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ABSTRACT: Most of the cancer xenograft models are derived from tumor cell lines, but they do not sufficiently represent clinical cancer characteristics. Our objective was to develop xenograft models of bladder cancer derived from human tumor tissue and characterize them molecularly as well as histologically. A total of 65 bladder cancer tissues were transplanted to immunodeficient mice. Passagable 6 cases with clinico-pathologically heterogeneous bladder cancer were selected and their tumor tissues were collected (012T, 025T, 033T, 043T, 048T, and 052T). Xenografts were removed and processed for the following analyses: (1) histologic examination, (2) short tandem repeat (STR) genotyping, (3) mutational analysis, and (4) array-based comparative genomic hybridization (array-CGH). The original tumor tissues (P 0) and xenografts of passage 2 or higher (≥ P2) were analyzed and compared. As a result, hematoxylin and eosin staining revealed the same histologic architecture and degree of differentiation in the primary and xenograft tumors in all 6 cases. Xenograft models 043T_P2 and 048T_P2 had completely identical STR profiles to the original samples for all STR loci. The other models had nearly identical STR profiles. On mutational analysis, 4 out of 6 xenografts had mutations identical to the original samples for TP53, HRAS, BRAF, and CTNNB1. Array-CGH analysis revealed that all 6 xenograft models had genomic alterations similar to the original tumor samples. In conclusion, our xenograft bladder cancer model derived from patient tumor tissue is expected to be useful for studying the heterogeneity of the tumor populations in bladder cancer and for evaluating new treatments.
Cancer Science 02/2013; · 3.33 Impact Factor
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ABSTRACT: The association of body mass index, smoking, and blood pressure, which are related to the three well-established risk factors of renal cell carcinoma, and survival in patients with renal cell carcinoma is not much studied. Our objective was to evaluate this association. A cohort of 1,036 patients with low stage (pT1 and pT2) renal cell carcinoma who underwent radical or partial nephrectomy were enrolled. We retrospectively reviewed medical records and collected survival data. The body mass index, smoking status, and blood pressure at the time of surgery were recorded. Patients were grouped according to their obesity grade, smoking status, and hypertension stage. Survival analysis showed a significant decrease in overall (P = 0.001) and cancer-specific survival (P < 0.001) with being underweight, with no differences of smoking status or perioperative blood pressure. On multivariate analysis, perioperative blood pressure ≥ 160/100 mmHg (HR, 2.642; 95% CI, 1.221-5.720) and being underweight (HR, 4.320; 95% CI, 1.557-11.984) were independent predictors of overall and cancer-specific mortality, respectively. Therefore, it is concluded that being underweight and perioperative blood pressure ≥ 160/100 mmHg negatively affect cancer-specific and overall survival, respectively, while smoking status does not influence survivals in patients with renal cell carcinoma.
Journal of Korean medical science 02/2013; 28(2):227-36. · 0.84 Impact Factor
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ABSTRACT: To analyze if clinically insignificant prostate cancer (CIPC) is more frequently detected with repeat prostate biopsies, we retrospectively analyzed the records of 2146 men diagnosed with prostate cancer after one or more prostate biopsies. The patients were divided into five groups according to the number of prostate biopsies obtained, e.g. group 1 had one biopsy, group 2 had two biopsies and group 3 had three biopsies. Of the 2146 patients diagnosed with prostate cancer, 1956 (91.1%), 142 (6.6%), 38 (1.8%), 9 (0.4%) and 1 (0.1%) men were in groups 1, 2, 3, 4 and 5, respectively. Groups 4 and 5 were excluded because of the small sample sizes. The remaining three groups (groups 1, 2 and 3) were statistically analyzed. There were no differences in age or prostate-specific antigen level among the three groups. CIPC was detected in 201 (10.3%), 28 (19.7%) and 9 (23.7%) patients in groups 1, 2 and 3, respectively (P<0.001). A multivariate analysis showed that the number of biopsies was an independent predictor to detect CIPC (OR=2.688 for group 2; OR=4.723 for group 3). In conclusion, patients undergoing multiple prostate biopsies are more likely to be diagnosed with CIPC than those who only undergo one biopsy. However, the risk still exists that the patient could have clinically significant prostate cancer. Therefore, when counseling patients with regard to serial repeat biopsies, the possibility of prostate cancer overdiagnosis and overtreatment must be balanced with the continued risk of clinically significant disease.Asian Journal of Andrology advance online publication, 31 December 2012; doi:10.1038/aja.2012.123.
