Hwang Gyun Jeon

Samsung Medical Center, Sŏul, Seoul, South Korea

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Publications (87)216.55 Total impact

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    ABSTRACT: Preoperative assessment of patients' immunologic and nutritional conditions is required to predict the outcome of patients with malignant tumors. The aim of the current study was to clarify the significance of the prognostic nutritional index (PNI), which simply accounts for immunological and nutritional conditions, in patients with renal cell carcinoma (RCC). We included 1437 patients who underwent nephrectomy for RCC between 1994 and 2008. PNI was calculated using the following formula: 10 × serum albumin concentration (g/dL) + 0.005 × lymphocyte counts (number/mm(2)) in peripheral blood. We examined the correlation of the preoperative PNI value with clinicopathological features. A Cox regression model and the Harrell concordance index with variables only or combined PNI data were used to evaluate the prognostic significance in the T1-4NallMall and T1-4N0M0 groups. The mean preoperative PNI value was 52.7 ± 6.3 (range 27.7-85.3). The mean PNI values were significantly lower in patients with more advanced tumor T stage, regional lymph node metastasis, distant metastases, higher Fuhrman grade, and sarcomatoid differentiation than in patients without such factors (p < 0.001). Patients with low PNI (<51) had poor survival rates compared to those with high PNI in univariate analysis (>51, p < 0.001). Multivariate analysis showed that low PNI was significantly associated with cancer-specific survival (p = 0.026 and p = 0.009) and overall survival (p = 0.013 and p = 0.011) in the T1-4NallMall and T1-4N0M0 groups, respectively, after correcting for other clinicopathological factors. PNI is an independent prognostic factor for predicting survival after nephrectomy in patients with RCC.
    Annals of Surgical Oncology 06/2015; DOI:10.1245/s10434-015-4614-0 · 3.94 Impact Factor
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    Wan Song, Hwang Gyun Jeon
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    ABSTRACT: The incidence of cancer is sharply increasing. Cancer is a leading cause of death as well as a significant burden on society. The incidence of urological cancer has shown a higher than average increase and will become an important concern in the future. Therefore, an overall and accurate understanding of the incidence of urological cancer is essential. In this study, which was based on the Korea National Cancer Incidence Database, annual incident cases, age-standardized incidence rates, annual percentage change (APC), and distribution by age group were examined in kidney, bladder, and prostate cancers, respectively. From 1999 to 2011, the total number of each type of urological cancer was as follows: kidney cancer (32,600 cases, 25.5%), bladder cancer (37,950 cases, 29.7%), and prostate cancer (57,332 cases, 44.8%). The age-standardized incidence rates of prostate cancer showed a significant increase with an APC of 12.3% in males. Kidney cancer gradually increased with an APC of 6.0% for both sexes and became the second most frequent urological cancer after 2008. Bladder cancer showed no significant change with an APC of -0.2% for both sexes and has decreased slightly since 2007. The distribution of kidney cancer according to age showed two peaks in the 50- to 54-year-old and 65- to 69-year-old age groups. Bladder and prostate cancers occurred mostly in the 70- to 74-year-old age group. The proportions of male to female were 2.5:1 in kidney cancer and 5.6:1 in bladder cancer. We have summarized the incidence trends of kidney, bladder, and prostate cancers and have provided useful information for screening and management of these cancers in the future.
    Korean journal of urology 06/2015; 56(6):422. DOI:10.4111/kju.2015.56.6.422
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    ABSTRACT: To evaluate the impact of three-dimensional tumor volume on cancer-specific survival for patients with pT1 clear-cell renal cell carcinoma (ccRCC). We reviewed a prospectively maintained database of 917 patients who underwent radical nephrectomy or nephron-sparing surgery for unilateral, pT1 ccRCC, including 654 pT1a and 263 pT1b patients, between April 1997 and December 2010. Three-dimensional tumor volume was measured using specialized volumetric software on cross-sectional computed tomography images of a preoperative venous phase. Kaplan-Meier and Cox regression analyses were carried out. The median age was 54 years with a follow-up of 60.8 months. Median tumor size and volume were 3.2 cm and 17.4 cm(3), respectively. Of 917 patients, 54 (5.9 %) had died, including 32 patients with ccRCC (9 patients in pT1a and 23 patients in pT1b). On multivariate analysis, tumor size >3.2 cm and tumor volume >17.4 cm(3) were associated with cancer-specific death in pT1 ccRCC patients. When stratified by pT1a/pT1b status and analyzed on median splits, tumor size >2.5 cm was associated with cancer-specific death but not tumor volume >9.5 cm(3) in pT1a patients. However, in pT1b patients, tumor volume >62.1 cm(3) (P = 0.036, HR 2.91, 95 % CI 1.02-7.77) was highly associated with cancer-specific death but not tumor size >5.0 cm (P = 0.159, HR 1.91, 95 % CI 0.78-4.70). In addition to tumor size, tumor volume is associated with cancer-specific death in pT1 ccRCC patients, particularly in pT1b ccRCC but not in pT1a ccRCC.
