Purpose:Lymphedema is a common complication following surgical procedures, particularly in breast cancer patients. However, no effective medical treatment has been clearly established. Venoactive compounds (venoactive drugs, VADs) are frequently used as an alternative option, despite limited supporting evidence. This study aimed to evaluate their potential therapeutic role in lymphedema. Methods:Human lymphatic endothelial cells (HLECs) were used to assess the effects of diosmin, calcium dobesilate, and Vitis vinifera extract. Cell viability was evaluated using the MTT assay to determine non-cytotoxic concentrations. Lymphangiogenesis was assessed using Transwell migration and Matrigel-based tube formation assays (Corning). Western blot analysis was performed to examine the activation of protein kinase B (AKT), extracellular signal-regulated kinase (ERK), and p38 mitogen-activated protein kinase (MAPK) signaling pathways. Results:Treatment with VADs showed an overall tendency to suppress cell migration compared to the control. On the other hand, there was no significant difference in the tube formation. Western blot analysis revealed that Vitis vinifera extract significantly inhibited the activation of AKT, ERK, and p38 MAPK pathways. Diosmin increased p38 activation without affecting AKT or ERK, while calcium dobesilate did not induce any significant changes in these signaling pathways. Conclusion:VADs did not directly promote lymphangiogenesis in HLECs. Their therapeutic effects in lymphedema may instead be mediated by microvascular stabilization through anti-inflammatory, antioxidant, and permeability-reducing mechanisms. Further experimental and clinical studies are needed to validate these findings.
Purpose:Postoperative cervical adhesions after thyroidectomy can lead to neck tightness, dysphagia, and cosmetic dissatisfaction, but the clinical benefits of antiadhesion agents remain unclear. This study compared the efficacy and safety of four commercially available antiadhesion agents applied after open thyroid surgery. Methods:This singlecenter prospective observational study at a tertiary care hospital included included patients aged 20-70 years undergoing their first open thyroid surgery with intraoperative application of 1 of 4 agents: MegaShield (MS; L&C Bio Co., Ltd.), MegaDerm (MD; L&C Bio Co., Ltd.), CollaBarrier (CB; Dalim Tissen Co., Ltd.), or ACE COL (AC; Korea BNC Co., Ltd. and IreBio Co., Ltd.). Two units were applied at the tracheal bed and subcutaneous layer at the end of surgery. A 7item adhesion questionnaire and the Vancouver Scar Scale (VSS) were assessed at 2 and 12 weeks postoperatively by an independent evaluator. Adverse events were recorded at each visit. Group differences were analyzed using nonparametric tests. Results:Of 200 enrolled patients, 180 completed followup (MS, 46; MD, 45; CB, 47; and AC, 42). Baseline characteristics were comparable. Adhesion scores increased at 2 weeks and improved by 12 weeks in all groups, with no significant betweengroup differences at any time point. VSS total scores showed a similar pattern, with only a transiently higher pigmentation score at 2 weeks in the MS group; no differences persisted at 12 weeks. Complication rates were low and similar across groups. Conclusion:Four different antiadhesion agents demonstrated comparable shortterm efficacy for adhesionrelated symptoms and scar quality after open thyroid surgery, with no clinically meaningful superiority of any single agent. All products were well tolerated.
Purpose:In papillary thyroid carcinoma (PTC), central lymph node metastasis (CLNM) is frequently detected only after surgery, even when preoperative ultrasonography (USG) and CT show no suspicious lymph nodes. Identifying readily available clinical factors associated with occult CLNM may guide the decision for prophylactic central neck dissection in clinically node-negative (cN0) PTC. We investigated factors associated with CLNM using a Common Data Model (CDM)-based cohort. Methods:Patients who underwent thyroid surgery for PTC between 2013 and 2022 and had no suspected nodal metastasis on preoperative USG or CT were included. Demographic and laboratory variables were extracted from the CDM database. Univariable and multivariable logistic regression analyses were performed to identify factors independently associated with CLNM. Results:A total of 1,020 patients (246 males, 774 females) were included. The mean age was 50.1 ± 13.2 years. CLNM was identified in 313 patients (30.7%). On multivariable analysis, male sex (adjusted odds ratio [aOR], 1.548; 95% confidence interval [CI], 1.138-2.106; P = 0.005) was independently associated with CLNM, whereas age ≥55 years was inversely associated (aOR, 0.687; 95% CI, 0.515-0.915; P = 0.010). Compared with tumors ≤1 cm, tumor size 1-2 cm (aOR, 2.231; 95% CI, 1.649-3.018; P < 0.001) and >2 cm (aOR, 2.739; 95% CI, 1.711-4.383; P < 0.001) were associated with higher odds of CLNM. Conclusion:In cN0 PTC, male sex, younger age, and larger tumor size were independently associated with occult CLNM. These factors may help identify patients who warrant closer consideration for central neck management despite negative preoperative imaging.
