Digital Twin Smart City: Integrating IFC and CityGML with Semantic Graph for Advanced 3D City Model Visualization.

The growing interest in building data management, especially the building information model (BIM), has significantly influenced urban management, materials supply chain analysis, documentation, and storage. However, the integration of BIM into 3D GIS tools is becoming more common, showing progress beyond the traditional problem. To address this, this study proposes data transformation methods involving mapping between three domains: industry foundation classes (IFC), city geometry markup language (CityGML), and web ontology framework (OWL)/resource description framework (RDF). Initially, IFC data are converted to CityGML format using the feature manipulation engine (FME) at CityGML standard's levels of detail 4 (LOD4) to enhance BIM data interoperability. Subsequently, CityGML is converted to the OWL/RDF diagram format to validate the proposed BIM conversion process. To ensure integration between BIM and GIS, geometric data and information are visualized through Cesium Ion web services and Unreal Engine. Additionally, an RDF graph is applied to analyze the association between the semantic mapping of the CityGML standard, with Neo4j (a graph database management system) utilized for visualization. The study's results demonstrate that the proposed data transformation methods significantly improve the interoperability and visualization of 3D city models, facilitating better urban management and planning.

mFOLFIRINOX versus mFOLFOX 6 as adjuvant treatment for high-risk stage III colon cancer - the FROST trial: study protocol for a multicenter, randomized controlled, phase II trial.

BACKGROUND: High-risk stage III colon cancer has a considerably poorer prognosis than stage II and low-risk stage III colon cancers. Nevertheless, most guidelines recommend similar adjuvant treatment approaches for all these stages despite the dearth of research focusing on high-risk stage III colon cancer and the potential for improved prognosis with intensive adjuvant treatment. Given the the proven efficacy of triplet chemotherapy in metastatic colorectal cancer treatment, the goal of this study is to evaluate the oncologic efficacy and safety of mFOLFIRINOX in comparison to those of the current standard of care, mFOLFOX 6, as an adjuvant treatment for patients diagnosed with high-risk stage III colon cancer after radical resection. METHODS: This multicenter, randomized (1:1), open-label, phase II trial will assess and compare the effectiveness and toxicity of mFOLFIRINOX and mFOLFOX 6 in patients with high-risk stage III colon cancer after radical resection. The goal of the trial is to enroll 312 eligible patients, from 11 institutes, aged between 20 and 70 years, with an Eastern Cooperative Oncology Group (ECOG) performance status of 0-2, or between 70 and 75 with an ECOG performance status of 0. Patients will be randomized into two arms - Arm A, the experimental arm, and Arm B, the reference arm - and will receive 12 cycles of mFOLFIRINOX and mFOLFOX 6 every 2 weeks, respectively. The primary endpoint of this study is the 3-year disease-free survival, and secondary endpoints include the 3-year overall survival and treatment toxicity. DISCUSSION: The Frost trial would help determine the oncologic efficacy and safety of adjuvant triplet chemotherapy for high-risk stage III colon cancers and ultimately improve prognoses. TRIAL REGISTRATION: ClinicalTrials.gov NCT05179889, registered on 17 December 2021.

Clinicopathological Outcomes in Patients With Locally Advanced Rectal Cancer Undergoing Preoperative Short-Versus Long-course Chemoradiotherapy With Delayed Surgery.