Asian Journal of Andrology 12/2012; · 1.52 Impact Factor
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ABSTRACT: The aim of this study was to evaluate the efficacy and safety of hexaminolevulinate fluorescence cystoscopy in the diagnosis of bladder cancer.
In a prospective design, we included patients who had a bladder lesion suggesting bladder cancer. Patients with massive hematuria, urethral Foley catheter insertion, chronic retention state, or urinary tract infection were excluded. After the bladder was emptied, hexaminolevulinate was gently administered into the bladder. One hour later, cystoscopy under white light and blue light was performed. After marking the lesions confirmed with white light or blue light, transurethral resection of the bladder lesion and pathologic confirmation were done. Transurethral resection of the lesions that were negative in both white and blue light was also performed.
From April 2010 to September 2010, 30 patients were enrolled. From the total of 30 patients (25 men and 5 women; mean age, 60.4±9.22 years), 134 specimens were extracted. Among these, 101 specimens showed positive results by blue light cystoscopy (BLC). The sensitivity of BLC and white light cystoscopy (WLC) was 92.3% and 80.8%, respectively (p=0.021). The specificity of BLC and WLC was 48% and 49.1%, respectively (p>0.05). The positive and negative predictive values of BLC were 71.2% and 81.8%, respectively, whereas those of WLC were 72.0% and 68.6%, respectively. With WLC, 48 specimens showed negative findings, but of that group, 15 specimens (31.2%) were revealed to be malignant with BLC. There were no significant side effects in the 24 hours after the instillation of hexaminolevulinate.
Photodynamic diagnosis with hexaminolevulinate helps to find tumors that could be missed by use of WLC only. Photodynamic diagnosis might be valuable in complete resection as well as for more accurate diagnosis of bladder tumor.
Korean journal of urology 12/2012; 53(12):821-5.
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ABSTRACT: PURPOSE:: We investigated the relationship between preoperative uric acid levels and GFR preoperatively and postoperatively in patients with RCC. MATERIALS AND METHODS:: We included 1,534 patients who underwent radical or partial nephrectomy for RCC between 1994 and 2008. Uric acid was measured preoperatively and estimated GFR was calculated using the modification of diet in renal disease equation preoperatively and postoperatively within 7 days and at 3 months, 1 year, and 3 years. We looked for correlations of uric acid with GFR, patient demographics, and comorbidities. We also evaluated the predictive value of uric acid for preoperative GFR and new-onset chronic kidney disease (GFR<60mL/min/1.73m(2)) after nephrectomy using multivariate regression analysis. RESULTS:: The mean uric acid (SD, range) concentration was 5.2 (1.5, 1.3-11.3)mg/dL. The mean preoperative uric acid level was correlated with preoperative GFR (r=-0.313, p<0.001) and associated with prevalent chronic kidney disease. Decreased preoperative GFR correlated significantly with earlier year of surgery (p<0.001), old age (p<0.001), male gender (p<0.001), hypertension (p<0.001), high uric acid level (p<0.001), and larger tumor size (p<0.001) in multivariate regression analysis. Hypertension (p<0.001), male gender (p<0.001), and a high body mass index (p<0.001) were correlated with high levels of uric acid. Older age (p<0.001), diabetes mellitus (p=0.002), a low preoperative GFR (p<0.001), and a high preoperative uric acid level (p=0.002) were significant predictors of new-onset chronic kidney disease at 3 years after nephrectomy. CONCLUSIONS:: The elevated preoperative uric acid level was an independent predictor of low preoperative GFR and new-onset chronic kidney disease in RCC patients who underwent nephrectomy.