Purpose:This study aimed to develop a statistical model for predicting hypertrophied future liver remnant volume (HFLRV) in patients with right hemihepatectomy (RHH). Methods:Patients who underwent RHH at Samsung Medical Center between January 2022 and March 2024 were included in this study. Liver volume was calculated from abdomen CT by using a deep learning-based volumetric tool. Results:A total of 98 patients were included. There were 58 and 40 patients whose liver regeneration index was less than 0.8 and 0.8 or more, respectively. The prediction model, which focused on identifying variables associated with HFLRV, included age at diagnosis (P = 0.14), sex (P = 0.01), both preoperative hemi-liver volumes (P < 0.001), and international normalized ratio (P < 0.05). This model demonstrated adjusted R2 of 0.60, correlation coefficient (r) of 0.78, and P-value of <0.001. Conclusion:This study developed a linear prediction model for HFLRV and determined which factors can be used to predict HFLRV before RHH.
Purpose:Deceased donor liver transplantation (DDLT) remains constrained by organ shortages, emphasizing the need for accurate predictive models to optimize allocation and improve outcomes. Although multiple indices, such as Model for End-Stage Liver Disease (MELD), MELD-Na, and donor-specific models, exist to predict recipient and graft survival, their comparative performance remains uncertain. Methods:This study compared 8 predictive models (MELD, MELD-Na, Gender-Equity Model for Liver Allocation [GEMA], GEMA-Na, Donor Rejection Organ Procurement Evaluation, Donor Risk Index, Kidney Donor Profile Index [KDPI], and Korean KDPI) in predicting overall and graft survival after DDLT. Data from 328 donor-recipient pairs at Samsung Medical Center (2000-2020) were retrospectively analyzed. Calibration was assessed using the Hosmer-Lemeshow test and R2 values, and discrimination using the Kaplan-Meier curves, concordance statistics (c-index), and receiver operating characteristic curves. Results:MELD-Na demonstrated the highest calibration and discrimination for both overall and graft survival, particularly at short-term follow-up. Recipient-based models (MELD, GEMA) showed satisfactory performance, with MELD closely following MELD-Na in predicting overall survival. In contrast, donor-based indices (KDPI, K-KDPI) exhibited weak predictive power. Integrating recipient and donor parameters improved the overall comprehensiveness of prediction. Conclusion:MELD-Na is the most reliable predictor of short-term survival after DDLT. Donor-specific indices provide valuable insights into organ quality but are limited in survival prediction. Integrating both donor and recipient factors may refine organ allocation and enhance posttransplant outcomes. Further validation across diverse populations and the incorporation of advanced technologies, including machine learning, are warranted to optimize predictive accuracy in liver transplantation.