    World Journal of Urology 05/2015; DOI:10.1007/s00345-015-1592-6 · 3.42 Impact Factor
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    ABSTRACT: We aimed to evaluate the performance of various GFR estimates compared with direct measurement of GFR (dGFR). We also sought to create a new formula for volume-based GFR (new-vGFR) using kidney volume determined by CT. GFR was measured using creatinine-based methods (MDRD, the Cockcroft-Gault equation, CKD-EPI formula, and the Mayo clinic formula) and the Herts method, which is volume-based (vGFR). We compared performance between GFR estimates and created a new vGFR model by multiple linear regression analysis. Among the creatinine-based GFR estimates, the MDRD and C-G equations were similarly associated with dGFR (correlation and concordance coefficients of 0.359 and 0.369 and 0.354 and 0.318, respectively). We developed the following new kidney volume-based GFR formula: 217.48-0.39XA + 0.25XW-0.46XH-54.01XsCr + 0.02XV-19.89 (if female) (A = age, W = weight, H = height, sCr = serum creatinine level, V = total kidney volume). The MDRD and CKD-EPI had relatively better accuracy than the other creatinine-based methods (30.7 % vs. 32.3 % within 10 % and 78.0 % vs. 73.0 % within 30 %, respectively). However, the new-vGFR formula had the most accurate results among all of the analyzed methods (37.4 % within 10 % and 84.6 % within 30 %). The new-vGFR can replace dGFR or creatinine-based GFR for assessing kidney function in donors and healthy individuals. • Accurate prediction of GFR is crucial in kidney donors. • DTPA is accurate but costly, invasive, and clinically difficult to apply. • Volume-based GFR estimation performs as well as the Cr-based method. • New volume-based GFR estimation performs better among GFR estimation formulas.
    European Radiology 05/2015; DOI:10.1007/s00330-015-3741-0 · 4.34 Impact Factor
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    ABSTRACT: To investigate structural hypertrophy and functional hyperfiltration as compensatory adaptations following radical nephrectomy (RN) in patients with renal cell carcinoma (RCC) according to the preoperative stage of chronic kidney disease (CKD). We retrospectively identified 543 patients who underwent RN for RCC between 1997 and 2012. Patients were classified according to preoperative GFR [No CKD:GFR≥90 mL/min/1.73m(2) (n=230, 42.4%), CKD stage II: 60≤GFR<90mL/min/1.73m(2) (n=227, 41.8%), CKD stage III: 30≤GFR<60 mL/min/1.73m(2) (n=86, 15.8%)]. CT images taken within 2 months prior to surgery and 1 year after surgery were used to assess functional renal volume (FRV) for measuring the degree of hypertrophy of the remnant kidney, and the pre- and postoperative GFR per unit volume of FRV (GFR/FRV) was used to calculate the degree of hyperfiltration. Among all patients (mean age: 56.0 years), the mean preoperative GFR, FRV, and GFR/FRV were 83.2mL/min/1.73m(2), 340.6cm(3), and 0.25ml/min/1.73m(2)/cm(3), respectively. The percent reduction in GFR was statistically significant according to CKD stage (no CKD:-31.2% vs. II:-26.5%vs. III:-12.8%; p<0.001); however, The degree of hypertrophic FRV in the remnant kidney was not statistically significant (no CKD:18.5% vs. II:17.3% vs. III:16.5%; p=0.250). The change in GFR/FRV was statistically significant (no CKD:18.5% vs. II:20.1% vs. III:45.9%; p<0.001). Factors that increased GFR/FRV above the mean value were Body mass index (p=0.012), diabetes mellitus (p=0.023), hypertension (p=0.015), and CKD stage (p<0.001). Patients with lower preoperative GFR had less of a reduction in postoperative renal function than patients with higher preoperative GFR due to greater degrees of functional hyperfiltration. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
    The Journal of urology 04/2015; DOI:10.1016/j.juro.2015.04.093 · 3.75 Impact Factor