The Journal of urology 11/2012; · 4.02 Impact Factor
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ABSTRACT: Abstract Objective. The aim of this study was to compare oncological and functional outcomes of pure laparoscopic radical prostatectomy (LRP) and robotic-assisted laparoscopic radical prostatectomy (RALRP) performed by a single surgeon. Material and methods. In total, 327 consecutive patients with prostate cancer who underwent radical prostatectomy (144 with LRP and 183 with RALRP) were enrolled. No significant differences were found in prostate-specific antigen level, biopsy Gleason score, clinical T stage or D'Amico risk stratification between the two groups. The operating time was longer in the LRP group (p < 0.001). The RALRP group patients had significantly lower postoperative pain numerical rating scale (NRS) (p = 0.016) and catheter duration (p < 0.001). There were no differences in pathological Gleason score, pathological T stage or positive surgical margin rate. No differences were found in biochemical recurrence-free survival. Postoperative pad-free continence rates revealed a more rapid recovery in the RALRP group, but rates at 12 months were not significantly different. Multivariate analysis showed that the type of surgery was a strong independent factor to predict early postoperative pad use. Postoperative potency rates were not significantly different at 3, 6 and 12 months in patients who underwent nerve-sparing procedures. Conclusions. LRP and RALRP performed by a single surgeon yielded similar results in terms of safety and oncological outcomes. More favorable outcomes were noted in operating time, pain NRS and catheter duration, as well as urinary continence recovery time. Therefore, RALRP showed more favorable components in terms of postoperative quality of life than LRP.
Scandinavian Journal of Urology and Nephrology 07/2012; · 0.99 Impact Factor
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Jong-Mu Sun,
Ji-Youn Sung,
Se Hoon Park,
Ghee Young Kwon,
Byong Chang Jeong, Seong Il Seo,
Seong Soo Jeon,
Hyun Moo Lee,
Jisuk Jo,
Han Yong Choi,
Ho Yeong Lim
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ABSTRACT: The role of adjuvant chemotherapy and the value of molecular biomarkers in bladder cancer have not been determined. We aimed to assess the predictive and prognostic values of excision repair cross-complementation 1 (ERCC1) in identifying appropriate patients who may potentially benefit from adjuvant chemotherapy for bladder cancer.
A retrospective analysis was performed on 93 patients with completely resected transitional cell carcinoma of the bladder. ERCC1 expression was assessed by immunohistochemistry. ERCC1 expression was analyzed in 57 patients treated with adjuvant gemcitabine plus cisplatin chemotherapy and 36 who were not treated.
Among 93 patients, ERCC1 expression was positive in 54 (58.1%) and negative in 39 (41.9%). ERCC1 positivity was significantly associated with longer survival (adjusted hazard ratio for death, 0.12, 95% confidence interval [CI] 0.014-0.99; P = 0.049) in the group without adjuvant chemotherapy while ERCC1 positivity was associated with shorter survival among patients who have received adjuvant chemotherapy (adjusted hazard ratio for death, 2.64; 95% CI 1.01-6.85; P = 0.047). Therefore, clinical benefit from adjuvant chemotherapy was associated with ERCC1 negativity as measured by overall survival (test for interaction, P = 0.034) and by disease-free survival (test for interaction, P = 0.20).
Among patients with completely resected transitional cell carcinoma of the bladder, those with ERCC1-negative tumors seemed to benefit more from adjuvant gemcitabine plus cisplatin chemotherapy than those with ERCC1-positive tumors. Future prospective, randomized studies are warranted to confirm our findings.
