What is the role of artificial intelligence in general surgery? / 이화의대지

The capabilities of artificial intelligence (AI) have recently surged, largely due to advancements in deep learning inspired by the structure and function of the neural networks of the human brain.In the medical field, the impact of AI spans from diagnostics and treatment recommendations to patient engagement and monitoring, considerably improving efficiency and outcomes. The clinical integration of AI has also been examined in specialties, including pathology, radiology, and oncology.General surgery primarily involves manual manipulation and includes preoperative, intraoperative, and postoperative care, all of which are critical for saving lives. Other fields have strived to utilize and adopt AI; nonetheless, general surgery appears to have retrogressed. In this review, we analyzed the published research, to understand how the application of AI in general surgery differs from that in other medical fields. Based on previous research in other fields, the application of AI in the preoperative stage is nearing feasibility. Ongoing research efforts aim to utilize AI to improve and predict operative outcomes, enhance performance, and improve patient care. However, the use of AI in the operating room remains significantly understudied. Moreover, ethical responsibilities are associated with such research, necessitating extensive work to gather evidence. By fostering interdisciplinary collaboration and leveraging lessons from AI success stories in other fields, AI tools could be specifically tailored for general surgery. Surgeons should be prepared for the integration of AI into clinical practice to achieve better outcomes; therefore, the time has come to consider ethical and legal implications.

Body composition index obtained by using a bioelectrical impedance analysis device can be a predictor of prolonged operative time in patients undergoing minimally invasive colorectal surgery

Purpose@#Obesity has been known to contribute to technical difficulties in surgery. Until now, body mass index (BMI) has been used to measure obesity. However, there are reports that BMI does not always correspond to the visceral fat. Recently, bioelectrical impedance analysis (BIA) has been used for body composition analysis. This study aimed to evaluate the usefulness of the body composition index obtained using a BIA device in predicting short-term postoperative outcomes. @*Methods@#Data of patients who underwent elective major colorectal surgery using minimally invasive techniques were reviewed retrospectively. Body composition status was recorded using a commercial BIA device the day before surgery. The relationship between BMI, body composition index, and short-term postoperative outcomes, including operative time, was analyzed. @*Results@#Sixty-six patients were enrolled in this study. In the correlation analysis, positive correlation was observed between BMI and body composition index. BMI and body composition index were not associated with short-term postoperative outcomes. Percent body fat (odds ratio, 4.226; 95% confidence interval [CI], 1.064–16.780; P=0.041) was found to be a statistically significant factor of prolonged operative time in the multivariate analysis. Correlation analysis showed that body fat mass was related to prolonged operative time (correlation coefficients, 0.245; P=0.048). In the area under curve analysis, body fat mass showed a statistically significant predictive probability for prolonged operative time (body fat mass: area, 0.662; 95% CI, 0.531–0.764; P=0.024). @*Conclusion@#The body composition index can be used as a predictive marker for prolonged operative time. Further studies are needed to determine its usefulness.

Weighing the benefits of lymphadenectomy in early-stage colorectal cancer

Recent advancements in endoscopic procedures have resulted in a growing diagnosis of early colorectal cancer (CRC) cases, where classical en bloc lymph node (LN) dissection is not performed and treatment is terminated with the removal of the main cancer lesion by endoscopy without pathologic LN staging. Although many studies report noninferior outcomes of endoscopic resection in comparison to surgical resection, a cautious approach to completing treatment with endoscopic resection alone is recommended because LN metastases may be present even in early-stage CRC. In most countries, including the United States, Europe, and South Korea, the guidelines for additional surgery after endoscopic resection are very similar. If LN metastasis is suspected, even in T1 stage or lower lesions, further surgery is an essential treatment modality, but confirmation of the presence of LN metastasis is perhaps the most difficult part of this process.Another paradoxical recent trend is the expansion of more extensive and complete surgical lymphadenectomy for CRC.The success rate of surgery has improved dramatically over the past decade with the introduction of surgical devices and minimally invasive surgery, and the associated risks have been significantly reduced. While the burden of surgery on patients is understandable, the indications for surgery in early colon cancer need to be carefully reviewed to improve cure rates. In this process, we believe that an integrated decision-making process with surgeons, radiologists, and pathologists, in addition to the opinions of endoscopists, will be an important process to improve the cure rate.