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    ABSTRACT: We evaluated the association between tumor size and preoperative volumetric kidney parameters measured with CT in patients with renal cell carcinoma (RCC). We prospectively identified 1118 patients who underwent radical or partial nephrectomy for RCC between 2011 and 2014. Contrast-enhanced CT was performed within three months before surgery. Kidney volume was measured using a tissue segmentation tool program from CT images. We classified patients into three groups depending on tumor size (A: ≤4 cm, B: 4-7 cm, C: >7 cm). The preoperative volumetric kidney parameters were compared and multivariable linear regression was used to analyze potential factors associated with compensatory hypertrophy of the contralateral normal kidney before surgery. Patients in group C had a significantly larger contralateral normal kidney volume than patients in A and B (A: 170.0 mL, B: 171.7 mL, C: 187.2 mL, p < 0.001). The contralateral kidney volume was not significantly different between groups A and B (p > 0.05). However, tumor-side real kidney volume in group C was significantly smaller than that of groups A and B (A: 168.8 mL, B: 164.9 mL, C: 150.9 mL, p < 0.001). On multivariable analysis, increased contralateral kidney volume was positively associated with male gender, higher BMI, DM, higher preoperative GFR, and tumor size (>7 cm), and negatively associated with older age (p < 0.05). Tumor size had the strongest positive association with contralateral kidney volume (>7 cm, partial regression coefficient = 30.2). Tumor size (>7 cm) is the strongest factor associated with compensatory hypertrophy in the contralateral normal kidney before surgery.
    World Journal of Urology 04/2015; 193(4). DOI:10.1007/s00345-015-1551-2 · 3.42 Impact Factor
  • The Journal of Urology 04/2015; 193(4):e65. DOI:10.1016/j.juro.2015.02.211 · 3.75 Impact Factor
  • European Urology Supplements 04/2015; 14(2):e832-e832a. DOI:10.1016/S1569-9056(15)60821-1 · 3.37 Impact Factor
  • The Journal of Urology 04/2015; 193(4):e561-e562. DOI:10.1016/j.juro.2015.02.1654 · 3.75 Impact Factor
  • The Journal of Urology 04/2015; 193(4):e787. DOI:10.1016/j.juro.2015.02.2391 · 3.75 Impact Factor
  • The Journal of Urology 04/2015; 193(4):e534. DOI:10.1016/j.juro.2015.02.1562 · 3.75 Impact Factor
  • PLoS ONE 03/2015; 10(3):e0122019. DOI:10.1371/journal.pone.0122019 · 3.53 Impact Factor
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    ABSTRACT: The aim of this study was to assess surgical outcome at radical prostatectomy (RP) in Korean men with a serum prostate-specific antigen (PSA) level of 2.5 to 3.0 ng/mL and compared with those of patients who had a PSA level of 3.0-4.0 and 4.0-10.0 ng/mL. We retrospectively compared clinico-pathological characteristics and biochemical recurrence (BCR) risk in patients with PSA level of 2.5-3.0 (group 1, n = 92, 5.7%), 3.0-4.0 (group 2, n = 283, 17.5%), or 4.0-10.0 ng/mL (group 3, n = 1,242, 76.8%) who underwent RP between 1995 and 2013. The pathologic characteristics including Gleason score, pathologic stage, and percentage of significant cancer in group 1 were similar to those in group 2 and group 3. Furthermore, pathological upgrading and upstaging were found in 23 (30.7%) and 10 (14.7%) in group 1, 84 (33.9%) and 19 (8.8%) in group 2, and 321 (32.8%) and 113 (12.8%) in group 3, respectively, with no significant differences among the three groups (all P > 0.05). In multivariate analysis, PSA grouping was not an independent predictor of BCR. Within the population with PSA lower than 10 ng/mL, substratification of PSA is not a significant predictor for upgrading, upstaging, or adverse prognosis. Graphical Abstract
    Journal of Korean Medical Science 03/2015; 30(3):317-22. DOI:10.3346/jkms.2015.30.3.317 · 1.25 Impact Factor
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    ABSTRACT: To investigate whether the apparent diffusion coefficient (ADC) from diffusion-weighted magnetic resonance imaging (DW-MRI) could help improve the prediction of insignificant prostate cancer in candidates for active surveillance (AS). Enrolled in this retrospective study were 287 AS candidates who underwent DW-MRI before radical prostatectomy. Patients were stratified into two groups; Group A consisted of patients with no visible tumour or a suspected tumour ADC value > 0.830 × 10(-3) mm(2)/sec and Group B consisted of patients with a suspected tumour ADC value < 0.830 × 10(-3) mm(2)/sec. We compared pathological outcomes in each group. Group A had 243 (84.7 %) patients and Group B had 44 (15.3 %) patients. The proportion of organ-confined