BMC Cancer 05/2012; 12:187. · 3.01 Impact Factor
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ABSTRACT: Growing evidence suggests that obesity, an established cause of renal cell cancer (RCC), may also be associated with a better prognosis. To evaluate the association between RCC survival and obesity, we analyzed a large cohort of patients with RCC and undertook a meta-analysis of the published evidence. We collected clinical and pathologic data from 1,543 patients who underwent nephrectomy for RCC between 1994 and 2008 with complete follow-up through 2008. Patients were grouped according to BMI (kg/m(2) ): underweight <18.5, normal weight 18.5 to <23, overweight 23 to <25 and obese ≥25. We estimated survival using the Kaplan-Meier method and Cox proportional hazard models to examine the impact of BMI on overall survival (OS) and cancer-specific survival (CSS) with adjustment for covariates. We performed a meta-analysis of BMI and OS, CSS and recurrence-free survival (RFS) from all relevant studies using a random-effects model. The 5-year CSS increased from 76.1% in the lowest to 92.7% in the highest BMI category. A multivariate analysis showed higher OS [hazard ratio (HR) = 0.45; 95% CI: 0.29-0.68) and CSS (HR = 0.47; 95% CI: 0.29-0.77] in obese patients than in normal weight patients. The meta-analysis further corroborated that high BMI significantly improved OS (HR = 0.57; 95% CI: 0.43-0.76), CSS (HR = 0.59; 95% CI: 0.48-0.74) and RFS (HR = 0.49; 95% CI: 0.30-0.81). Our study shows that preoperative BMI is an independent prognostic indicator for survival among patients with RCC.
International Journal of Cancer 05/2012; · 5.44 Impact Factor
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Seok-Soo Byun,
Sangchul Lee,
Sang Eun Lee,
Eunsik Lee, Seong Il Seo,
Hyun Moo Lee,
Han Yong Choi,
Cheryn Song,
Hanjong Ahn,
Young Deuk Choi,
Jin Seon Cho
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ABSTRACT: The aim of this study was to evaluate the recent changes in the clinicopathologic features of prostate cancer in Korea and to compare these features with those of Western populations.
We retrospectively reviewed the data of 1582 men undergoing radical prostatectomy for clinically localized prostate cancer between 1995 and 2007 at 10 institutions in Korea for comparison with Western studies. The patients were divided into two groups in order to evaluate the recent clinicopathological changes in prostate cancer: Group 1 had surgery between 1995 and 2003 (n=280) and Group 2 had surgery between 2004 and 2007 (n=1302). The mean follow-up period was 24 months.
Group 1 had a higher prostate-specific antigen level than Group 2 (10.0 ng/mL vs. 7.5 ng/mL, respectively; p<0.001) and a lower proportion of biopsy Gleason scores ≤6 (35.0% vs. 48.1%, respectively; p<0.001). The proportion of patients with clinical T1 stage was higher in Group 2 than in Group 1. Group 1 had a lower proportion of organ-confined disease (59.6% vs. 68.6%; p<0.001) and a lower proportion of Gleason scores ≤6 (21.3% vs. 33.0%; p<0.001), compared to Group 2. However, the relatively higher proportion of pathologic Gleason scores ≤6 in Group 2 was still lower than those of Western men, even though the proportion of organ-confined disease reached to that of Western series.
Korean men with prostate cancer currently present better clinicopathologic parameters. However, in comparison, Korean men still show relatively worse pathologic Gleason scores than Western men.
Yonsei medical journal 05/2012; 53(3):543-9. · 0.77 Impact Factor
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ABSTRACT: The aim of the current study was to examine the impact of preoperative body mass index (BMI) in Korean patients with surgically treated renal cell carcinoma (RCC).
From 1994 to 2008, a total of 1,487 patients underwent nephrectomy for RCC. All patients were classified into three groups according to Asian BMI classification by Asia Cohort Consortium: <18.5, 18.5 to <25, and 25 kg/m(2) or greater group, which represents the underweight (n = 42, 2.8%), normal (n = 833, 56.0%), and obesity (n = 612, 41.2%) group, respectively. Survival analyses and predictive factors for cancer-specific survival among the three groups were evaluated. Subgroup survival analysis of organ-confined and advanced disease was performed.