Is restrictive transfusion sufficient in colorectal cancer surgery? A retrospective study before and during the COVID-19 pandemic in Korea

Purpose@#Blood transfusion is one of the most common procedures used to treat anemia in colorectal surgery. Despite controversy regarding the adverse effects of blood products, surgeons have maintained standards for administering blood transfusions. However, this trend was restrictive during the COVID-19 pandemic because of a shortage of blood products. In this study, we conducted an analysis to investigate whether the restriction of blood transfusions affected postoperative surgical outcomes. @*Methods@#Medical records of 318 patients who underwent surgery for colon and rectal cancer at Ewha Womans University Mokdong Hospital between June 2018 and March 2022 were reviewed retrospectively. The surgical outcomes between the liberal and restrictive transfusion strategies in pre– and post–COVID-19 groups were analyzed. @*Results@#In univariate analysis, postoperative transfusion was associated with infectious complications (odds ratio [OR], 1.705; 95% confidence interval [CI], 1.015–2.865; P=0.044). However, postoperative transfusion was not an independent risk factor for the development of infectious complications in multivariate analysis (OR, 1.305; 95% CI, 0.749–2.274; P=0.348). In subgroup analysis, there was no significant association between infectious complications and the hemoglobin threshold level for the administration of a transfusion (OR, 1.249; 95% CI, 0.928–1.682; P=0.142). @*Conclusion@#During colorectal surgery, the decision to perform a blood transfusion is an important step in ensuring favorable surgical outcomes. According to the results of this study, restrictive transfusion is sufficient for favorable surgical outcomes compared with liberal transfusion. Therefore, modification of guidelines is suggested to minimize unnecessary transfusion-related side effects and prevent the overuse of blood products.

National cancer screening program for colorectal cancer in Korea

Colorectal cancer is the 3rd leading cause of cancer-related deaths in Korea, ranking 4th and 3rd among men and women, respectively. It is also the most common cause of cancer-related deaths in women older than 64 years. This study assessed the National Cancer Screening Program for colorectal cancer and examined its efficacy in enhancing public health. The fecal occult blood test (FOBT), a traditional noninvasive colorectal cancer screening test that can be performed on an outpatient basis was replaced with the fecal immunochemical test (FIT) because of the latter’s better predictive value. Since 2004, the Government of South Korea has recommended an annual FIT for people aged 50 years and older as the first step in colorectal cancer screening. Individuals who test positive on the FIT are scheduled for follow-up screening procedures, such as colonoscopy or double-contrast barium enema, whereas those who have a negative FOBT are not recommended for colonoscopy. Colonoscopy, as a screening tool in Korea, has definite merits because it is highly accessible to patients and is performed by qualified specialists. Although the domestic colorectal cancer screening rate is relatively stable, there is scope for improvement. Owing to the low cost of colonoscopy and the wealth of skilled endoscopy specialists, the number of intention-to-screen procedures for colonoscopy has increased. As Korea is rapidly becoming an ultra-elderly society, it is time to reconsider the revision of the classical screening program and recommend regionspecific, cost-effective guidelines.

Steroid Induced Perforation of Colon in Systemic Lupus Erythematosus / 이화의대지

no abstract available.

Is It Possible to Apply the Metaverse to Health Care System? / 이화의대지

no abstract available.

Efficacy of a rehabilitation program using minor muscles in colorectal cancer patients with chemotherapy-induced neuropathy: preliminary study

Purpose@#Chemotherapy-induced peripheral neuropathy (CIPN) is one of the common reasons that colorectal cancer patients cannot maintain their routine chemotherapy schedules. Some medications are used for pain relief; however, the effect of medication is disappointing. We carried out this study to confirm that a rehabilitation program using minor muscles might provide a valuable aid in symptom relief of CIPN. @*Methods@#Eleven colorectal cancer patients participated in the basic craftwork program which encouraged the use of the minor muscles of the hands to make and decorate the handicrafts and it was held for 2 hours once a week, for a total of four times. There were no limitations in the stage of cancer or types of chemotherapy to participate the program. Questionnaires were obtained from participants before and after the basic handicrafts program. @*Results@#Of the 11 patients (3 men, 8 women; mean age, 53.0±11.2 years), six received 5-fluorouracil (5-FU) chemotherapy, four received FOLFOX4 (combination of 5-FU, leucovorin, and oxaliplatin) chemotherapy, and one received 5-FU, FOLFOX4, and FOLFIRI (combination of 5-FU, leucovorin, and irinotecan) chemotherapy sequentially. Patients attended the program a mean of 3.8±0.4 times. Common symptoms of CIPN were “throbbing pain,” “aching pain,” and “numbness.” The mean score of the questionnaires between pre- and post-program was 34.1±31.7 points and 24.4±21.5 points each, and it was significantly decreased (P=0.040). @*Conclusion@#Patients often suffered from CIPN symptoms like throbbing or aching pain and numbness during their adjuvant chemotherapy. A rehabilitation program using minor muscles for CIPN is expected to be effective.