BACKGROUND/AIM: We aimed to compare the clinicopathological outcomes in patients with locally advanced rectal cancer after short- or long-course concurrent chemoradiotherapy (CCRT) followed by delayed surgery. PATIENTS AND METHODS: The records of 94 patients with cT3-4N0-2M0 rectal cancer who received CCRT between 2010 and 2017 were reviewed. Short-course radiotherapy (RT) was delivered with a median total dose of 25 Gy in five fractions (n=27), and long-course RT was delivered with a median total dose of 50.4 Gy in 28 fractions (n=67). The following concurrent chemotherapy regimens were administered: 5-fluorouracil plus leucovorin in 58 and capecitabine in 24; in 12 cases agents were unknown. The median interval between CCRT and surgery was 8 weeks. Adjuvant chemotherapy was administered after surgery in 80 patients (5-fluorouracil plus leucovorin, n=54; capecitabine, n=9; other, n=14; and unknown, n=3). Propensity-score matching analysis was conducted. RESULTS: The median follow-up duration was 4.3 years. There were no statistically significant differences between the short- and long-course RT groups in sphincter preservation (85.2% vs. 92.5%, p=0.478), pathological complete remission (18.5% vs. 14.9%, p=0.905), downstaging (44.4% vs. 26.9%, p=0.159), and negative circumferential resection margin (92.6% vs. 89.6%, p=0.947) rates. No differences were found in survival outcomes between the short- and long-course groups at 3 years (overall survival: 91.8% vs. 88.1%, p=0.790; disease-free survival, 75.2% vs. 72.5%, p=0.420; locoregional relapse-free survival, 90.5% vs. 98.4%, p=0.180; and distant metastasis-free survival, 79.6% vs. 73.5%, p=0.490). Similar results were observed after PSM. CONCLUSION: Clinically, short-course CCRT may be a feasible alternative to long-course CCRT in patients with locally advanced rectal cancer.

Total neoadjuvant therapy for rectal cancer: evidence and challenge.

Recent advances in the management of rectal cancer have dramatically changed the clinical practice of colorectal surgeons because the main focus of rectal cancer treatment has changed from sphincter-saving to an organ-preserving strategies. Modifying the delivery of systemic chemotherapy to improve patients' survival is another progress in colorectal cancer management, known as total neoadjuvant therapy (TNT). TNT is a new strategy used by colorectal surgeons to improve the quality of life and survival of patients after treatment. TNT poses limitations or obstacles, such as overtreatment issues in patients with stage I rectal cancer. However, considering the quality-of-life issues in patients with low-lying rectal cancer necessitating a permanent colostomy, the indication for TNT will be expanded. This review summarizes the recently conducted clinical trials and foresees future perspectives on TNT.

Block-HPCT: Blockchain Enabled Digital Health Passports and Contact Tracing of Infectious Diseases like COVID-19.

Due to its significant global impact, both domestic and international efforts are underway to cure the infection and stop the COVID-19 virus from spreading further. In resource-limited environments, overwhelmed healthcare institutions and surveillance systems are struggling to cope with this epidemic, necessitating a specific strategic response. In this study, we looked into the COVID-19 situation and to establish trust, accountability, and transparency, we employed blockchain's immutable and tamper-proof properties. We offered a smart contract (SC)-based solution (Block-HPCT) that has been successfully tested to preserve a digital health passport (DHP) for vaccine recipients; also, for contact tracing (CT) we employed proof of location concept, which aids in a swift and credible response directly from the appropriate healthcare authorities. To connect on-chain and off-chain data, trusted and registered oracles were integrated and to provide a double layer of security along with symmetric key encryption; both Interplanetary File System (IPFS) and Hyperledger Fabric were merged as storage center. We also provided a full description of the suggested solution's system design, implementation, experiment results, and evaluation (privacy and cost analysis). As per the findings, the suggested approach performed satisfactorily across all significant assessment criteria, implying that it can lead the way for practical implementations and also can be used for similar types of situations where contact tracing of infectious can be crucial.

Is Laparoscopic Complete Mesocolic Excision and Central Vascular Ligation Really Necessary for All Patients With Right-Sided Colon Cancer?

Colon cancer treatment is on the way to evolution over several decades. The minimally invasive surgery has improved postoperative short-term outcomes. Adjuvant chemotherapy has prolonged the survival of advanced colon cancer patients. Hohenberger proposed the noble concept of complete mesocolic excision (CME) which consists of 3 components: plane surgery, sufficient longitudinal bowel resection, and central vascular ligation (CVL). Mesocolic plane surgery shares the same surgical principle of total mesorectal excision, which is maintaining the intact mesothelial envelope. However, there remain debates about the extent of bowel resection and the level of CVL for maximizing lymph node dissection. There is no solid clinical evidence for the oncological necessity and benefit of extended radical dissection in right hemicolectomy. CME with CVL based on open surgery has been adopted in laparoscopic surgery. So, it is also necessary to look at how the CME could be transformed and successfully implanted in the laparoscopic era. Recent rapid advances in surgical technology and cancer biology are preparing for fundamental changes in cancer surgery. In this study, we reviewed the history, oncological necessity, and compatibility of CME for the right hemicolectomy in the laparoscopic era and outline the new perspectives on the evolution of cancer surgery.