An overall median follow-up was 54.8 months. Mean ± SE estimated cancer-specific survival in all patients at 5 and 10 years was 88.0 ± 1.0% and 81.4 ± 1.4%, respectively. In the multivariate model after adjusting preoperative and postoperative variables, the underweight group had a significantly worse prognosis than the normal group (hazard ratio (HR): 2.17, 95% confidence interval (95% CI): 1.16-4.08, p = 0.016), meanwhile the obesity group was associated with improved survival (HR: 0.66, 95% CI: 0.45-0.96, p = 0.032). In the subgroup analysis of advanced RCC, obesity was associated with better prognosis than the normal group after applying multivariate analysis (p = 0.001).
Preoperative underweight could be a new independent factor to predict unfavorable cancer-specific survival in Korean patients with RCC treated by surgery. Moreover, obesity was verified to be associated with superior cancer-specific survival.
Cancer Causes and Control 03/2012; 23(3):505-11. · 2.88 Impact Factor
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ABSTRACT: We determined the effects of warm ischemia time on the recovery of renal function after partial nephrectomy under pneumoperitoneum.
In this prospective study 37 consecutive patients who underwent laparoscopic partial nephrectomy or robot-assisted partial nephrectomy between June 2008 and May 2009 to remove a single cT1 renal tumor were evaluated using (99m)Tc-diethylenetriamine pentaacetic acid renal scintigraphy preoperatively, and at 3 and 12 months postoperatively.
The most significant reduction in the glomerular filtration rate of the affected kidney at 3 and 12 months after surgery (p = 0.018, p = 0.036, respectively) was seen for a warm ischemia time cutoff of 28 minutes. The glomerular filtration rate of the affected kidney was consistently and significantly reduced at 3 and 12 months postoperatively (-22.4% to -30.6%, p <0.001) in patients with a warm ischemia time greater than 28 minutes. In contrast, no significant glomerular filtration rate change was seen in patients with a warm ischemia time of 28 minutes or less. In terms of the contributional change of the affected kidney to total renal function, there is a trend toward a recovery after an initial decrease in both groups with a warm ischemia time greater than 28 minutes vs 28 minutes or less. On multivariate analysis warm ischemia time was a strong independent predictor of glomerular filtration rate reduction even 12 months after surgery (β = -1.3; 95% CI -1.8, -0.7; p <0.001).
If the warm ischemia time is greater than 28 minutes during laparoscopic partial nephrectomy or robot-assisted partial nephrectomy, the functional damage to the affected kidney progresses even up to 1 year after surgery.
The Journal of urology 03/2012; 187(3):802-6. · 4.02 Impact Factor
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ABSTRACT: The aim of this study was to evaluate oncologic outcomes and adverse events for patients with prostate cancer after treatment by high-intensity focused ultrasound (HIFU).
Between February 2004 and August 2010, patients with prostate cancer who underwent HIFU treatment were reviewed about oncologic outcomes and complications. Biochemical recurrence (BCR) was defined as prostate-specific antigen (PSA) nadir plus 1.2 ng/ml. Kaplan-Meier analysis was performed to evaluate BCR- and disease progression-free survival according to risk stratification. Predictors for BCR and disease progression were identified using the Cox-proportional hazard method.
The overall BCR rate was 59.5%, and median time to BCR was 13.8 months. The 5-year BCR-free survival rates of the low-, intermediate-, and high-risk groups were 66.3, 40.2, and 21.0% (P = 0.001), respectively, and the 5-year disease progression-free survival rates were 73.5, 46.0, and 29.2%, respectively (P = 0.008). Multivariate analysis showed that risk stratification, PSA nadir, and time to PSA nadir were significant predictors of BCR and disease progression. In the first 3 months post-op, 11 patients (8.7%) had complications. There were no patients who required blood transfusions or who had wound problems, stroke, deep vein thrombosis, or bowel dysfunction.
