPLS) for colon cancer at 3 tertiary referral hospitals between September 2011 and December 2019. We modified and applied the Korean version of the Patient and Observer Scar Assessment Scale (POSAS) to assess cosmetic outcomes. To assess the interobserver reliability using intraclass correlation coefficient values for the Observer Scar Assessment Scale (OSAS), the surgeons evaluated 5 images of postoperative scars.
Results:
No significant differences were observed in the time before the return of normal bowel function, time to sips of water and soft diet initiation, length of in-hospital stay, and postoperative complication rate. The SPLS group had a shorter total incision length than the MPLS group. The POSAS favored the SPLS approach, revealing significant differences in the Patient Scar Assessment Scale (PSAS), OSAS, and overall scores. The SPLS approach was an independent factor influencing the POSAS, PSAS, and OSAS scores. Eleven colorectal surgeons had a significantly substantial intraclass coefficient.
Conclusion
The cosmetic outcomes of SPLS as assessed by the patients and surgeons were superior to those of MPLS in colon cancer. Reducing the number of ports is an independent factor affecting scar assessment by patients and observers.
4.Impact of single-port laparoscopic approach on scar assessment by patients and observers: a multicenter retrospective study
Sung Uk BAE ; Kyeong Eui KIM ; Chang-Woo KIM ; Ji-Hoon KIM ; Woon Kyung JEONG ; Yoon-Suk LEE ; Seong Kyu BAEK ; Suk-Hwan LEE ; Jun-Gi KIM
Annals of Coloproctology 2025;41(2):154-161
Purpose:
This study aimed to compare the wound cosmesis of a single-incision approach on scar assessment after laparoscopic surgery for colon cancer.
Methods:
This study included 32 patients undergoing single-port laparoscopic surgery (SPLS) and 61 patients undergoing multiport laparoscopic surgery (MPLS) for colon cancer at 3 tertiary referral hospitals between September 2011 and December 2019. We modified and applied the Korean version of the Patient and Observer Scar Assessment Scale (POSAS) to assess cosmetic outcomes. To assess the interobserver reliability using intraclass correlation coefficient values for the Observer Scar Assessment Scale (OSAS), the surgeons evaluated 5 images of postoperative scars.
Results:
No significant differences were observed in the time before the return of normal bowel function, time to sips of water and soft diet initiation, length of in-hospital stay, and postoperative complication rate. The SPLS group had a shorter total incision length than the MPLS group. The POSAS favored the SPLS approach, revealing significant differences in the Patient Scar Assessment Scale (PSAS), OSAS, and overall scores. The SPLS approach was an independent factor influencing the POSAS, PSAS, and OSAS scores. Eleven colorectal surgeons had a significantly substantial intraclass coefficient.
Conclusion
The cosmetic outcomes of SPLS as assessed by the patients and surgeons were superior to those of MPLS in colon cancer. Reducing the number of ports is an independent factor affecting scar assessment by patients and observers.
5.Impact of single-port laparoscopic approach on scar assessment by patients and observers: a multicenter retrospective study
Sung Uk BAE ; Kyeong Eui KIM ; Chang-Woo KIM ; Ji-Hoon KIM ; Woon Kyung JEONG ; Yoon-Suk LEE ; Seong Kyu BAEK ; Suk-Hwan LEE ; Jun-Gi KIM
Annals of Coloproctology 2025;41(2):154-161
Purpose:
This study aimed to compare the wound cosmesis of a single-incision approach on scar assessment after laparoscopic surgery for colon cancer.
Methods:
This study included 32 patients undergoing single-port laparoscopic surgery (SPLS) and 61 patients undergoing multiport laparoscopic surgery (MPLS) for colon cancer at 3 tertiary referral hospitals between September 2011 and December 2019. We modified and applied the Korean version of the Patient and Observer Scar Assessment Scale (POSAS) to assess cosmetic outcomes. To assess the interobserver reliability using intraclass correlation coefficient values for the Observer Scar Assessment Scale (OSAS), the surgeons evaluated 5 images of postoperative scars.
Results:
No significant differences were observed in the time before the return of normal bowel function, time to sips of water and soft diet initiation, length of in-hospital stay, and postoperative complication rate. The SPLS group had a shorter total incision length than the MPLS group. The POSAS favored the SPLS approach, revealing significant differences in the Patient Scar Assessment Scale (PSAS), OSAS, and overall scores. The SPLS approach was an independent factor influencing the POSAS, PSAS, and OSAS scores. Eleven colorectal surgeons had a significantly substantial intraclass coefficient.
Conclusion
The cosmetic outcomes of SPLS as assessed by the patients and surgeons were superior to those of MPLS in colon cancer. Reducing the number of ports is an independent factor affecting scar assessment by patients and observers.
6.Impact of single-port laparoscopic approach on scar assessment by patients and observers: a multicenter retrospective study
Sung Uk BAE ; Kyeong Eui KIM ; Chang-Woo KIM ; Ji-Hoon KIM ; Woon Kyung JEONG ; Yoon-Suk LEE ; Seong Kyu BAEK ; Suk-Hwan LEE ; Jun-Gi KIM
Annals of Coloproctology 2025;41(2):154-161
Purpose:
This study aimed to compare the wound cosmesis of a single-incision approach on scar assessment after laparoscopic surgery for colon cancer.