Purpose:Endoscopic submucosal dissection (ESD) is a minimally invasive treatment for early gastric cancer (EGC) with a low risk of lymph node metastasis. However, 17%-21% of patients require additional curative gastrectomy (ACG) due to non-curative factors. Although ESD may induce fibrosis or adhesions that could complicate subsequent surgery, its impact on surgical outcomes after ACG remains unclear. This study aimed to evaluate the impact of prior ESD on postoperative outcomes following ACG. Methods:We retrospectively analyzed national data from the Korean Gastric Cancer Association, including 11,594 patients with EGC who underwent gastrectomy between January 2019 and December 2019. Of these, 913 patients underwent ACG after non-curative ESD, while 10,681 underwent primary gastrectomy. Outcomes were compared between the ACG and surgery-only groups using 1:1 propensity score matching. Results:A total of 1,826 matched patients were analyzed, with 913 patients in each group. There was no significant difference in severe complication rates (Clavien-Dindo grade ≥III) between the post-ESD group and the surgery-only group (4.4% vs. 5.3%, P = 0.986). Operative time, blood loss, and 30-day mortality were also comparable between groups. Higher body mass index (odds ratio [OR], 1.069; P = 0.043) and total gastrectomy (OR, 2.088; P = 0.006) were associated with an increased risk of severe complications. Conclusion:This study is the first to use national data to evaluate surgical outcomes after ACG following non-curative ESD. The results suggest that prior ESD does not adversely affect postoperative outcomes, providing evidence to guide surgical decision-making in patients with EGC requiring ACG.
Purpose:Evidence regarding long-term prognosis after surgery by pathological stage in pancreatic ductal adenocarcinoma (PDAC) patients following neoadjuvant treatment (NAT) remains limited. Methods:757 patients who underwent PDAC resection between 2017 and 2021 were analyzed retrospectively. Among them, 262 received NAT followed by surgery (NAT group) and 415 underwent upfront surgery (UFS group). Propensity score matching (PSM) was performed for balanced comparison using the following variables: age, sex, American Society of Anesthesiologists physical status class, and adjuvant treatment. Results:After PSM, the UFS group showed higher postoperative CA 19-9, larger tumors, less advanced initial clinical stage, but more advanced pathological stage and fewer positive lymph nodes compared with the NAT group. Median overall survival (OS) was similar between groups (NAT vs. UFS: 35 vs. 34 months, P = 0.88). In stage IA, UFS patients had longer OS compared to NAT (not reached vs. 42 months, P = 0.037). No significant OS differences were observed at stages IB, IIA, IIB, and III. Conclusion:Postoperative survival did not differ between NAT and UFS groups when stratified by pathological stage, except for stage IA where UFS showed better outcomes.
Purpose:Many studies compared the outcomes of hernia repair in children between open and laparoscopic techniques. However, the results still need to be clarified. Moreover, the reports from developing countries are also limited. Methods:We compared the outcomes of hernia repair between the open and laparoscopic techniques in children and associated them with risk factors. Results:We involved 92 children, consisting of laparoscopy (36 males and 10 females) and open (42 males and 4 females) methods. There was a significant difference between 2 groups regarding the gestational age and age at surgery (both P < 0.001). Laparoscopy had a shorter length of stay (LOS) than the open group (1.09 ± 0.28 days vs. 1.37 ± 0.57 days, P = 0.004), while the duration of surgery was similar in both groups (P = 0.801). Multivariate analysis revealed no significant association between the recurrence of hernia and risk factors, including the surgical procedure, sex, age at surgery, and prematurity (P > 0.05). Conclusion:Laparoscopic surgery might have a beneficial effect on shorter LOS compared with open hernia repair. None of the risk factors is significantly associated with hernia recurrence after repair. A further prospective multicenter study with a larger sample size is necessary to clarify our findings.
Purpose:Accurate identification of the bile duct bifurcation site is crucial in pure laparoscopic donor right hepatectomy (PLDRH) for living donor liver transplantation. This study aimed to develop and evaluate a deep learning model to predict the bile duct bifurcation site for surgical precision. Methods:We retrospectively analyzed 55 PLDRH procedures conducted between August 2021 and April 2022. A deep learning model combining UNet with a MiT-B3 encoder was trained on 150 manually annotated frames. We then incorporated expert-reviewed pseudo-labels from an additional 901 frames to refine the model. Performance was evaluated using 5-fold cross-validation and an independent test set. Results:Clinical evaluation showed a 97% accuracy in 5-fold cross-validation and 93.3% accuracy in the independent test set. From the initial to final model, dice similarity coefficient improved from 0.392 to 0.472, intersection over union from 0.279 to 0.339, and sensitivity from 0.487 to 0.643, while specificity remained consistent at 0.993. Conclusion:The proposed artificial intelligence (AI) model demonstrated strong clinical performance in predicting the bile duct bifurcation site during PLDRH. Despite modest quantitative scores, the high clinical accuracy highlights the potential of integrating AI for precise donor hepatectomy.