HIFU treatment does not provide effective oncologic outcomes even in low risk patients with prostate cancer as well as in the intermediate or high risk groups. Therefore, patients selected to undergo HIFU treatment for prostate cancer must be very carefully chosen. On the other hand, HIFU treatment for prostate cancer had a very low rate of complications.
The Prostate 01/2012; 72(13):1399-406. · 3.48 Impact Factor
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ABSTRACT: The purpose of our study was to prospectively evaluate whether MRI before an initial transrectal ultrasound-guided biopsy contributed to detection of prostate cancer in patients with high prostate-specific antigen (PSA) level and no previous biopsy.
Men with an abnormal digital rectal examination or high PSA level were enrolled in this prospective randomized study. Participants were randomly allocated into two groups; the MRI group underwent 3-T MRI and then a transrectal ultrasound-guided biopsy with knowledge of the cancer location. The non-MRI group did not undergo MRI before transrectal ultrasound-guided biopsy. The cancer detection rate and positive core rate were obtained to compare the MRI and non-MRI groups.
The MRI and non-MRI groups contained 44 and 41 patients, respectively. There was no significant difference between the two groups with respect to age, PSA, and prostate volume. The MRI group (13/44, 29.5%) had a significantly higher cancer detection rate than the non-MRI group (4/41, 9.8%) (p = 0.03). The MRI group (52/527, 9.9%) had a significantly higher positive core rate than the non-MRI group (11/432, 2.5%) (p = 0.00). Regarding cancer detection rate and positive core rate, odds ratios were 3.9 (95% CI, 1.1-13.1) and 4.2 (95% CI, 2.2-8.1), respectively.
In patients with PSA level and no previous biopsy, 3-T MRI that is performed before transrectal ultrasound-guided biopsy may contribute to the detection of prostate cancer.
American Journal of Roentgenology 11/2011; 197(5):W876-81. · 2.78 Impact Factor
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ABSTRACT: The aim of our study was to compare early complication rates between the robot-assisted radical cystectomy (RARC) and open radical cystectomy (ORC) using a standardized reporting system.
From September 2008 to March 2011, 35 and 104 patients underwent ORC and RARC, respectively. Demographics and perioperative and complication data on all patients were reviewed retrospectively and compared between the two groups. All complications were categorized using a modified Clavien reporting system. We also sought to identify independent predictive factors of grade II or greater complications.
There were no significant differences between the ORC and RARC groups with regard to age, body mass index, American Society of Anesthesiologists score, clinical stage, surgical procedure history, or sex. The RARC group had more cases of ileal neobladder urinary diversion (P<0.001). We did not find any differences in terms of pathologic stage or length of stay. The ORC group had more grade II or greater complications (P=0.001), wound problems (P=0.043), multiple complications (P=0.014), greater estimated blood loss (EBL) (P<0.001), and needed more transfusions (P<0.001). A longer operative time was needed in the RARC group, however. Multivariate logistic regression analysis demonstrated that the ORC (P=0.045, odds ratio [95% confidence interval]=2.44 [1.02-5.85]), EBL (>500 mL, P=0.013, 2.75 [1.24-6.10]), and female sex (P=0.028, 4.06 [1.12-14.11]) were independent predictors of grade II or greater complications.
Our results showed that the RARC group was comparable to the ORC group with respect to complications using the Clavien reporting system. Further long-term and randomized trials are needed, however, because RARC is still not considered the standard therapy for bladder cancer.
Journal of endourology / Endourological Society 10/2011; 26(6):670-5. · 1.75 Impact Factor
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ABSTRACT: We analyzed the surgical and functional outcomes of 100 consecutive laparo-scopic radical prostatectomies (LRP) performed by a single surgeon.