Impact of COVID-19 on the care of acute appendicitis: a single-center experience in Korea.

PURPOSE: Coronavirus disease 2019 (COVID-19) affects healthcare systems worldwide; however, few studies have assessed the impact of COVID-19 on emergent surgical diseases. This study aimed to investigate the impact of COVID-19 on the care given to patients with acute appendicitis in Korea. METHODS: Between November 2019 and November 2020, 495 patients underwent laparoscopic surgery for acute appendicitis. The patients were divided into prepandemic and pandemic groups. The baseline characteristics and perioperative outcomes were compared. RESULTS: The time between admission and surgery was longer in the pandemic group than in the prepandemic group (17.6 hours vs. 9 hours, P < 0.001). The operation time was longer (5.8 minutes, P = 0.014), inflammation was more severe (10%, P = 0.036), and more patients visited the emergency room (82.1% vs. 73.3%, P = 0.025) in the pandemic group than in the prepandemic group. There were no significant differences in postoperative complications or length of hospital stay between the 2 groups. After propensity score matching, the time to surgery was delayed (17.3 hours vs. 9 hours, P < 0.001) and more patients visited the emergency room (84.5% vs. 73.3%, P = 0.020) in the pandemic group. CONCLUSION: In the COVID-19 era, the characteristics of patients with acute appendicitis and inflammation worsened. The time to surgery was delayed due to the requirement for preoperative COVID-19 testing and increased the severity of appendicitis did not affect the perioperative outcomes.

Colorectal cancer screening using a stool DNA-based SDC2 methylation test: a multicenter, prospective trial.

BACKGROUND: Prevention and early detection of colorectal cancer (CRC) is a global priority, with many countries conducting population-based CRC screening programs. Although colonoscopy is the most accurate diagnostic method for early CRC detection, adherence remains low because of its invasiveness and the need for extensive bowel preparation. Non-invasive fecal occult blood tests or fecal immunochemical tests are available; however, their sensitivity is relatively low. Syndecan-2 (SDC2) is a stool-based DNA methylation marker used for early detection of CRC. Using the EarlyTect™-Colon Cancer test, the sensitivity and specificity of SDC2 methylation in stool DNA for detecting CRC were previously demonstrated to be greater than 90%. Therefore, a larger trial to validate its use for CRC screening in asymptomatic populations is now required. METHODS: All participants will collect their stool (at least 20 g) before undergoing screening colonoscopy. The samples will be sent to a central laboratory for analysis. Stool DNA will be isolated using a GT Stool DNA Extraction kit, according to the manufacturer's protocol. Before performing the methylation test, stool DNA (2 µg per reaction) will be treated with bisulfite, according to manufacturer's instructions. SDC2 and COL2A1 control reactions will be performed in a single tube. The SDC2 methylation test will be performed using an AB 7500 Fast Real-time PCR system. CT values will be calculated using the 7500 software accompanying the instrument. Results from the EarlyTect™-Colon Cancer test will be compared against those obtained from colonoscopy and any corresponding diagnostic histopathology from clinically significant biopsied or subsequently excised lesions. Based on these results, participants will be divided into three groups: CRC, polyp, and negative. The following clinical data will be recorded for the participants: sex, age, colonoscopy results, and clinical stage (for CRC cases). DISCUSSION: This trial investigates the clinical performance of a device that allows quantitative detection of a single DNA marker, SDC2 methylation, in human stool DNA in asymptomatic populations. The results of this trial are expected to be beneficial for CRC screening and may help make colonoscopy a selective procedure used only in populations with a high risk of CRC. TRIAL REGISTRATION: This trial (NCT04304131) was registered at ClinicalTrials.gov on March 11, 2020 and is available at https://clinicaltrials.gov/ct2/show/NCT04304131?cond=NCT04304131&draw=2&rank=1 .

A Deep Learning Method for 3D Object Classification and Retrieval Using the Global Point Signature Plus and Deep Wide Residual Network.