Purpose:Right lobe living donor liver transplantation (LDLT) with dual portal veins (PVs) remains technically challenging. This study aimed to identify independent risk factors for PV complications. Methods:We retrospectively analyzed 111 recipients of dual PV LDLT between 2011 and 2020. Recipient characteristics, anatomical geometry, and surgical factors were evaluated. Outcomes were overall PV complications and major PV complications (Clavien-Dindo grade ≥III). Logistic regression was performed. Results:PV complications developed in 41 patients (36.9%), including 16 major events (14.4%). Univariate analysis revealed associations with right posterior PV (RPPV) diameter, axial angle, and coronal angle. On multivariate analysis, larger RPPV diameter (odds ratio [OR], 1.79; P = 0.041) and wider axial angle (OR, 1.08; P = 0.015) were independent predictors of major PV complications. Reconstruction method was not significant. Patients with overall major Clavien-Dindo grade ≥III complications had inferior 100-month survival (80% vs. 100%; P = 0.014, log-rank test). Conclusion:In dual PV LDLT, anatomical geometry-specifically RPPV diameter and axial angle-independently predicts major PV complications, whereas surgical technique does not. Preoperative 3-dimensional imaging and anatomical risk stratification should inform donor selection and surgical planning.
Purpose: Pediatric surgery in Korea has historically been undervalued under the national fee system. Since 2021, the government has progressively expanded surgical add-on reimbursement for pediatric surgeries, yet their real-world impact remains unclear. Methods: We retrospectively analyzed pediatric surgeries (<19 years) performed at 4 tertiary institutions from 2020 to 2025. Surgeries were divided into 4 periods based on major policy changes. Variables included the number of surgeries, claimed surgical fees, patient age and weight, and eligibility for add-on reimbursement. Trends over time and variations among hospitals were examined. Results: A total of 1,959 surgeries were analyzed. Surgical volume did not significantly change across periods (P = 0.342). In contrast, total claimed surgical fees increased 1.66-fold in Period 2, 3.26-fold in Period 3, and 3.42-fold in Period 4 compared with Period 1. The proportion of surgeries eligible for add-on reimbursement rose to 76.6% in Period 4. The average claimed fee per case increased from 973,446 Korean won in Period 1 to 3,463,428 in Period 4. Patients <1,500 g demonstrated the largest increase (471%). Across hospitals, the magnitude of claimed fee increases varied, but all institutions showed substantial growth in claimed surgical fees. Conclusion: Stepwise expansion of pediatric surgical add-on reimbursement substantially increased claimed surgical fees across institutions without inflating surgical volume. These reforms improved financial reimbursement and may support future improvements in workforce sustainability, training, and care equity. Continuous policy monitoring will be essential to ensure long-term effectiveness and fiscal balance.
Purpose: Esophagojejunostomy leakage (EJL) continues to be a serious and potentially fatal complication following total gastrectomy for gastric cancer. This study aimed to evaluate the clinical outcomes of endoscopic Histoacryl (B. Braun) injection in comparison to alternative treatment strategies for EJL. Methods: Out of 885 patients who underwent total gastrectomy at a single institution between January 2003 and August 2023, 26 (2.9%) developed EJL. Patients were categorized into four groups according to the management received: conservative treatment (n = 5), endoscopic Histoacryl injection (n = 10), reoperation (n = 8), and combined therapy (n = 3). Outcomes assessed included postoperative hospital stay, duration to oral intake, treatment success rate, and mortality. Results: Of the 26 patients with EJL, 3 (11.5%) succumbed to sepsis: two in the reoperation group and 1 in the Histoacryl group. In the 23 successfully managed cases, the Histoacryl group achieved the shortest median postoperative hospital stay, the shortest time to resuming of oral intake, and a 90% success rate without any procedure-related complications. The reoperation group experienced increased morbidity and mortality. Stent migration was reported in one patient from the combined treatment group. Differences in recovery between the four groups reached statistical significance (P < 0.05). Conclusion: Endoscopic Histoacryl injection represents a safe, effective, and minimally invasive modality for managing EJL, providing improved recovery times and reduced complication rates. It is beneficial both as a primary intervention and as part of combination therapy.