Methods:
This study included 32 patients undergoing single-port laparoscopic surgery (SPLS) and 61 patients undergoing multiport laparoscopic surgery (MPLS) for colon cancer at 3 tertiary referral hospitals between September 2011 and December 2019. We modified and applied the Korean version of the Patient and Observer Scar Assessment Scale (POSAS) to assess cosmetic outcomes. To assess the interobserver reliability using intraclass correlation coefficient values for the Observer Scar Assessment Scale (OSAS), the surgeons evaluated 5 images of postoperative scars.
Results:
No significant differences were observed in the time before the return of normal bowel function, time to sips of water and soft diet initiation, length of in-hospital stay, and postoperative complication rate. The SPLS group had a shorter total incision length than the MPLS group. The POSAS favored the SPLS approach, revealing significant differences in the Patient Scar Assessment Scale (PSAS), OSAS, and overall scores. The SPLS approach was an independent factor influencing the POSAS, PSAS, and OSAS scores. Eleven colorectal surgeons had a significantly substantial intraclass coefficient.
Conclusion
The cosmetic outcomes of SPLS as assessed by the patients and surgeons were superior to those of MPLS in colon cancer. Reducing the number of ports is an independent factor affecting scar assessment by patients and observers.
7.Safety and patient’s satisfaction of preoperative carbohydrate drink until 2 hours before colorectal cancer surgery: a single-center, prospective randomized controlled trial
Yun Min LEE ; Kyeong Eui KIM ; Sung Uk BAE ; Seong Kyu BAEK ; Woon Kyung JEONG
Annals of Coloproctology 2025;41(6):519-527
Purpose:
Traditionally, fasting from midnight has been a standard practice in elective surgery for reduce the risk of aspiration. However, Enhanced Recovery After Surgery (ERAS) programs recommend clear fluid intake until 2 hours before anesthesia. This study aimed to evaluate the safety and patient satisfaction of preoperative carbohydrate drink intake until 2 hours before colorectal cancer surgery.
Methods:
Sixty patients who underwent colorectal cancer surgery between April 2021 and February 2023 at Keimyung University Dongsan Medical Center were enrolled. This study included 30 patients who fasted from midnight (nothing by mouth [NPO] group) and 30 patients who consumed a high concentration of complex carbohydrate fluids (New Care NO-NPO) until 2 hours before surgery (No-NPO group). Patient satisfaction was assessed using a visual analog scale. Perioperative and postoperative outcomes were compared.
Results:
Basic characteristics of patients were similar for the 2 groups. The No-NPO group had a significantly higher patient satisfaction score than the NPO group (3.7 vs. 2.2, P=0.040). Scores of operative difficulty, operation time, blood loss, postoperative recovery parameters, and postoperative complication rates were similar for the 2 groups. Pathological outcomes were also comparable. No mortality occurred in either group.
Conclusion
High-concentration carbohydrate fluid intake until 2 hours before induction of anesthesia could improve patient satisfaction without increasing postoperative complications, demonstrating its safety and feasibility in colorectal cancer surgery.Trial registration CRIS (cris.nih.go.kr) identifier: KCT0011323.
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.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.
10.Correlation between urine cytology results on the day after overnight continuous saline irrigation following transurethral resection of bladder tumor and bladder tumor recurrence
Dae Hyun KIM ; Min Sung CHOI ; Jae Hwi CHOI ; Chunwoo LEE ; Seong Uk JEH ; Sung Chul KAM ; Jeong Seok HWA ; Jae Seog HYUN ; See Min CHOI
Investigative and Clinical Urology 2024;65(3):279-285
Purpose:
To investigate the relationship between urine cytology results after overnight continuous saline irrigation (OCSI) following transurethral resection of bladder tumor (TURBT) and bladder tumor recurrence in non-muscle invasive bladder cancer (NMIBC).
Materials and Methods:
A retrospective study was conducted on patients diagnosed with NMIBC between 2016 and 2020 after undergoing TURBT at our hospital. All patients received OCSI following TURBT and had urine cytology test at postoperative 1 day.Urine cytology was classified into three groups: Negative, low-grade urothelial neoplasm (LGUN)+atypical urothelial cells (AUC), and suspicious for high-grade urothelial carcinoma (SHGUC)+high-grade urothelial carcinoma (HGUC). Recurrence-free survival (RFS) in each group was compared using the Kaplan–Meier method. Univariable and multivariable Cox regression analyses were performed to evaluate independent prognostic factors.
Results:
A total of 172 patients were included in this study. Based on urine cytology group (after OCSI), RFS did not reach the median value in the Negative group. In the LGUN+AUC group, the median RFS was 615.00 days. In the SHGUC+HGUC group, the median RFS was 377.00 days. In survival analysis, the Negative group had a longer RFS than the SHGUC+HGUC group (p=0.013).However, Cox regression analysis showed that SHGUC+HGUC was not an independent prognostic factor for recurrence.
Conclusions
Urine cytology results after OCSI following TURBT in NMIBC were associated with bladder tumor recurrence. Specifically, SHGUC or HGUC in urine cytology after OCSI showed earlier recurrence than negative cases. However, further research is needed to accurately determine whether it is an independent prognostic factor.

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