A vital and challenging task in computer vision is 3D Object Classification and Retrieval, with many practical applications such as an intelligent robot, autonomous driving, multimedia contents processing and retrieval, and augmented/mixed reality. Various deep learning methods were introduced for solving classification and retrieval problems of 3D objects. Almost all view-based methods use many views to handle spatial loss, although they perform the best among current techniques such as View-based, Voxelization, and Point Cloud methods. Many views make network structure more complicated due to the parallel Convolutional Neural Network (CNN). We propose a novel method that combines a Global Point Signature Plus with a Deep Wide Residual Network, namely GPSP-DWRN, in this paper. Global Point Signature Plus (GPSPlus) is a novel descriptor because it can capture more shape information of the 3D object for a single view. First, an original 3D model was converted into a colored one by applying GPSPlus. Then, a 32 × 32 × 3 matrix stored the obtained 2D projection of this color 3D model. This matrix was the input data of a Deep Residual Network, which used a single CNN structure. We evaluated the GPSP-DWRN for a retrieval task using the Shapnetcore55 dataset, while using two well-known datasets-ModelNet10 and ModelNet40 for a classification task. Based on our experimental results, our framework performed better than the state-of-the-art methods.

A Classification Method for the Cellular Images Based on Active Learning and Cross-Modal Transfer Learning.

In computer-aided diagnosis (CAD) systems, the automatic classification of the different types of the human epithelial type 2 (HEp-2) cells represents one of the critical steps in the diagnosis procedure of autoimmune diseases. Most of the methods prefer to tackle this task using the supervised learning paradigm. However, the necessity of having thousands of manually annotated examples constitutes a serious concern for the state-of-the-art HEp-2 cells classification methods. We present in this work a method that uses active learning in order to minimize the necessity of annotating the majority of the examples in the dataset. For this purpose, we use cross-modal transfer learning coupled with parallel deep residual networks. First, the parallel networks, which take simultaneously different wavelet coefficients as inputs, are trained in a fully supervised way by using a very small and already annotated dataset. Then, the trained networks are utilized on the targeted dataset, which is quite larger compared to the first one, using active learning techniques in order to only select the images that really need to be annotated among all the examples. The obtained results show that active learning, when mixed with an efficient transfer learning technique, can allow one to achieve a quite pleasant discrimination performance with only a few annotated examples in hands. This will help in building CAD systems by simplifying the burdensome task of labeling images while maintaining a similar performance with the state-of-the-art methods.

Does surgical smoke matter?

The coronavirus disease 2019 (COVID-19) pandemic has dramatically changed our daily lives and medical practices since it was first reported in December 2019 in Wuhan, China. Unlike the usual transmission patterns of other viral diseases, the asymptomatic or presymptomatic transmission of COVID-19 has caused difficulties in disease control around the globe. Surgical smoke or fumes may carry viruses. However, there is no evidence that the severe acute respiratory syndrome coronavirus 2, which causes COVID-19, is transmitted via surgical smoke or fumes. Laparoscopic surgeries should be continued to ensure optimal patient care. This review article aimed to investigate the current evidence relating to COVID-19 in surgical care and to discuss future remedies as the COVID-19 pandemic continues.

Laparoscopic Hartmann's Reversal: Application of a Single-Port Approach Through the Colostomy Site.

PURPOSE: Recently, laparoscopic reversal of Hartmann's colostomy was performed with favorable outcomes by many surgeons. We partially applied the concepts of single-port laparoscopic procedure through the colostomy site to remove intraperitoneal adhesion during initial step of the laparoscopic Hartmann's reversal. This study aimed to evaluate the feasibility and safety of the laparoscopic reversal of Hartmann's colostomy with the application of single-port laparoscopic techniques through the colostomy site. METHODS: From October 2008 to November 2018, the laparoscopic Hartmann's reversal was attempted in 20 patients. After colostomy take-downs, the single-port device was installed at the colostomy site and the single-port laparoscopic procedure was performed to remove intraperitoneal adhesions to provide space for additional trocars. After additional trocars were inserted, the descending colon and rectal stump were mobilized, and the colorectal anastomosis was completed. We retrospectively reviewed the medical records and analyzed the data to identify the perioperative complication rates as the primary outcome. RESULTS: Of the 20 patients, 3 patients (15.0%) had open conversions due to severe adhesions. Intraoperative small bowel injuries occurred in 2 patients (10.0%) and these were repaired through the colostomy site. Postoperative complications developed in 4 patients (20.0%) and were managed with medical treatments or wound closures under local anesthesia. CONCLUSION: The single-port laparoscopic procedure through the colostomy site is sufficiently safe in order to complete the Hartmann's reversal. We recommend that the colostomy site should be used as the access route into the abdominal cavity for the Hartmann's reversal.

