Myeong Hun Oh

Background/Objectives: Preoperative CT may not reliably distinguish gallbladder malignancy from inflammatory disease, complicating surgical planning. We examined transitions from CT impressions through operative plans, intraoperative reassessment, index procedures, and subsequent treatment. Methods: This retrospective descriptive study screened 651 consecutive patients who underwent gallbladder surgery by a single surgeon at a tertiary referral center from January 2023 to December 2025. The analytic cohort included 41 patients with indeterminate or suspicious CT impressions or malignancy on final pathology. CT categories were assigned from original radiology reports independently of operative intent and pathology. Results: CT impressions were benign in six patients, indeterminate in 11, and suspicious in 24; malignancy was confirmed in six, three, and 16, respectively. Among indeterminate cases, eight had simple cholecystectomy plans, two frozen-guided plans, and one a radical-possible plan; all three malignant cases had conditional oncologic plans. Frozen section was performed in 11 patients, identifying malignancy in nine. Of 19 extended index procedures, 18 were performed under plans allowing oncologic extension; one represented an unanticipated extension. Six patients with T1b or more advanced cancer initially underwent simple cholecystectomy; three subsequently underwent completion surgery. Conclusions: Patients with the same CT impression followed different operative and subsequent management pathways. These findings highlight the clinical importance of considering diagnostic uncertainty throughout the surgical course, from preoperative planning and intraoperative reassessment to subsequent treatment decisions informed by final pathology.

Liver resection is a curative treatment for selected patients with hepatocellular carcinoma. As laparoscopic techniques have advanced, laparoscopic liver resection has been increasingly used. However, its long-term oncologic adequacy compared with open liver resection remains debated. We retrospectively analyzed patients who underwent liver resection for hepatocellular carcinoma at Pusan National University Hospital between August 2019 and December 2022. Patients were divided into laparoscopic and open liver resection groups. Perioperative outcomes and long-term survival outcomes were compared. In total, 257 patients were included, with 209 undergoing laparoscopic and 48 undergoing open liver resection. Liver function and tumor stage were similar between groups. Estimated blood loss was lower in the laparoscopic group, whereas operative time and hospital stay were comparable. Major postoperative complications were more frequent after open surgery, while 90-day mortality was similar. During follow-up, disease-free and overall survival did not differ between groups. Multivariable analysis showed that oncologic outcomes were associated with tumor-related factors, resection margin status, and liver cirrhosis, but not with surgical approach. Laparoscopic liver resection achieved perioperative and oncologic outcomes comparable to those of open liver resection. It may be considered an acceptable surgical option in appropriately selected patients.

Jeong Hee Han, Byoung Chul Lee, Jung Bum Choi, Min Ju Kim, Sun Ho Ok, Hong Jae Jo, Myeong Hun Oh. Journal of Digestive Cancer Research 2026;14:185-90. https://doi.org/10.52927/jdcr.2026.14.2.185

Background/Objectives: In standardized low-event surgery such as laparoscopic cholecystectomy (LC), discharge-based outcomes may be insufficiently sensitive to capture differences in recovery trajectory. We investigated whether early gastrointestinal recovery after standardized LC differed according to anesthetic maintenance strategy. Methods: This single-center retrospective cohort study included consecutive adults who underwent scheduled LC between September 2023 and December 2025 within a standardized perioperative pathway. The primary exposure was anesthetic maintenance strategy, comparing remimazolam-based with desflurane-based maintenance. The primary outcome was time to first flatus. Key secondary outcomes included postoperative day 1 (POD 1) high-sensitivity C-reactive protein (hs-CRP), C-reactive protein-to-albumin ratio (CAR), diet delay, prolonged hospital stay, postoperative nausea and vomiting, and 30-day readmission. Associations were evaluated using a log-normal accelerated failure time model, multivariable logistic regression, and log-transformed linear models for inflammatory markers. Results: A total of 316 patients were included (remimazolam, n = 171; desflurane, n = 145). Time to first flatus was shorter in the remimazolam group, with an unadjusted median difference of 8 h (28.0 [24.0–37.0] vs. 36.0 [28.0–52.0] h). After adjustment, remimazolam-based maintenance remained associated with a 21% shorter time to first flatus (time ratio, 0.79; 95% confidence interval [CI], 0.72–0.86; p < 0.001), corresponding to an adjusted median reduction of 8.0 h. The remimazolam group also showed earlier flatus recovery across predefined time windows and lower POD 1 hs-CRP and CAR, whereas later outcomes were largely similar. Conclusions: In standardized LC, early gastrointestinal recovery appeared more sensitive to anesthetic maintenance strategy than discharge-based outcomes. These findings support the use of early functional recovery measures, in addition to discharge timing, when evaluating perioperative recovery in low-event short-stay surgery.