Purpose:Timely surgical intervention is crucial in trauma care, particularly in patients with hypotensive abdominal injuries. In South Korea, the regional trauma center system has adopted a quality metric mandating initiation of emergency surgery within 1 hour of emergency department (ED) arrival for such patients. We evaluated the impact of ED-to-surgery time on clinical outcomes in hypotensive abdominal trauma and assessed the appropriateness of the 1-hour threshold. Methods:This multicenter retrospective study included 425 trauma patients who underwent emergency abdominal surgery at 2 regional trauma centers between 2019 and 2022. Patients with an initial or lowest recorded systolic blood pressure (SBP) <90 mmHg were included. The primary outcome was in-hospital mortality; secondary outcomes included complications, intensive care unit stay, and total hospital stay. Patients were categorized into early (≤1 hour) and delayed (>1 hour) surgery groups. Statistical analyses included logistic regression, propensity score matching (PSM), receiver operating characteristic curve, and complication analysis by 30-minute intervals. Results:We found that 243 patients (57.2%) underwent surgery within 1 hour. In-hospital mortality did not differ significantly between early and delayed groups. Age, Glasgow Coma Scale, lowest SBP, 4-hour RBC transfusion volume, and abdominal Abbreviated Injury Scale were independent mortality predictors. PSM confirmed no mortality difference by surgical timing. However, complication rates increased with surgical delays. Conclusion:While surgical delay was not associated with mortality, it was linked to increased complications. Future trauma quality metrics should incorporate refined patient stratification and evaluate the entire process aimed at restoring physiological instability, rather than relying on a strict 1-hour threshold.
Purpose:Thyroid cancer is the most common endocrine cancer, developing in an average of 5%-7% of all nodules. In this study, we aimed to estimate the true risk, including multifocality and microcarcinomas, in patients who underwent total thyroidectomy after repeat Bethesda III cytology and in the other Bethesda groups. Methods:Three hundred patients participated in the study. Eighty-three (27.7%) of the patients were male and 217 (72.3%) were female. In the study, the diagnostic performances of the R-TIRADS (Revised Thyroid Imaging Reporting and Data System) classification used in the diagnosis of malignancy in thyroid nodules were compared with the Bethesda cytological classification. In order to compare the malignancy prediction powers, receiver operating characteristic curves were created for each system and area under the curve values were calculated. In all statistical analyses, a P-value below 0.05 was interpreted as statistically significant. A total of 150 cases (50.0%) with atypia of unknown significance (AUS) or follicular lesions of unknown significance (FLUS) were retrospectively evaluated. Results:Histopathology results were consistent with malignancy in 103 patients. Of these patients, 27 had multifocality (26.2%), 26 had microcarcinomas (25.2%), and 22 had both multifocality and microcarcinoma (21.3%). The majority of the carcinomas (46.6%) were seen to arise in AUS with cellular and nuclear atypias. Conclusion:Prevalence of Bethesda category III cytologies is significantly higher than reported. A high rate of multifocality and incidental microcarcinomas in the definitive histopathology reports shows that the Bethesda classification falls short in the accuracy of risk in AUS/FLUS.