Short-term Outcomes of Single-port Versus Multiport Laparoscopic Surgery for Colon Cancer: The SIMPLE Multicenter Randomized Clinical Trial.

OBJECTIVE: To compare short-term perioperative outcomes of single-port laparoscopic surgery (SPLS) and multiport laparoscopic surgery (MPLS) for colon cancer. SUMMARY BACKGROUND DATA: Although many studies reported short- and long-term outcomes of SPLS for colon cancer compared with MPLS, few have reported results of randomized controlled trials. METHODS: This was a multicenter, prospective, randomized controlled trial with a noninferiority design. It was conducted between August 2011 and June 2017 at 7 sites in Korea. A total of 388 adults (aged 19-85 yrs) with clinical stage I, II, or III adenocarcinoma of the ascending or sigmoid colon were enrolled and randomized. The primary endpoint was 30-day postoperative complication rates. Secondary endpoints were the number of harvested lymph nodes, length of the resection margin, postoperative pain, and time to functional recovery (bowel movement and diet). Patients were followed for 30 days after surgery. RESULTS: Among 388 patients, 359 (92.5%) completed the study (SPLS, n = 179; MPLS, n = 180). The 30-day postoperative complication rate was 10.6% in the SPLS group and 13.9% in the MPLS group (95% confidence interval, -10.05 to 3.05 percentage points; P < 0.0001). Total incision length was shorter in the SPLS group than in the MPLS group (4.6 cm vs 7.2 cm, P < 0.001), whereas the length of the specimen extraction site did not differ (4.4 cm vs 4.6 cm, P = 0.249). There were no significant differences between groups for all secondary endpoints and all other outcomes. CONCLUSIONS: Even though there was no obvious benefit to SPLS over MPLS when performing colectomy for cancer, our data suggest that SPLS is noninferior to MPLS and can be considered an option in selected patients, when performed by experienced surgeons.Trial registration: ClinicalTrials.gov Identifier: NCT01480128.

Quality of life and patient satisfaction after single- and multiport laparoscopic surgery in colon cancer: a multicentre randomised controlled trial (SIMPLE Trial).

BACKGROUND: The clinical benefits of single-port laparoscopic surgery (SPLS) in patients with colon cancer patients are unclear because only a few studies have reported on the quality of life (QoL) of such patients. This study aimed to compare the QoL and patient satisfaction between SPLS and multiport laparoscopic surgery (MPLS) in colon cancer. METHODS: The multicentre randomised controlled SIngle-port versus MultiPort Laparoscopic surgEry (SIMPLE) trial included patients with colon cancer who underwent radical surgery at seven hospitals in South Korea. We performed a pre-planned secondary analysis of the QoL data of 359 patients from that trial. The QoL was surveyed using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 preoperatively and at 1, 3, 6, and 12 months postoperatively. Patient satisfaction was measured with a 5-point questionnaire at these postoperative time points. RESULTS: Overall, 145 and 147 patients were included in the SPLS and MPLS groups, respectively. Most QoL domains were similar between the groups. In the subgroup analysis of patients without adjuvant chemotherapy, patients in the SPLS group presented with significantly better global health status (p = 0.017), fatigue (p = 0.047), and pain (p = 0.005) scores and tended to have improved physical (p = 0.055), emotional (p = 0.064), and social (p = 0.081) functioning, with marginal significance at 1 month postoperatively, compared to those in the MPLS group. Patient satisfaction regarding surgery (p = 0.002) and appearance of the abdominal scar (p = 0.002) was significantly higher with SPLS than with MPLS at 12 months postoperatively. CONCLUSION: Patients who underwent SPLS without adjuvant chemotherapy had better global health status, fatigue status, and pain at 1 month postoperatively; however, these improvements were minimal and temporary. In the near future, the effect of SPLS on postoperative QoL should be confirmed through a randomised controlled trial targeting the QoL in colon cancer patients. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01480128.