Minute Colon Perforation by a Nonabsorbable Suture Knot after Uterine Myomectomy / 이화의대지

We report a rare case of suture material-related colon perforation. A 60-year-old woman visited clinics because of the nonspecific abdominal discomfort for several months. There were no specific medical history except previous laparoscopic myomectomy 15 years ago. Colonoscopy and abdomen-pelvis computed tomography revealed an unknown foreign body penetrating the sigmoid colon wall adjacent to the uterus. We performed laparoscopic exploration with foreign body removal and primary colon wall repair. The foreign body was identified as a non-absorbable suture material suggestive of used in previous myomectomy. With recent trends for minimally invasive procedures in the field of pelvic organ surgery, surgeons, especially those without sufficient training have to pay attention to selecting the proper surgical suture materials. (Ewha Med J 2022;45(3):e7)

Publication Ethics Part 3: Plagiarism / 이화의대지

no abstract avaliable

Robotic single-incision right hemicolectomy with extended lymphadenectomy using the da Vinci SP Surgical Platform

The da Vinci SP Surgical System (dVSP; Intuitive Surgical, Sunnyvale, CA, USA) was introduced to overcome this limitation of single-incision laparoscopic surgery. This new surgical platform has been demonstrated favorable performance in colorectal surgery and its use has been increasing. And, in accordance with the increment of adoption of dVSP, the indication to apply this platform has been expanding. Herein, we report a technique of right hemicolectomy with extended lymphadenectomy beyond conventional lymph node dissection using dVSP.

Robotic single-incision right hemicolectomy with extended lymphadenectomy using the da Vinci SP Surgical Platform

The da Vinci SP Surgical System (dVSP; Intuitive Surgical, Sunnyvale, CA, USA) was introduced to overcome this limitation of single-incision laparoscopic surgery. This new surgical platform has been demonstrated favorable performance in colorectal surgery and its use has been increasing. And, in accordance with the increment of adoption of dVSP, the indication to apply this platform has been expanding. Herein, we report a technique of right hemicolectomy with extended lymphadenectomy beyond conventional lymph node dissection using dVSP.

Computed tomography based cross-sectional anatomy of the pelvis predicts surgical outcome after rectal cancer surgery

Purpose@#Narrow pelvis has been considered an adverse factor for postoperative and oncologic outcomes after rectal cancer surgery. The aim of this study was to investigate the validity of using only axial CT scan images to calculate the pelvic cross-sectional area for the prediction of adverse outcomes after rectal cancer surgery. @*Methods@#The medical records of patients who underwent rectal cancer surgery were reviewed and analyzed retrospectively. Axial images of CT scan were used to measure the pelvic cross-sectional area. Pelvic surgical site infection (SSI), positive resection margin, and early local recurrence were adopted as end-points to analyze the impact of pelvimetry on surgical outcome. @*Results@#The mean pelvic cross-sectional area was 84.3 ± 10.9 cm2. Males had significantly smaller pelvic areas than females (P < 0.001). Comparing pelvic cross-sectional areas according to the surgical outcomes, the results indicated that patients with pelvic SSI and local failure (positive resection margin or local recurrence within 1 year) have significantly smaller cross-sectional-area than SSI and local failure-free patients (P = 0.013 and P = 0.031). A calculated crosssectional area of 88.8 cm2 was determined as the cutoff value for the prediction of pelvic SSI and/or local failure, which was significant in a validating analysis. @*Conclusion@#The pelvic cross-sectional area obtained from a routine axial CT scan image was associated with pelvic SSI, positive resection margin, and early local recurrence. It might be an intuitive, feasible, and easily adoptable method for predicting surgical outcomes.

Computed tomography based cross-sectional anatomy of the pelvis predicts surgical outcome after rectal cancer surgery

Purpose@#Narrow pelvis has been considered an adverse factor for postoperative and oncologic outcomes after rectal cancer surgery. The aim of this study was to investigate the validity of using only axial CT scan images to calculate the pelvic cross-sectional area for the prediction of adverse outcomes after rectal cancer surgery. @*Methods@#The medical records of patients who underwent rectal cancer surgery were reviewed and analyzed retrospectively. Axial images of CT scan were used to measure the pelvic cross-sectional area. Pelvic surgical site infection (SSI), positive resection margin, and early local recurrence were adopted as end-points to analyze the impact of pelvimetry on surgical outcome. @*Results@#The mean pelvic cross-sectional area was 84.3 ± 10.9 cm2. Males had significantly smaller pelvic areas than females (P < 0.001). Comparing pelvic cross-sectional areas according to the surgical outcomes, the results indicated that patients with pelvic SSI and local failure (positive resection margin or local recurrence within 1 year) have significantly smaller cross-sectional-area than SSI and local failure-free patients (P = 0.013 and P = 0.031). A calculated crosssectional area of 88.8 cm2 was determined as the cutoff value for the prediction of pelvic SSI and/or local failure, which was significant in a validating analysis. @*Conclusion@#The pelvic cross-sectional area obtained from a routine axial CT scan image was associated with pelvic SSI, positive resection margin, and early local recurrence. It might be an intuitive, feasible, and easily adoptable method for predicting surgical outcomes.