Purpose:Drainage fluid may serve as a biologically informative indicator of immune and infectious status during postsurgical recovery after trauma. However, microbiome shifts in drainage fluid associated with clinical resilience have not yet been characterized. This study aimed to investigate microbial dynamics in drainage fluid across the intensive care unit (ICU) and ward recovery phases in Korean trauma patients. Methods:A total of 25 drainage and 10 stool samples were collected from 10 trauma patients who underwent abdominal surgery at a regional trauma center. Microbial composition was analyzed using 16S ribosomal RNA amplicon sequencing. Alpha and beta diversity were compared between sample types and recovery stages. Linear mixed-effects models were used to identify recovery-associated taxa while adjusting for clinical variables, and predicted metabolic pathways were assessed using PICRUSt2. Results:Drainage fluid harbored distinct microbial communities independent of the intestinal microbiota. Shared taxa between drainage and stool increased significantly in patients with bowel injury, suggesting microbial translocation. Seven genera and 5 species showed significantly decreased abundance during the ward stage, with Modestobacter and Blastococcus tunisiensis demonstrating the highest discriminative ability between recovery stages (area under the curve = 0.721). Predicted metabolic pathways related to fatty acid degradation, amino acid degradation, and pro-inflammatory processes were more active during the ICU stage. Conclusion:These findings provide preliminary evidence that drainage fluid microbiome profiles may reflect recovery dynamics following trauma, supporting its potential utility for microbiome-based monitoring and biomarker discovery in trauma surgery.
Purpose:Microvascular invasion (MVI) is a well-known pathological prognostic factor in hepatocellular carcinoma (HCC). This study aimed to predict MVI and to assess post-resection prognosis using the ADV (multiplication of AFP, des-γ-carboxyprothrombin-also known as proteins induced by vitamin K absence or antagonist-II [PIVKA-II], and tumor volume), AP (multiplication of AFP and PIVKA-II), and MoRAL (model to predict tumor recurrence [TR] after liver transplantation) scores. Methods:This international multicenter study included 9,061 patients who underwent hepatic resection for solitary HCC measuring 1.0-10 cm from 2010 to 2017 at ten Korean centers and 73 Japanese centers, and were followed up until 2020. Results:The receiver operating characteristic (ROC) area under the curve (AUC) for diagnosis of MVI was 0.734 for the ADV score at 4.7log, 0.684 for the AP score at 3.7log, and 0.705 for the MoRAL score at 162.0. The ADV score exhibited the strongest predictive ability for MVI. The ROC AUC for actuarial 5-year TR was 0.586 for the ADV score, 0.583 for the AP score, and 0.586 for the MoRAL score, demonstrating similar prognostication efficacy. The hazard ratios for TR and overall survival demonstrated strong, stepwise positive correlations with increases in both the ADV and AP scores, but not the MoRAL score. Conclusions:The ADV score is a superior integrated biomarker for predicting post-resection prognosis in patients with HCC, outperforming both the AP and MoRAL scores. The AP score appears to be a simplified alternative to the ADV score, particularly in cases of small HCC.
Purpose: Distant metastasis of breast cancer significantly affects the prognosis. Serum markers such as CEA and cancer antigen (CA) 15-3 are used for surveillance. However, the nonspecificity and nonmalignant elevation of CEA limit its absolute value in predicting metastatic recurrence. We reevaluated the clinical value of CEA kinetics in predicting metastatic recurrence in breast cancer. Methods: In this multicenter retrospective cohort study, we utilized electronic medical record data from eight institutions (2008-2023), including 4,872 surgically treated patients with invasive breast cancer. Novel CEA kinetic indices were defined. Predictive capabilities were assessed using logistic regression, Kaplan-Meier survival curves, and Cox proportional hazards models. Results: CEA velocity (vCEA) and last-interval vCEA (vCEA-L) showed higher accuracy and sensitivity in predicting distant metastasis than absolute CEA indices. All tumor marker indices were independent predictors; vCEA, vCEA-L, and maximum vCEA (vCEAmax) showed the highest association. In the 5-year distant disease-free survival analysis of patients, vCEA showed the most significant difference based on whether its cutoff value was exceeded (84.1% vs. 47.2%) (P < 0.001). Cox analysis showed that vCEA was the strongest predictor (hazard ratio, 4.509; P < 0.001). vCEAmax remained prognostic even when CEAmax was below its cutoff value. Conclusion: Analysis of dynamic CEA changes, particularly velocity-based indices, offers superior predictive power than the static-based CEA indices for metastatic recurrence in breast cancer. These kinetic markers enhance prognostic accuracy when combined with CA 15-3. Future research should integrate these markers with imaging, liquid biopsy, and artificial intelligence for personalized follow-up.
