Background This study aimed to investigate the effect of the time from diagnosis to breast cancer surgery on breast cancer patients’ prognosis. Methods Of the 1900 patients diagnosed with invasive (stage 1–3) breast cancer who underwent surgery in KUH between 2012 and 2019, 279 patients were enrolled in this study. All patients, including those who received neoadjuvant chemotherapy, were classified as Model 1 subjects, and those who received immediate surgical treatment were classified as Model 2 subjects. We conducted a Cox regression analysis to identify prognostic factors of breast cancer associated with the time from diagnosis to surgery. Results The univariate results indicated a sharp drop in both groups’ survival rates when the time to surgery was delayed for more than 8 weeks (Model 1 p = 0.000; Model 2 p = 0.001). In the multivariate analysis, the hazard ratio (HR) of Model 1increased (HR = 6.84, 95% CI 1.06–44.25) in response to a delay in surgery of more than 8 weeks. Smoking and the American Joint Committee on Cancer (AJCC) staging system had a negative effect on breast cancer prognosis, while hormone therapy had a positive effect. Conclusion For all patients, a delay in breast cancer surgery of more than 8 weeks was inversely associated with survival.

series on this issue, after a 25 year experience in surgical BDI repair in a single center in Buenos Aires, Argentina. The key-factors to be considered are: 1Best time to resolve; 2Strategy to implement; 3Who should resolve; 4Adequate procedure. Method: Between 1990 and 2015, 8110 elective cholecystectomies were performed in our institution. Twenty three patients with BDI (0.28%) were registered and forty one referred from other centers were included. Sixty four repairs of severe BDI were performed along this period. Results: HeppeCouinaud was the most commonly used technique. Bi or tri-hepatico-jejunostomy were performed in another cases, some of them with hepatic resection. Global morbidity rate was 18.7% (12 patients with Grade IeII complications according to DindoeClavien classification-most of them limited bile leakages). No mortality has been registered up to the moment. Conclusions: The key-factors showed to be the basis of success at the moment to repair a BDI.

Purpose: Laparoscopic cholecystectomy (LC) is a commonly performed procedure for the management of acute cholecystitis. The presence of an inexperienced scopist or a shortage of manpower could be problematic in emergency surgical cases. To overcome these potential problems while ensuring a stable surgical view during LC, we performed solo surgery. Methods:We retrospectively reviewed the results of 22 patients who underwent solo three-incision LC (S-TILC) and 31 patients who underwent the conventional three-incision LC (C-TILC) from March 1, 2015, to August 31, 2015. We compared the two groups with respect to the patients' clinical characteristics, and intraoperative and postoperative results; and severity grade as defined by the updated Tokyo guidelines 2013 (TG13) criteria.Results: No significant differences in baseline characteristics were found between the two groups.The intraoperative perforation rates were higher in the C-TILC group than in the S-TILC group (p=0.016). Two cases were converted to human-assisted LC in the S-TILC group because of severe adhesions and the scope holder breaking down. No significant differences were found between the groups with respect to length of hospital stay; postoperative diet habit; or rates of postcholecystectomy diarrhea, abdominal pain, wound complication, or complication according to the Clavien-Dindo grade.Conclusion: S-TILC and C-TILC were comparable in terms of results, and this solo surgery in LC could be performed for cases of acute cholecystitis during shortage of skilled manpower.

Objectives: Serum levels of carcinoembryonic antigen and cancer antigen 15-3 tumor markers are used for breast cancer prognosis. This study developed a breast cancer prognosis prediction model.Methods: We retrospectively analyzed data of 639 patients diagnosed between January 2012 and December 2019. We selected 20 independent variables with carcinoembryonic antigen and cancer antigen 15-3 serum levels and employed four machine-learning algorithms for the model: artificial neural network, random forest, support vector machine, and logistic regression.Results: Significant differences in carcinoembryonic antigen and cancer antigen 15-3 serum levels, age, history of other diseases excluding hypertension and diabetes mellitus, chemotherapy, and drug therapy were noted between control (n = 576) and case groups (n = 63). The sensitivity and specificity of the artificial neural network model for prognosis prediction were 26.7% and 92.6%, respectively.Conclusions: Carcinoembryonic antigen and cancer antigen 15-3 serum levels were the most significant variables for developing a breast cancer prognosis prediction model using the Shapley additive explanations model. The proposed machine-learning model and tumor marker serum levels may be useful for breast cancer prognosis.

Purpose: Despite the recent increasing application of minimally invasive techniques to treat necrotizing pancreatitis, few reports on laparoscopic necrosectomy have appeared. The aim of the present study was to evaluate the role played by laparoscopic necrosectomy in treatment of necrotizing pancreatitis. We review our own experience and the relevant literature.Methods: All patients undergoing laparoscopic necrosectomy at Seoul National University Bundang Hospital from March 2005 to January 2016 were included in the study. Data on patient demographics, CT severity index score, American Society of Anesthesiologists' score, preoperative procedures, operative methods, operation time, estimated blood loss, postoperative complications, and length of hospital stay were retrospectively analyzed. We also performed an up-to-date review of the relevant literature.Results: Laparoscopic necrosectomy was performed on four patients with infective pancreatic necrosis that was inadequately treated by percutaneous drainage. A transgastrocolic, transmesocolic, or retrocolic approach was used. The median time from diagnosis to operation was 57 days (range, 34~109 days) and the median operation time 203 min (range, 180~255 min). There was no operative mortality. The necrotic tissue was successfully removed in a single operation in three of the four patients. Three patients experienced postoperative complications, including pleural effusion and recurrence of necrosis. The median postoperative hospital stay was 39 days (range, 16~99 days). Conclusion:Laparoscopic necrosectomy is safe and effective when used to treat necrotizing pancreatitis. Such treatment is especially useful for patients with solid, necrotic pancreatic components that are not removed by percutaneous or endoscopic drainage.