Between October 2007 and May 2010, a total of 100 consecutive patients underwent LRP for prostate cancer at our institution. We retrospectively reviewed the medical records of these patients to determine surgical and functional results. We compared surgical and functional outcomes between three groups divided on the basis of operation period (Group 1; first 40 cases; Group 2; next 30 cases; Group 3; last 30 cases).
The operative time decreased significantly as the surgeon's experience increased over time (P<0.01). The learning curve for operative time was surpassed after approximately 40 cases. The overall positive surgical margin (PSM) rate was 17.5% in Group 1, 16.7% in Group 2, and 10% in Group 3. For organ-confined disease, the PSM rate was 2.5%, 6.7%, and 3.3% in Groups 1, 2, and 3, respectively. The continence rate (absence of a pad) was 73.2% and the social continence rate was 94.7% at 12 months after surgery. There was a significant difference in continence (absence of pad) between the early (Group 1) and late group (Group 3) at 1, 3, and 6 months (P<0.0001). The continence rate was not affected by whether the pubic bone-anchoring procedure or the Rocco suture method was used. The overall potency rate was 16.7% and 48.6% at 6 and 12 months, respectively. For bilateral nerve-sparing cases, the potency rate was 20% and 57.1% at 6 and 12 months, respectively.
Our surgical and functional outcomes indicate that even in this 'robotic era', LRP is still an attractive treatment option for patients with localized prostate cancer, especially in areas with limited access to surgical robots.
Korean journal of urology 08/2011; 52(8):517-23.
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ABSTRACT: A primary extraskeletal osteosarcoma (EOS) is a rare tumour. An EOS of the seminal vesicle has not been reported in the literature. We describe a case of a seminal vesicle EOS initially detected as a pre-rectal mass on a routine transrectal ultrasound in a 48-year-old man. A computed tomography (CT) scan confirmed the tumour to be arising from the left seminal vesicle. A robot-assisted laparoscopic seminal vesiculectomy was performed to avoid neurovascular bundle injury. Microscopic examination of the resected specimen showed a poorly differentiated osteosarcoma originating from the seminal vesicle. The patient received adjuvant chemotherapy. He is doing well without voiding or erectile dysfunction and he is tumour-free five months after surgery.
Annals of The Royal College of Surgeons of England 05/2011; 93(4):e6-8. · 1.23 Impact Factor
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ABSTRACT: The standard treatment for a small mass has shifted from radical nephrectomy to partial nephrectomy. The benefits of partial nephrectomy, including preserving renal function, prolonging overall survival, preventing postoperative chronic kidney disease, and reducing cardiovascular events, have been discussed in many studies. With the accumulation of surgeons' experience and simplification of the operative procedures, the warm ischemic time has become shorter despite the indication of tumor size becoming larger. With the help of intraoperative ultrasound, partial nephrectomy can be performed for an endophytic renal mass. Recently, laparoscopic partial nephrectomy has become well indicated for most renal tumors in many centers with advanced laparoscopic expertise. Open partial nephrectomy remains indicated for complex tumors. With technical innovation, robotic partial nephrectomy shows at least comparable perioperative outcomes with a benefit for challenging cases. Laparoendoscopic single-site partial nephrectomy has recently been tried in limited indications and seems to be feasible.
Korean journal of urology 05/2011; 52(5):301-9.
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ABSTRACT: Radiofrequency ablation (RFA) is accepted as a minimally invasive treatment of renal cell carcinoma (RCC). However, RFA is not fully evaluated for treating RCC in patients with von Hippel Lindau (VHL) disease who cannot undergo surgery due to serious postoperative morbidity or mortality.
To evaluate the role of RFA of RCC in patients with VHL disease previously undergoing renal surgery.
Percutaneous RFA was performed for treating 14 RCCs in six patients who had undergone radical nephrectomy (n = 3) or repeated nephron-sparing surgery (n = 3). Treatment feasibility, complications, outcome, and the change of renal function were evaluated.