Gleason ≤ 6 disease and insignificant prostate cancer was significantly higher in Group A than Group B (61.3 % vs. 38.6 %, p = 0.005 and 47.7 % vs. 25.0 %, p = 0.005, respectively). On multivariate analysis, a high ADC value was the independent predictor of organ-confined Gleason ≤ 6 disease and insignificant prostate cancer (odds ratio = 2.43, p = 0.011 and odds ratio = 2.74, p = 0.009, respectively). Tumour ADC values may be a useful marker for predicting insignificant prostate cancer in candidates for AS. • ADC from DW-MRI can help assess prostate cancer aggressiveness in potential AS candidates. • There was a closed correlation between higher ADC values and insignificant prostate cancer. • The absence of lesions on DWI/DWI can help select potential AS candidates.
    European Radiology 01/2015; 25(6). DOI:10.1007/s00330-014-3566-2 · 4.34 Impact Factor
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    ABSTRACT: Objectives To determine the effect of visceral obesity on the prognosis of advanced renal cell carcinoma patients undergoing nephrectomy.Methods We reviewed clinicopathological data of 2187 patients who underwent nephrectomy for renal cell carcinoma (localized [T1–2, N0, M0], n = 1738 [79.5%]; advanced [T3–4, any N and M], n = 449 [20.5%]) at Samsung Medical Center, Seoul, Korea. The visceral fat area and subcutaneous fat area were determined at the level of the umbilicus on computed tomograms obtained before surgery. Patients were categorized as either viscerally obese or non-obese according to visceral fat area and visceral fat area/subcutaneous fat area ratio.ResultsHigh visceral fat area (greater than 50 percentiles in each sex) was associated with longer cancer-specific survival (P = 0.01) or overall survival (P = 0.03), whereas visceral fat area/subcutaneous fat area ratio showed no influence on survival outcomes. By multivariate analysis adjusted with clinicopathological variables, low visceral fat area was an independent predictor of cancer-specific death and overall death (cancer-specific survival P = 0.004, hazard ratio = 2.19; overall survival P = 0.003, hazard ratio = 2.22), as well as old age (P = 0.01), radical nephrectomy (P = 0.002), high tumor grade (P = 0.01) and the presence of a sarcomatoid component (P < 0.001) in the subgroup analysis of advanced renal cell carcinoma.Conclusion High visceral fat area might represent a predictor of better prognosis in patients with advanced renal cell carcinomas undergoing nephrectomy.
    International Journal of Urology 01/2015; 22(5). DOI:10.1111/iju.12716 · 1.80 Impact Factor
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    ABSTRACT: To compare the perioperative outcomes of laparoscopic partial nephrectomy (LPN) and robotic partial nephrectomy (RPN) for moderately or highly complex tumors (RENAL nephrometry score≥7). A retrospective analysis was performed for 127 consecutive patients who underwent either LPN (n=38) or RPN (n=89) between 2007 and 2013. Perioperative outcomes were compared. There were no significant differences between the two groups with respect to patient gender, laterality, RENAL nephrometry score, or body mass index. The RPN group had a slightly higher RENAL nephrometry score (7.8 vs. 7.5, p=0.061) and larger tumor size (3.0 cm vs. 2.5 cm, p=0.044) but had a lower Charlson comorbidity index (3.7 vs. 4.4, p=0.017) than did the LPN group. There were no significant differences with respect to warm ischemia time, estimated blood loss, intraoperative complications, or operative time. Only one patient who underwent LPN had a positive surgical margin. There were statistically significant differences in surgical marginal width between the LPN and RPN groups (0.6 cm vs. 0.4 cm, p=0.001). No significant differences in postoperative complications were found between the two groups. Owing to potential baseline differences between the two groups, we performed a propensity-based matching analysis, in which differences in surgical margin width between the LPN and RPN groups remained statistically significant (0.6 cm vs. 0.4 cm, p=0.029). RPN provides perioperative outcomes comparable to those of LPN and has the advantage of healthy parenchymal preservation for complex renal tumors (RENAL score≥7).