Background: As life expectancy increases, a growing number of elderly patients are considered for curative hepatectomy for hepatocellular carcinoma (HCC). However, perioperative outcomes in elderly patients in the contemporary era of minimally invasive liver surgery remain incompletely defined. Methods: We retrospectively reviewed 277 consecutive patients who underwent elective curative hepatectomy for HCC between 2019 and 2023. Outcomes were compared using age thresholds of ≥75 and ≥80 years. The primary endpoints were 90-day mortality and major postoperative complications (Clavien–Dindo grade ≥ III). Multivariable logistic regression identified predictors of major complications. Results: Elderly patients had more comorbidities, whereas liver function, tumor characteristics, and extent of resection were comparable across age groups. Laparoscopic hepatectomy was performed more frequently in patients aged ≥80 years. Major complication rates and 90-day mortality were similar regardless of age, with no deaths among patients aged ≥75 or ≥80 years. Age ≥75 years, higher ALBI score, major comorbidities, and longer Pringle maneuver time were independently associated with major postoperative complications. Conclusions: Hepatectomy for hepatocellular carcinoma may be performed with acceptable short-term outcomes in carefully selected elderly patients, including octogenarians. Chronological age alone should not be considered an absolute contraindication to surgery, although findings should be interpreted with caution.

Immunoglobulin G4 (IgG4)-related disease is a fibroinflammatory condition that can involve multiple organs. Isolated involvement of the gallbladder is exceptionally uncommon and often radiologically indistinguishable from gallbladder carcinoma, resulting in diagnostic uncertainty before surgery. A 77-year-old man presented with right upper abdominal discomfort lasting 1 month. Cross-sectional imaging revealed irregular gallbladder wall thickening with contrast enhancement, raising suspicion for resectable gallbladder cancer. The patient underwent a radical cholecystectomy with partial hepatectomy. Histopathological analysis demonstrated dense lymphoplasmacytic infiltration, storiform fibrosis, and marked infiltration of IgG4-positive plasma cells exceeding established diagnostic thresholds, consistent with IgG4-related cholecystitis. The postoperative course was uneventful, and no additional treatment was required. IgG4-related cholecystitis should be considered in the differential diagnosis of gallbladder malignancy, particularly in atypical or indeterminate cases. However, when imaging findings strongly suggest carcinoma, radical surgical resection remains an appropriate oncologic approach.

Background: Epstein–Barr virus (EBV)-related primary splenic tumors are exceptionally rare and encompass a heterogeneous group of entities, including inflammatory pseudotumor (IPT), IPT-like follicular dendritic cell (FDC) tumors or sarcomas, and EBV-positive diffuse large B-cell lymphoma (DLBCL). Because clinical presentation and imaging findings are often nonspecific, establishing a definitive diagnosis remains challenging and frequently necessitates splenectomy for histopathologic confirmation. Methods: We retrospectively reviewed patients who underwent laparoscopic splenectomy for suspected primary splenic lesions at a single tertiary institution between June 2014 and August 2025. Among 67 patients, five consecutive patients were pathologically confirmed as EBV-related primary splenic tumors. Clinical characteristics, imaging features, histopathologic and immunophenotypic findings, EBV in situ hybridization results, treatment, and follow-up outcomes were analyzed. Results: This case series comprised four spindle cell–predominant EBV-related tumors (IPT or IPT-like FDC tumors/sarcomas) and one EBV-positive DLBCL. All patients presented with splenic masses that could not be definitively characterized by preoperative imaging alone and therefore required splenectomy. EBV in situ hybridization was positive in tumor cells in all cases. Patients with non-lymphomatous tumors achieved durable disease control following splenectomy alone, with disease-free survival of up to five years. In contrast, the patient with EBV-positive DLBCL required postoperative systemic immunochemotherapy. Conclusions: EBV-related primary splenic tumors represent a diagnostically challenging and clinically diverse disease spectrum. This case series highlights the pivotal role of splenectomy in establishing definitive diagnosis and guiding subsequent management, particularly for isolated splenic lesions with indeterminate imaging findings.

Jeong Hee Han, Byoung Chul Lee, Jung Bum Choi, Min Ju Kim, Jun Hyung Bang, Sun Ho Ok, Myeong Hun Oh. Journal of Digestive Cancer Research 2025;13:309-14. https://doi.org/10.52927/jdcr.2025.13.3.309

Inflammatory myofibroblastic tumors (IMTs) of the duodenum are exceptionally uncommon, and their epidemiologic and clinical characteristics remain poorly defined because of the limited number of reported cases. We previously reported a case of duodenal IMT in the Korean Journal of Gastroenterology in 2018, with follow-up data available only up to 12 months. IMTs typically behave in a benign manner, but they may occasionally demonstrate local invasiveness and recurrence; therefore, achieving complete surgical excision is crucial, followed by long-term surveillance. In the present manuscript, we provide a subsequent long-term follow-up report of the same patient, offering an extended 88-month postoperative course and additional radiologic and pathologic details not included in the earlier publication. This follow-up report highlights the long-term benign behavior of the tumor despite positive surgical margins and anaplastic lymphoma kinase (ALK)-negative immunohistochemistry, contributing meaningful information to the scarce literature on adult duodenal IMTs.

Myeong Hun Oh, Hyung Il Seo, Young Mok Park, Byeong Gwan Noh, Su Bin Song. Ann Hepatobiliary Pancreat Surg -0001;0:. https://doi.org/10.14701/ahbps.25-164