A Strictly Unsupervised Deep Learning Method for HEp-2 Cell Image Classification.

Classifying the images that portray the Human Epithelial cells of type 2 (HEp-2) represents one of the most important steps in the diagnosis procedure of autoimmune diseases. Performing this classification manually represents an extremely complicated task due to the heterogeneity of these cellular images. Hence, an automated classification scheme appears to be necessary. However, the majority of the available methods prefer to utilize the supervised learning approach for this problem. The need for thousands of images labelled manually can represent a difficulty with this approach. The first contribution of this work is to demonstrate that classifying HEp-2 cell images can also be done using the unsupervised learning paradigm. Unlike the majority of the existing methods, we propose here a deep learning scheme that performs both the feature extraction and the cells' discrimination through an end-to-end unsupervised paradigm. We propose the use of a deep convolutional autoencoder (DCAE) that performs feature extraction via an encoding-decoding scheme. At the same time, we embed in the network a clustering layer whose purpose is to automatically discriminate, during the feature learning process, the latent representations produced by the DCAE. Furthermore, we investigate how the quality of the network's reconstruction can affect the quality of the produced representations. We have investigated the effectiveness of our method on some benchmark datasets and we demonstrate here that the unsupervised learning, when done properly, performs at the same level as the actual supervised learning-based state-of-the-art methods in terms of accuracy.

Laparoscopic Surgery for Colorectal Cancer in Korea: Nationwide Data from 2013 to 2018.

PURPOSE: We report nationwide data on the current status of laparoscopic surgery for colorectal cancer (CRC) in Korea. MATERIALS AND METHODS: Nationwide data of patients who underwent surgery for CRC from 2013 to 2018 were obtained from the Health Insurance Review & Assessment Service database. Data and trends of laparoscopy use for colorectal resection over six years were examined. RESULTS: In Korea, a total of 117,320 patients underwent surgical resection for CRC from 2013 to 2018. The proportion of laparoscopic resection increased from 64.9% in 2013 to 78.5% in 2018. The rate of laparoscopic resection for colon cancer increased from 64.7% in 2013 to 77.4% in 2018. For rectal cancer, the rate of laparoscopic resection increased from 65.4% to 81.6%. Males accounted for 59.8% of all patients, but females surpassed males at over 80 years of age. The age of peak incidence was in the 60s for males and in the 70s for females. A steady increase in the number of patients undergoing surgery for CRC was observed over 80 years of age. CONCLUSION: The laparoscopic penetration rate for CRC in Korea continued to increase annually and reached 78.5% in 2018.

International consensus on natural orifice specimen extraction surgery (NOSES) for gastric cancer (2019).

At present, natural orifice specimen extraction surgery (NOSES) has attracted more and more attention worldwide, because of its great advantages including minimal cutaneous trauma and post-operative pain, fast post-operative recovery, short hospital stay, and positive psychological impact. However, NOSES for the treatment of gastric cancer (GC) is still in its infancy, and there is great potential to improve its theoretical system and clinical practice. Especially, several key points including oncological outcomes, bacteriological concerns, indication selection, and standardized surgical procedures are raised with this innovative technique. Therefore, it is necessary to achieve an international consensus to regulate the implementation of GC-NOSES, which is of great significance for healthy and orderly development of NOSES worldwide.

Resident Learning Curve for Laparoscopic Appendectomy According to Seniority.