To completely ablate 14 RCCs, 23 ablations during 12 sessions were necessary. Of 14 RCCs, nine were in proximity (<5 mm) to one or more following organs: bowel (n = 4), ureteropelvic junction or pelvis (n = 2), psoas muscle (n = 2), vascular pedicle (n = 1), and pancreas (n = 1). Of 12 sessions, one major complication (pneumothorax) developed in one session (8%). No residual or recurrent tumors were identified at the ablation areas. However, new three solid tumors less than 1 cm in diameter developed during the follow-up period but ablation was withheld until these tumors had grown to more than 1 cm in size. The mean level of serum creatinine increased with 6.4% and the mean estimated glomerular filtration rate decreased by 12.8% after the last ablation compared to those before the initial ablation (P < 0.05).
Despite technical difficulties, percutaneous RFA is a promising treatment for VHL patients who cannot undergo surgery because of excellent treatment outcome and minimal change of renal function.
Acta Radiologica 04/2011; 52(6):680-5. · 1.37 Impact Factor
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Changhee Yoo,
Cheol Young Oh,
Jin Seon Cho,
Cheryn Song, Seong Il Seo,
Hanjong Ahn,
Tae-Kon Hwang,
Jun Cheon,
Kang Hyun Lee,
Tae Gyun Kwon, [......],
Moon Kee Chung,
Sang Eun Lee,
Hyun Moo Lee,
Eun Sik Lee,
Young Deuk Choi,
Byung Ha Chung,
Hyung Jin Kim,
Wun-Jae Kim,
Seok-Soo Byun,
Han Yong Choi
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ABSTRACT: We investigated the clinical significance of large difference (≥ 2 points) between biopsy-derived (bGS) and post-prostatectomy Gleason scores (pGS). At 14 medical centers in Korea, 1,582 men who underwent radical prostatectomy for prostate cancer were included. According to the difference between bGS and pGS, the patients were divided into three groups: A (decreased in pGS ≥ 2, n = 30), B (changed in pGS ≤ 1, n = 1,361; control group), and C (increased in pGS ≥ 2, n = 55). We evaluated various clinicopathological factors of prostate cancer and hazards for biochemical failure. Group A showed significantly higher mean maximal percentage of cancer in the positive cores (max%) and pathological T stage than control. In group C, the number of biopsy core was significantly smaller, however, tumor volume and max% were significantly higher and more positive biopsy cores were presented than control. Worse pathological stage and more margin-positive were observed in group A and C than in control. Hazard ratio for biochemical failure was also higher in group A and C (P = 0.001). However, the groups were not independent factors in multivariate analysis. In conclusion, large difference between bGS and pGS shows poor prognosis even in the decreased group. However it is not an independent prognostic factor for biochemical failure.
Journal of Korean medical science 04/2011; 26(4):507-12. · 0.84 Impact Factor
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ABSTRACT: The present study was performed to determine the incidence and predictive factors of benign renal lesions in Korean patients undergoing nephrectomy for presumed renal cell carcinoma on preoperative imaging. We analyzed the pathologic reports and medical records of 1,598 eligible patients with unilateral, nonmetastatic, and nonfamilial renal masses. Of the 1,598 renal masses, 114 (7.1%) were benign lesions, including angiomyolipoma in 47 (2.9%), oncocytoma in 23 (1.4%), and complicated cysts in 18 (1.1%) patients. On univariate analysis, the proportion of benign lesions was significantly higher in female patients, and in patients with smaller tumors, cystic renal masses, and without gross hematuria as a presenting symptom. When renal lesions were stratified by tumor size, the proportion of benign as opposed to malignant lesions decreased significantly as tumor size increased. On multivariate analysis, female gender, smaller tumor size, and cystic lesions were significantly associated with benign histological features. The findings in this large cohort of Korean patients show a lower incidence (7.1%) of benign renal lesions than those of previous Western reports. Female gender, cystic renal lesions, and smaller tumor size are independent predictors of benign histological features.
Journal of Korean medical science 03/2011; 26(3):360-4. · 0.84 Impact Factor
