While overtreatment in medical services had been the topic of interest among the medical community for a long time, there are numerous academic papers concerning over-diagnosis nowadays. The use of imaging studies for screening might lead to over-diagnosis of small renal masses (SRMs) therefore the incidence of kidney cancer increased 5 times higher than that of mortality in Korea between 2000 and 2011. The best treatment for SRMs had been debated and the present strategies include surgery, local treatment, and active surveillance. Competing risks to mortality should be considered to determine initial management strategies, and a period of initial active surveillance in patients with SRMs is safe. Tumor growth rate is the primary driver for delayed intervention of SRMs patients, and the risk of metastasis on active surveillance for SRMs is 1%–2% at 2-year follow-up.
Follow-Up Studies ; Humans ; Incidence ; Kidney Neoplasms ; Kidney ; Korea ; Mass Screening ; Medical Overuse ; Mortality ; Neoplasm Metastasis

Cytomegalovirus (CMV) disease is an important cause of morbidity and mortality in immunocompromised patients. Transplant recipients, patients with malignancies and those receiving immunosuppressive therapies are susceptible to CMV diseases. While the gastrointestinal infection of CMV is relatively common in AIDS, it is uncommon in other immunocompromised patients. We report a case of CMV gastric ulcer mimicking Borrmann typeIII gastric cancer on gastroscopy in a patient with immunosuppressive therapy.
Cytomegalovirus* ; Gastroscopy ; Humans ; Immunocompromised Host ; Immunosuppression ; Kidney Transplantation ; Mortality ; Stomach Neoplasms* ; Stomach Ulcer* ; Transplantation

PURPOSE: The incidence of malignancy in kidney transplantation recipient was increased in accordance with the prolonged graft survival due to a development of new immunosuppressive agents. The malignancy is not only lethal to the patients but also imposed the major cause of morbidity and mortality. We analyzed 1) the relationship between the kidney transplanted patients who was operated in our hospital and type of malignancy of them after transplantation 2) treatment and prevention via analysis of risk factors of malignancy after transplantation. METHODS: The retrospective analysis was performed in 10 patients with malignancy among the 916 patients who underwent kidney transplantation in our hospital from 1990 to 1999 and the 3 patients with malignancy who underwent kidney transplantation in other hospital and followed up in our hospital. RESULTS: In 916 renal transplant patients, 885 patients were the CsA-based group and the other 31 patients were tacrolimus-based group. In the 13 malignancy patients, 12 were CsA-based group and the other 1 patient was tacrolimus-based group . Mean duration of tumor occurrence after transplantation was 36.2 month (5-80 month). There were 4 squamous epithelial cancer, 2 post-transplant lymphoproliferative disease (PTLD), 2 Kaposi's sarcoma, 2 gastric cancer and 1 breast cancer. There was no difference of interval for tumor development among diverse malignancy. We could not find any predisposing factors for tumor occurrence in this short term observation. CONCLUSION: Even though there were some epithelial and gastrointestinal tract cancer patients after renal transplantation, there were no specific risk factors which increase the incidence of cancer in immunocompromised patient save the locally endemic occurrence such as GI malignancy.
Breast Neoplasms ; Causality ; Gastrointestinal Neoplasms ; Graft Survival ; Humans ; Immunocompromised Host ; Immunosuppressive Agents ; Incidence ; Kidney Transplantation* ; Kidney* ; Mortality ; Retrospective Studies ; Risk Factors ; Sarcoma, Kaposi ; Stomach Neoplasms

OBJECTIVES: The prostate specific antigen test is widely used as the main method of screening prostate cancer in Korea. Additionally, the use of ultrasound sonography may lead to overdiagnosis of kidney cancer as well as thyroid cancer. This study aimed to highlight epidemiological evidences regarding overdiagnosis of prostate and kidney cancers in Korean. METHODS: The annual trends of national incidence and mortality of prostate and kidney cancers provided by the Korean Statistical Information Service were evaluated. RESULTS: The rate of increase in the incidence of prostate and kidney cancer was 6 and 5 times higher than that of mortality between 2000 and 2011, respectively. Additionally, the age group showing the highest incidence in prostate cancer shifted from 85 years and older to 75-79 years. CONCLUSIONS: This evidence suggests that prostate and kidney cancers are overdiagnosed in Korea. Further research in this area, using national cancer registry databases, should be encouraged to prevent overdiagnosis.
Disease Progression ; Early Detection of Cancer ; Humans ; Incidence ; Information Services ; Kidney Neoplasms* ; Kidney* ; Korea ; Mass Screening ; Mortality ; Prostate* ; Prostate-Specific Antigen ; Prostatic Neoplasms ; Thyroid Neoplasms ; Ultrasonography

BACKGROUNDWith a trend that renal tumors are being detected at an earlier stage, classical radical nephrectomy is being reconsidered. More conservative techniques are being proposed. To clarify the indication for synchronous adrenalectomy in radical nephrectomy for renal cell carcinoma which has been questioned since the 1980s, this study evaluates the role of adrenalectomy and recommends a new indication for adrenalectomy in renal cell carcinoma.