Purpose:This study was conducted to evaluate the clinical efficacy of autologous parathyroid transplantation into the forearm brachioradialis muscle during thyroid surgery and analyze the timing of graft function recovery. Methods:A total of 52 patients undergoing thyroid surgery with autologous parathyroid transplantation were selected. Serum parathyroid hormone (PTH) levels were measured at various postoperative intervals, and instances of hypoparathyroidism were recorded. Results:Postoperative PTH levels on the transplant side were significantly higher than on the non-transplant side from week 1 to 1 year. Effective graft rates were 1.9% on day 1, 40.4% at week 1, 84.6% at 1 month, and stabilized at around 73% after 1 year. Transient hypoparathyroidism was observed in 17.3% of patients, with no permanent cases. Conclusion:Autologous parathyroid transplantation into the forearm brachioradialis muscle effectively preserves parathyroid function, with grafts regaining optimal function within 2-3 months and the graft still having good secretory function 1 year after surgery.
Purpose:Metabolic bariatric surgery (MBS) efficacy and safety is established for older patients, but East Asian data are limited. This study aimed to evaluate the safety and efficacy of MBS by comparing older (≥55 years) and younger (<55 years) East Asian patients with obesity. Methods:This multicenter, retrospective review included 410 patients undergoing MBS from January to December 2019. Patients were stratified into the older group (OG, age ≥55 years; n = 39) and the younger group (YG, age <55 years; n = 371). We compared surgical safety, weight parameters, and comorbidity resolution rates. Results:The OG had lower mean body weight (97.9 ± 16.4 kg vs. 113.2 ± 23.1 kg, P < 0.001) but more comorbidities and lower average ABCD score for type 2 diabetes mellitus (T2DM) remission. Postoperative complication rate (12.8% vs. 7.5%, P = 0.400) and postoperative hospital stay (4.1 ± 1.8 days vs. 4.0 ± 8.9 days, P = 0.773) showed no significant differences. At 12 months, the percentage of total weight loss was significantly lower in the OG (23.7 ± 6.9% vs. 27.8 ± 8.4%, P = 0.014). Remission rates for T2DM (47.6% vs. 80.5%, P < 0.001), hypertension (34.6% vs. 57.5%, P = 0.073), and dyslipidemia (12.5% vs. 44.4%, P = 0.012) were also lower in the OG, yet still demonstrated clinically meaningful metabolic improvement. Conclusion:MBS is a safe and effective treatment for older East Asians with obesity, offering substantial comorbidity resolution despite achieving a lower weight loss compared to the younger patients.
Purpose: Colorectal cancer (CRC) remains a leading cause of cancer-related mortality, necessitating the identification of novel therapeutic targets. The E3 ubiquitin ligase WW domain-containing E3 ubiquitin protein ligase 2 (WWP2) has been implicated in various cancers, yet its specific role and underlying molecular mechanisms in CRC are poorly understood. This study aimed to investigate the functional role of WWP2 in CRC progression and to elucidate its regulatory mechanisms. Methods: WWP2 expression was evaluated in CRC patient tissues and cell lines using immunohistochemistry, quantitative real-time polymerase chain reaction, and western blotting. The biological functions of WWP2 were assessed using in vitro assays for cell proliferation, migration, and invasion following adenovirus-mediated overexpression. The molecular mechanism was investigated by analyzing the protein expression levels of p53 and its downstream target, p21, via western blot. An in vivo xenograft mouse model was used to confirm the oncogenic role of WWP2. Results: WWP2 expression was significantly upregulated in CRC tissues. Overexpression of WWP2 promoted CRC cell proliferation, migration, and invasion. Mechanistically, increased WWP2 expression led to a marked reduction in the protein levels of the tumor suppressor p53. Consequently, the expression of the p53 downstream target, the cell cycle inhibitor p21, was also suppressed. In the xenograft model, WWP2 overexpression significantly enhanced tumor growth. Conclusion: Our findings demonstrate that WWP2 functions as an oncogene in CRC. It promotes cancer progression by destabilizing the tumor suppressor p53 and downregulating p21. This study highlights the WWP2-p53-p21 axis as a potential novel therapeutic target for CRC.
