Background: In the era of nucleoside analogs (NA), we investigated the safety of using hepatitis B surface antigen (HBsAg)-positive grafts in liver transplantation (LT) using nationwide KOTRY data. Methods: Among 4,265 adult LTs in the KOTRY registry (April 2014–January 2020), 20 (0.5%) used HBsAg(+) grafts. The S(+) group was compared with HBsAg-nega-tive groups, both HBcAb(+) (C[+]) and HBcAb(−) (SC[−]), using 1:1 propensity scorematching. Patient and graft survival were evaluated using Kaplan–Meier analysis.Cox regression was used to identify prognostic factors. Results: No significant differences were observed in patient or graft survival be-tween S(+) and C(+) or SC(−) groups. Key prognostic factors for patient survivalincluded age, HCC, MELD score, ascites, and encephalopathy. For graft survival, HCC, preoperative HCC treatment, MELD score, ascites, and encephalopathy were significant. HBV recurrence occurred in the S(+) group, but did not compromise outcomes. Conclusion In HBV-endemic regions, HBsAg(+) liver grafts can be safely used to expand the donor pool without compromising LT outcomes when combined with appropriate prophylaxis.

Purpose: Neoadjuvant treatment (NAT) is now the standard for borderline resectable pancreatic cancer (RPC) and is being considered for RPC. Early recurrence after curative surgery in RPC is often seen as a treatment failure, prompting considerations for NAT. Our goal was to develop an artificial intelligence (AI)-based predictive model utilizing preoperatively available factors to forecast early recurrences of resected RPC. Methods: This study included 469 patients who underwent surgery for RPC between 2011 and 2019. Clinicopathologic and oncologic data were retrospectively reviewed. Preoperative variables, including laboratory data and imaging findings, were collected. Early recurrence was defined as recurrence occurring within a year after surgery. Deep neural networks were then used to select variables by assessing their importance. A new model predicting early recurrence of RPC was subsequently developed. Results: Of the patients evaluated, 199 (42.4%) experienced early recurrence. The predictive model included 14 preoperative variables: CA 19-9, preoperative pancreatitis, serum albumin, platelet count, lymphocyte count, the American Society of Anesthesiologists physical status classification, tumor size, monocyte count, age, body mass index, CRP, hemoglobin, WBC count, and CEA. The area under the curve for the model was 0.786 in the training set and 0.734 in the test set. Conclusion We developed an AI-based model to predict the early recurrence of RPC using preoperative parameters. By identifying patients at risk of early recurrence, optimal individualized treatments such as NAT can be considered. Future prospective studies are crucial to establish clear indications for NAT in RPC.

Purpose: This study assesses preoperative prognostic factors in intrahepatic cholangiocarcinoma (ICC) to improve risk assessment and inform clinical decisions, focusing on the role of lymph node dissection (LND). Methods: We conducted a retrospective analysis of 234 patients who underwent surgery for ICC at a single institution between 2010 and 2019. Prognostic factors affecting overall survival (OS) were identified through univariate and multivariable logistic regression analyses. Patients were categorized into high-, intermediate-, and low-risk groups based on the number of adverse prognostic factors. Survival curves were compared between the groups that underwent LND and those that did not within each risk category. Results: Of the 234 patients, 138 (59.0%) underwent LND, and 96 (41.0%) did not (non-LND). Significant prognostic factors included preoperative elevation of CEA (>5 ng/mL), CA 19-9 (>37 U/mL), tumor multiplicity, tumor size >5 cm, and extrahepatic invasion. These factors were associated with adverse OS (hazard ratio ranging from 1.69 to 2.54). High-risk patients had significantly lower median OS compared to intermediate and low-risk groups in both LND and non-LND cohorts, but no significant difference in median OS between LND and non-LND groups within each risk category was observed. Conclusion Preoperative prognostic factors such as CEA, CA 19-9, tumor size, and multiplicity are vital for assessing patient risk in ICC. These factors guide clinical decision-making and emphasize the need for targeted treatment strategies, including the consideration of LND, particularly in high-risk patients. The study underscores the importance of these prognostic indicators in enhancing treatment outcomes.

Purpose: To evaluate patient‐reported experiences of 3 primary treatments for localized or locally advanced prostate cancer—radical prostatectomy (RP), radiation therapy (RT), and active surveillance (AS)—based on cross‐sectional data from a prospective registry, and to explore how these findings can inform a structured shared decision making (SDM) framework. Materials and Methods: Men with clinical stage cT3aN0M0 or lower were enrolled. Those who underwent RP or RT were surveyed 6–24 months posttreatment; men on AS had 6–60 months of follow‐up. All participants completed the EORTC QLQ‐PR25 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Prostate Cancer Module), capturing urinary, bowel, hormonal, and sexual function. The Kruskal‐Wallis test evaluated group differences, with significance set at p<0.05. Results: Among 542 patients, 435 underwent RP, 73 received RT (43% with androgen deprivation therapy), and 34 were on AS. RP patients reported higher rates of urinary incontinence and sexual dysfunction, whereas RT patients had more severe urinary irritative and bowel symptoms. AS generally preserved baseline sexual function but still involved some urinary complaints and anxiety regarding disease progression. These findings underscore the distinct trade‐offs among the 3 management strategies, emphasizing the importance of individualized SDM that accounts for functional priorities and patient values. Conclusion Each treatment modality poses unique impacts on quality of life. Incorporating these patient‐reported data into SDM discussions can improve alignment between clinical recommendations and patient preferences, potentially reducing decisional regret and enhancing long‐term outcomes.