    Korean journal of urology 12/2014; 55(12):808-13. DOI:10.4111/kju.2014.55.12.808
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    ABSTRACT: Traditionally, urologists recommend an interval of at least 4 weeks after prostate biopsy before radical prostatectomy. The aim of our study was to evaluate whether the interval from prostate biopsy to radical prostatectomy affects immediate operative outcomes, with a focus on differences in surgical approach. The study population of 1,848 radical prostatectomy patients was divided into two groups according to the surgical approach: open or minimally invasive. Open group included perineal and retropubic approach, and minimally invasive group included laparoscopic and robotic approach. The cut-off of the biopsy-to-surgery interval was 4 weeks. Positive surgical margin status, operative time and estimated blood loss were evaluated as endpoint parameters. In the open group, there were significant differences in operative time and estimated blood loss between the <4-week and ≥4-week interval subgroups, but there was no difference in positive margin rate. In the minimally invasive group, there were no differences in the three outcome parameters between the two subgroups. Multivariate analysis revealed that the biopsy-to-surgery interval was not a significant factor affecting immediate operative outcomes in both open and minimally invasive groups, with the exception of the interval ≥4 weeks as a significant factor decreasing operative time in the minimally invasive group. In conclusion, performing open or minimally invasive radical prostatectomy within 4 weeks of prostate biopsy is feasible for both approaches, and is even beneficial for minimally invasive radical prostatectomy to reduce operative time. Graphical Abstract
    Journal of Korean Medical Science 12/2014; 29(12):1688-93. DOI:10.3346/jkms.2014.29.12.1688 · 1.25 Impact Factor
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    ABSTRACT: To analyze the location of the positive surgical margin (PSM) and its association with the biochemical recurrence (BCR) rate in cases of radical prostatectomy (RP) according to the type of surgery. We retrospectively analyzed 1,880 cases of RP. Baseline characteristics were analyzed. Locations of the PSM were recorded in the four surgery groups as apex, anterior, posterolateral, and base and were analyzed by using chi-square test. The association of the location of the PSM with the BCR rate was analyzed by using Kaplan-Meier survival analysis according to the type of surgery, which included radical perineal prostatectomy (RPP, n=633), radical retroperitoneal prostatectomy (RRP, n=309), laparoscopic radical prostatectomy (LRP, n=164), and robot-assisted laparoscopic radical prostatectomy (RALRP, n=774). A PSM was found in a total of 336 cases (18%): 122 cases of RPP (18%), 67 cases of RRP (17%), 29 cases of LRP (17%), and 119 cases of RALRP (15%). The PSM rate did not differ significantly by surgical type (p=0.142). The location of the PSM was the apex in 136 cases (7.2%), anterior in 67 cases (3.5%), posterolateral in 139 cases (7.3%), and base in 95 cases (5.0%), and showed no significant difference according to surgical type (p=0.536, p=0.557, p=0.062, and p=0.109, respectively). The BCR rate according to the location of the PSM did not differ significantly for the four types of surgery (p=0.694, p=0.301, p=0.445, and p=0.309 for RPP, RRP, LRP, and RALRP, respectively). The location of the PSM seemed to be unrelated to type of RP. There was no significant correlation between the BCR rate and the location of the PSM for any of the RP types.
