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Background@#Recently, active surveillance (AS) has been introduced as an alternative to early surgery (ES) for the management of papillary thyroid microcarcinoma (PTMC), because of its indolent features and low mortality. However, its cost effects have not been determined and the findings of current studies differ, according to each country’s medical system. @*Methods@#A Markov model was constructed to compare the cost-effectiveness of AS and ES, based on a reference case of a 40-year-old patient diagnosed with PTMC. Costs and transition probabilities were derived from previous clinical studies in Korean populations, and the incremental cost-effectiveness ratio (ICER) and net monetary benefit (NMB) were calculated. The willingness-to-pay (WTP) threshold was set at USD 100,000 per quality-adjusted life year (QALY) gained. Sensitivity analyses were conducted to address the uncertainties in the model’s variables. @*Results@#From the base scenario, the cumulative costs and effectiveness were both higher in ES than AS. The ICER for ES, compared with AS, was USD 6,619.86/QALY, lower than the set WTP. The NMB difference between AS and ES increased across the stages (USD 5,980 at the first stage and USD 159,667 at the last stage). The ICER increased along with decreasing age and increasing cost of surgery. The higher the ES utility score and the lower that of AS, the more cost-effective ES, with WTP set at USD 30,000. @*Conclusion@#In the current Korean medical system, ES is more cost-effective than AS. ES is more cost-effective as it is diagnosed at young age and followed-up for a long time.
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Purpose@#The number of international visiting scholars has been on the increase in Korea and we aim to investigate the program’s current situation. @*Methods@#This cross-sectional study is based on an online survey questionnaire responded by international visiting scholars in surgical departments of 8 Korean hospitals between 2014 and 2018 about their experiences and satisfaction with the visiting scholar program. @*Results@#A total of 1,496 international scholars from 80 countries visited various surgical departments in 8 Korean hospitals between 2014 and 2018. The numbers have been on the increase over the years. Out of 355 visiting scholars in 2018, 71 replied to the online survey, of whom 52 were male and 19 female, and mostly in their 30s and 40s. Information about the program was accessed mostly through friends or colleagues (42.3%) and international conferences (36.6%). The commonest funding source was private (35.2%) and more than half stayed for less than 3 months. The visiting scholar’s main roles were mostly observation or participation in surgery and clinical research. All but 1 were satisfied with the program (98.6%) and would recommend it to friends and colleagues, although the language barrier was identified as an inconvenience. Those aged 20–39 years with governmental or institutional funding were associated with stays of more than 1 year. @*Conclusion@#The number of international visiting scholars at surgical departments in Korean hospitals has been on the increase with high satisfaction levels. Improvements need to be made on funding sources and lengthening visiting period to maximize the benefits of the program.
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PURPOSE: A laparoscopic approach, rather than conventional laparotomy, is the well-accepted first choice for excision of an adrenal or perinephric retroperitoneal mass. The purpose of this study was to investigate the factors that affect surgical outcomes and analyze the clinical effectiveness of this surgical treatment modality. METHODS: We conducted a retrospective analysis of 62 patients who underwent laparoscopic adrenalectomies from September 2007 to February 2013. These operations were performed by a single surgeon. Demographic characteristics, operative data, tumor characteristics, and surgical outcomes were analyzed. RESULTS: Of 62 patients, 21 were men and 41 were women. The mean operative time was 151.16+/-48.58 minutes and the mean amount of blood loss was 179.51+/-161.66 ml. There were two cases of metastatic adrenal tumors that were resected completely with prolonged survival. There was one case of recurrence during the postoperative period. Preoperatively, it was only a tumor measuring 3.5 cm without evidence of malignancy. Postoperative complications occurred in three patients. However, there was no case of conversion to laparotomy. Previous history of open abdominal operation did not affect post-operative outcomes. CONCLUSION: Laparoscopic approach for adrenal tumors is indicated regardless of its type or past history of abdominal surgery. Unless greater than 10 cm, relatively large tumors can be safely removed using this method. In particular, due to the possibility of malignant potential, aggressive surgical intervention is recommended for tumors measuring between 3 and 5 cm. Use of a laparoscopic approach is associated with low risk of surgical complication and the benefits outweigh the disadvantages.