For the Appropriate Authorship in Medical Journal / 이화의대지

No abstract available.

Initial Clinical Experience of Pure Single-Incision Robotic Right Hemicolectomy with da Vinci SP Platform

The da Vinci SP Surgical System (dVSP; Intuitive Surgical, Sunnyvale, CA, USA) was introduced to perform pure single-incision surgery in 2018. This new surgical platform demonstrated favorable performance compared with the positive aspect of single-incision laparoscopic surgery and robot surgery. To date, its use has mainly been in urological and gynecological procedures. We report a case of successful robotic single-incision right hemicolectomy for cecal cancer with the dVSP.

Factors Affecting Body Image and Sexual Life for the Colorectal Cancer Patients with Stoma

PURPOSE: The purpose of this study was to describe factors affecting body image and sexual life for colorectal cancer patients with stoma. METHODS: A cross-sectional descriptive correlational study was applied to 102 ostomates from June to November in 2015 using self-report questionnaires: the Body image scale (BIS), and the Derogatis interview for sexual functioning self report (DISF-SR). RESULTS: The influencing factors for body image were ‘need for preoperative sexual education and sexual counseling’ (β=−.29, p=.003), and clinical stage II of colorectal cancer (β=−.26, p=.006). The influencing factor for sexual life was educational level (college education or higher) (β=.21, p=.02). CONCLUSION: The results of this study showed that colorectal cancer patients with stoma had a negative body image. The sexual counseling and education for ostomates should be approached by considering gender characteristics.

Role of β₁-Integrin in Colorectal Cancer: Case-Control Study / 이화의대지

OBJECTIVES: In the metastatic process, interactions between circulating tumor cells (CTCs) and the extracellular matrix or surrounding cells are required. β1-integrin may mediate these interactions. The aim of this study was to investigate whether β1-integrin is associated with the detection of CTCs in colorectal cancer. METHODS: We enrolled 30 patients with colorectal cancer (experimental group) and 30 patients with benign diseases (control group). Blood samples were obtained from each group, carcinoembryonic antigen (CEA) mRNA for CTCs marker and β1-integrin mRNA levels were estimated by using reverse transcription-polymerase chain reaction, and the results were compared between the two groups. RESULTS: CEA mRNA was detected more frequently in colorectal cancer patients than in control patients (P=0.008). CEA mRNA was significantly reduced after surgery in the colorectal cancer patients (P=0.032). β1-integrin mRNA was detected more in colorectal cancer patients than in the patients with benign diseases (P<0.001). In colorectal cancer patients, expression of β1-integrin mRNA was detected more for advanced-stage cancer than for early-stage cancer (P=0.033) and was significantly decreased after surgery (P<0.001). In addition, expression of β1-integrin mRNA was significantly associated with that of CEA mRNA in colorectal cancer patients (P=0.001). CONCLUSION: In conclusion, β1-integrin is a potential prognostic factor following surgical resection in colorectal cancer patients. β1-integrin may be a candidate for use as a marker for early detection of micrometastatic tumor cells and for monitoring the therapeutic response in colorectal cancer patients.

What's Wrong with the Gift Author? / 이화의대지

No abstract available.

Silencing the livin gene enhances the cytotoxic effects of anticancer drugs on colon cancer cells

PURPOSE: Livin is associated with drug response in several cancers. The aim of this study was to investigate the effect of silencing the livin gene expression on anticancer drug response in colorectal cancer. METHODS: siRNA was transfected at different concentrations (0, 10, and 30nM) into HCT116 cells, then cells were treated with either 5-fluorouracil (FU)/leucovorin (LV) or oxaliplatin (L-OHP)/5-FU/LV. Cellular viability and apoptosis were evaluated following silencing of livin gene expression combined with treatment with anticancer drugs. RESULTS: Livin gene expression was effectively suppressed by 30nM siRNA compared with control and 10nM siRNA. The 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide assay showed that proliferation was effectively inhibited in cells treated with a combination of both siRNA and an anticancer drug, compared to cells treated with siRNA-Livin or anticancer drug alone. In particular, the combination of 30nM siRNA and L-OHP/5-FU/LV resulted in a 93.8% and 91.4% decrease, compared to untreated control or L-OHP/5-FU/LV alone, respectively. Cellular proliferation was most effectively suppressed by a combination of 30nM of siRNA and L-OHP/5-FU/LV compared to other combinations. CONCLUSION: siRNA-mediated down-regulation of livin gene expression could significantly suppress colon cancer growth and enhance the cytotoxic effects of anticancer drugs such as 5-FU and L-OHP. The results of this study suggest that silencing livin gene expression in combination with treatment with anticancer drugs might be a novel cancer therapy for colorectal cancer.