The usefulness of the living kidney donor profile index (LKDPI) has not been widely demonstrated; therefore, it requires verification before clinical application. We analyzed the LKDPI using data from the Korean Organ Transplantation Registry (KOTRY) to confirm whether the LKDPI can be used to predict the survival of allografts in living donor kidney transplantation (LDKT) patients in Korea. Methods: The study population was obtained from the KOTRY database. A total of 2,598 kidney recipients registered in the KOTRY database were enrolled between May 2014 and December 2020. Donor and recipient information was observed, and the LKDPI was measured. Results: Median LKDPI score was 15.5 with a follow-up duration of 33.7 ± 16.1 months. According to LKDPI scores (group 1, <0; group 2, 0–20; group 3, 20–40; and group 4, >40), LKDPI group 4 had significantly higher death-censored graft loss than LKDPI group 1 (hazard ratio [HR], 1.89; 95% confidence interval [CI], 1.06– 3.40; p = 0.03). When divided based on the cutoff value (LKDPI, 36.6), the high LKDPI group had higher graft loss than the low LKDPI group (HR, 2.14; 95% CI, 1.37–3.34; p < 0.001). When follow-up was repeated after transplantation, it was confirmed that the higher the LKDPI value was, the lower the average estimated glomerular filtration rate (p < 0.001). Conclusion: This study confirmed that LKDPI can serve as an independent predictor for assessing the risk of allograft failure and transplant outcomes in Korean LDKT patients.

Purpose: Improvements in surgical quality and patient safety are critical components of the healthcare system. Despite excellent cancer survival rates in Korea, there is a lack of standardized postoperative complication management systems.To address this gap, the Korean Surgical Society initiated the development of the Korean Quality Improvement Platform in Surgery (K-QIPS) program. Methods: K-QIPS was successfully launched in 87 general hospitals. This nationwide surgical quality improvement program covers 5 major surgical fields: gastric surgery, colorectal surgery, hepatectomy and liver transplantation, pancreatectomy, and kidney transplantation. Results: Common and surgery-specific complication platforms will be developed, and the program will work toward the implementation of an artificial intelligence-based complication prediction system and the provision of evidence-based feedback to participating institutions. K-QIPS represents a significant step toward improving surgical quality and patient safety in Korea. Conclusion This program aims to reduce postoperative complications, mortality, and medical costs by providing a standardized platform for complication management and prediction. The successful implementation of this nationwide project may provide a good model for other countries that are required to improve surgical outcomes and patient care.

Purpose: Improvements in surgical quality and patient safety are critical components of the healthcare system. Despite excellent cancer survival rates in Korea, there is a lack of standardized postoperative complication management systems.To address this gap, the Korean Surgical Society initiated the development of the Korean Quality Improvement Platform in Surgery (K-QIPS) program. Methods: K-QIPS was successfully launched in 87 general hospitals. This nationwide surgical quality improvement program covers 5 major surgical fields: gastric surgery, colorectal surgery, hepatectomy and liver transplantation, pancreatectomy, and kidney transplantation. Results: Common and surgery-specific complication platforms will be developed, and the program will work toward the implementation of an artificial intelligence-based complication prediction system and the provision of evidence-based feedback to participating institutions. K-QIPS represents a significant step toward improving surgical quality and patient safety in Korea. Conclusion This program aims to reduce postoperative complications, mortality, and medical costs by providing a standardized platform for complication management and prediction. The successful implementation of this nationwide project may provide a good model for other countries that are required to improve surgical outcomes and patient care.

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.

Background: A decline in masticatory function may indicate brain dysfunction related to dementia, but the relationship between masticatory function and dementia risk remains unclear. This study aimed to investigate whether masticatory function is associated with the risk of cognitive decline and dementia. Methods: Data were obtained from the nationwide prospective cohort study of randomly sampled community-dwelling Koreans aged ≥ 60 years. The 5,064 non-demented participants, whose number of chewing cycles per bite was assessed by clinical interview, were followed for 8 years with biennial assessments of cognitive performance and clinical diagnoses of all-cause dementia and Alzheimer’s disease (AD). Structural brain magnetic resonance imaging was collected from a subset of cohort participants and their spouses for imaging analyses. Results: Males who chewed ≥ 30 cycles/bite had faster decline in global cognition and memory function and were at higher risk for incident all-cause dementia (hazard ratio [HR], 2.91; 95% confidence interval [CI], 1.18–7.18) and AD (HR, 3.22; 95% CI, 1.14–9.11) compared to males with less than 10 cycles/bite. Additionally, increased chewing cycles in males were associated with reduced brain volume, particularly in regions involved in compensatory cognitive control of mastication. There was no significant association between chewing cycles and the risk of dementia or brain volume in females. Conclusion Older men who frequently chew their meals could be considered a notable population at risk for dementia who should be carefully assessed for their cognitive trajectories.