    Korean journal of urology 12/2014; 55(12):802-7. DOI:10.4111/kju.2014.55.12.802
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    ABSTRACT: To provide an overview of the incidence, bacteriologic characteristics, and antimicrobial resistance in acute prostatitis after transrectal ultrasonography (TRUS)-guided prostate biopsy. We reviewed the medical records of 9568 patients who underwent TRUS-guided biopsy between March 1995 and May 2013. These patients received oral quinolone and/or cephalosporin and intramuscular aminoglycoside as antibiotic prophylaxis. In patients with acute prostatitis, blood and urine cultures were obtained on hospital admission. The incidences of acute prostatitis and antimicrobial resistance were examined according to time period. A total of 11,345 cases of TRUS-guided biopsy were performed for 9568 patients. Acute prostatitis developed in 103 patients (0.91%). In 63 patients, the causative organism was isolated from blood and/or urine culture. The most frequent etiologic organism was Escherichia coli, which was present in 47 of 49 patients (95.9%) in blood and from 39 of 41 patients (95.1%) in urine. Extended-spectrum beta-lactamase (ESBL)-producing E coli were detected continuously since 2008 and found in 10 patients (21.3%) in blood and 8 patients (20.5%) in urine. Forty-four patients (93.6%) in blood and 36 patients (92.3%) in urine of the positive cultures and all cases with ESBL-producing E coli infection showed resistance to quinolone. ESBL-producing E coli were susceptible to imipenem, amikacin, and cefoxitin. In the treatment of acute prostatitis after TRUS-guided biopsy, quinolone is not an effective antimicrobial of choice. We should take into account antimicrobial-resistant patterns because of the high prevalence of quinolone resistance and emergence of an ESBL-producing strain. Copyright © 2014 Elsevier Inc. All rights reserved.
    Urology 10/2014; 84(5). DOI:10.1016/j.urology.2014.06.052 · 2.13 Impact Factor
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    ABSTRACT: Purpose We evaluated the accuracy of preoperative multiparametric 3.0-T magnetic resonance imaging for local staging of prostate cancer and its influence in the decision to preserve neurovascular bundles at robotic assisted laparoscopic radical prostatectomy. Materials and Methods The study included 353 patients who had confirmed prostate cancer and underwent preoperative magnetic resonance imaging and robotic assisted laparoscopic radical prostatectomy between 2008 and 2011. The extent of neurovascular bundle sparing was initially determined on the basis of the clinical information and the nerve sparing surgical plan was reevaluated after review of the magnetic resonance imaging report. The value of preoperative magnetic resonance imaging in the prediction of extracapsular extension and in the decision of surgical plan according to D'Amico risk classification was analyzed. Results The magnetic resonance imaging performed correct staging, over staging and under staging in 261 (73.9%), 43 (12.2%), and 49 (13.9%) patients, respectively. After review of the magnetic resonance imaging reports, the initial surgical plan was not changed in 260 patients (74%) and was changed in 93 patients (26%). Robotic assisted laparoscopic radical prostatectomy was changed to a more preservable neurovascular bundle sparing procedure in 53 patients (57%) and changed to a more aggressive neurovascular bundle resecting procedure in 40 patients (43%). For the patients with a change to more conservative surgery, the appropriateness was 91%. The sensitivity of magnetic resonance imaging in predicting extracapsular extension showed a tendency to increase from low to high risk groups (33%, 46%, 80%, respectively, p <0.001). In intermediate and high risk groups, there was a surgical plan change in 40 patients (of 129, 31%) and 27 patients (of 67, 40%), respectively. Conclusions Preoperative magnetic resonance imaging significantly improves the decision making to preserve or resect the neurovascular bundle at robotic assisted laparoscopic radical prostatectomy, which lacks haptic feedback.
    The Journal of Urology 07/2014; 192(1):82–88. DOI:10.1016/j.juro.2014.01.005 · 3.75 Impact Factor

Publication Stats

522 Citations
216.55 Total Impact Points

Institutions

  • 2014–2015
    • Samsung Medical Center
      • Department of Urology
      Sŏul, Seoul, South Korea
  • 2012–2015
    • Sungkyunkwan University
      • Department of Urology
      Sŏul, Seoul, South Korea
  • 2010–2012
    • CHA University
      Sŏul, Seoul, South Korea
  • 2005–2010
    • Seoul National University
      • Department of Urology
      Seoul, Seoul, South Korea
  • 2009
    • Asan Medical Center
      Sŏul, Seoul, South Korea
  • 2004–2009
    • Seoul National University Hospital
      • Department of Urology
      Sŏul, Seoul, South Korea