PURPOSE: To delineate the learning curve (LC) for laparoscopic appendectomy (LA) performed by residents according to seniority in training. METHODS: Between October 2015 and November 2016, 150 patients underwent LA by three residents (in their first, second, and third year of training) under supervision. The patients were non-randomly assigned to each resident. The data were reviewed and analyzed retrospectively from prospectively collected database. The perioperative outcomes were compared between the three residents including operation time, complication, conversion, and so on. The LCs were evaluated by the moving average method and cumulative sum control chart (CUSUM) for operation time and surgical completion. RESULTS: Baseline characteristics and perioperative outcomes were similar except for age and location of the appendix among the three groups. Operation time was not different among the three residents (43.9, 45.3, and 48.4 min for A, B, and C, respectively). The moving average method for operation time showed a decreasing tendency for all residents. CUSUM for operation time showed that the peak points occurred at the 24th, 18th, and 31st cases for resident A, B, and C, respectively. In terms of surgical failure, residents A, B, and C reached steady states after the 35th, 11th, and 16th cases, respectively. Perforation of the appendix base was the only risk factor for surgical failure. CONCLUSION: The LC for LA by residents was 11-35 cases according to multidimensional statistical analyses. The accumulation of surgical experience of residents might affect the LC, especially for surgical completion rather than for operation time.

Validation of Korean Version of Low Anterior Resection Syndrome Score Questionnaire.

PURPOSE: Patients who undergo radical surgery for rectal cancer often experience low anterior resection syndrome (LARS). Symptoms of this syndrome include frequent bowel movements, gas incontinence, fecal incontinence, fragmentation, and urgency. The aim of this study was to investigate the convergent validity, discriminative validity, and reliability of the Korean version of the LARS score questionnaire. METHODS: The English LARS score questionnaire was translated into Korean using the forward-and-back translation method. A total of 146 patients who underwent radical surgery for rectal cancer answered the Korean version of the LARS score questionnaire including an anchor question assessing the impact of bowel function. Participants answered the questionnaire once more after 2 weeks. RESULTS: The Korean LARS score questionnaire showed high convergent validity in terms of high correlation between the LARS score and quality of life (perfect fit 55.5% vs. moderate fit 37.6% vs. no fit 6.8%, respectively; P < 0.001). The LARS score also showed good discriminative validity between groups of patients differing by sex (29 for males vs. 25 for females; P = 0.014), tumor level (29 for ≤8 cm vs. 24 for >8 cm; P = 0.021), and radiotherapy (32 for yes vs. 24 for no; P = 0.001). The LARS score also demonstrated high reliability at test-retest with no difference between scores at the first and second tests (intraclass correlation coefficient: Q1 = 0.932; Q2 = 0.909, Q3 = 0.944, Q4 = 0.931, and Q5 = 0.942; P < 0.001, respectively). CONCLUSION: The Korean version of the LARS score questionnaire has proven to be a valid and reliable tool for measuring LARS in Korean patients with rectal cancer.

Which strategy is better for resectable synchronous liver metastasis from colorectal cancer, simultaneous surgery, or staged surgery? Multicenter retrospective analysis.

PURPOSE: The optimal treatment for synchronous liver metastasis (LM) from colorectal cancer (CRC) depends on various factors. The present study was intended to investigate the oncologic outcome according to the time of resection of metastatic lesions. METHODS: Data from patients who underwent treatment with curative intent for primary CRC and synchronous LM between 2004 and 2009 from 9 university hospitals in Korea were collected retrospectively. One hundred forty-three patients underwent simultaneous resection for primary CRC and synchronous LM (simultaneous surgery group), and 65 patients were treated by 2-stage operation (staged surgery group). RESULTS: The mean follow-up length was 41.2 ± 24.6 months. In the extent of resection for hepatic metastasis, major hepatectomy was more frequently performed in staged surgery group (33.8% vs. 8.4%, P < 0.001). The rate of severe complications of Clavien-Dindo classification grade III or more was not significantly different between the 2 groups. The 3-year overall survival (OS) rate was 85.0% in staged surgery group and 69.4% in simultaneous surgery group (P = 0.013), and the 3-year recurrence-free survival (RFS) rate was 46.4% in staged surgery group and 30.2% in simultaneous surgery group (P = 0.143). In subgroup analysis based on the location of primary CRC, the benefit of staged surgery for OS and RFS was clearly shown in rectal cancer (P = 0.021 and P = 0.015). CONCLUSION: Based on our results, staged surgery with or without neoadjuvant chemotherapy should be considered for resectable synchronous LM from CRC, especially in rectal cancer, as a safe and fairly promising option.