METHODSA systemic search was performed, using PubMed and Google Scholar, of all English language studies published up to March 2012 that compared adrenalectomy with adrenal-sparing surgery, in surgery for renal cell carcinoma. We assessed preoperative imaging for adrenal involvement and the relationship of tumor location with adrenal metastases. Twenty-one studies (20 retrospective and 1 prospective) involving 11 736 patients were included.

RESULTSThe mean incidence of ipsilateral adrenal involvement from renal cell carcinoma was 4.5%. Synchronous adrenalectomy did not alter survival (hazard ratio (HR) = 0.89, 95% confidence interval (CI) 0.67 - 1.19, P = 0.43; odds ratio (OR) = 1.10, 95%CI 0.84 - 1.44, P = 0.49). Upper pole tumors were not associated with a higher incidence of ipsilateral adrenal metastases. Pooled preoperative imaging: sensitivity, specificity, positive predictive value and negative predictive value were 92% (95%CI 0.84 - 0.97), 95% (95%CI 0.93 - 0.96), 71.6% and 98.5% respectively.

CONCLUSIONSAdrenal involvement from renal cell carcinoma is rare, even in advanced tumours. Synchronous adrenalectomy does not offer any benefit, even for "high risk" patients. We suggest that only patients with a positive preoperative adrenal finding on preoperative imaging for a solitary adrenal metastasis should undergo adrenalectomy as part of the radical nephrectomy.

Adrenal Gland Neoplasms ; secondary ; surgery ; Adrenalectomy ; methods ; Carcinoma, Renal Cell ; mortality ; surgery ; Humans ; Kidney Neoplasms ; mortality ; surgery ; Nephrectomy ; methods ; Survival Rate

BACKGROUND: The prognosis following surgery for gastric cancer has been markedly improved as a result of early diagnosis and advancements both in operative techniques and perioperative management. However, gastrointestinal surgery in the presence of hepatic cirrhosis has shown high operative morbidity and mortality due to severe perioperative complications, such as bleeding, lymphorrhea, anastomosis leakage, hepatic failure, fluid retention, acute renal failure and multiple organ failure. Recently, the frequency of gastric cancer involving liver cirrhosis has been increasing, especially early gastric cancer cases. METHODS: From June 1995 to December 1997, a total of 410 patients with gastric cancer were treated surgically. Among them, 9 cases with liver cirrhosis underwent gastric resection. RESULTS: Three major postoperative complications occurred in 2 patient, anastomosis leakage in one, and bleeding in both. CONCLUSIONS: The purposes of this study were to assess the causes of complications and to decide the appropriate operation type for improving the prognosis for these patients with liver cirrhosis.
Acute Kidney Injury ; Early Diagnosis ; Hemorrhage ; Humans ; Liver Cirrhosis* ; Liver Failure ; Mortality ; Multiple Organ Failure ; Postoperative Complications ; Prognosis ; Stomach Neoplasms*

PURPOSE: This study reviews our experience with a step- by-step management approach of increasing aggressiveness and evaluates the treatment outcome for intraluminal hemorrhage. METHODS: The study group was comprised of patients who had experienced intraluminal hemorrhage after a low anterior resection with the double stapling technique from 1999 to 2003. The choice of management was selected according to our step-by-step management protocol, and the outcomes were evaluated for each step, lincluding mortality and complications. RESULTS: Nine patients (6 males and 3 females, mean age 55 years) were identified, the mean volume of packed RBC transfusion was 2 pints, and the mean distance of the anastomotic site from the anal verge was 6 cm. The median stapler size was 31 mm. The first step was cold saline irrigation and drainage; four of 9 patients were controlled. The second step was retention enema with topical hemostatics; one of remaining 5 patients stopped bleeding. The third step was colonoscopic hypertonic saline injection around the bleeding site with direct colonoscopic electrocauterization, two of remaining 4 patients were controlled. The last step was suturing the bleeding site through the anus, the remaining 2 patients stopped bleeding. One of the 9 patients developed leakage from the anastomotic site after the last step management, three of the 9 patients had long standing ileus, and one of the 9 patients developed acute renal failure after a massive transfusion. There were no postoperative deaths. CONCLUSIONS: It is safer and easier to control bleeding with step-by-step management system of increasing aggressiveness.
Acute Kidney Injury ; Anal Canal ; Drainage ; Enema ; Female ; Hemorrhage* ; Hemostatics ; Humans ; Ileus ; Male ; Mortality ; Rectal Neoplasms ; Treatment Outcome*

The aim of this study was to investigate the relationship of cyclooxygenase (COX) -2 and p53 expression with prognosis in patients with conventional renal cell carcinoma (RCC). Formalin-fixed, paraffin-embedded tissue sections of conventional RCC from 92 patients, who had undergone radical nephrectomy, were examined for COX-2 and p53 expression by immunohistochemistry and compared with clinicopathological variables. The COX-2 expression significantly correlated only with tumor size (p=0.049), whereas the p53 expression profoundly correlated with the TNM stage (p=0.024), M stage (p=0.001), and metastasis (synchronous or metachronous; p= 0.004). The COX-2 overexpression did not significantly associate with p53 positivity (p=0.821). The survival rate of patients correlated with the p53 expression (p < 0.0001) but not with the COX-2 expression (p=0.7506). Multivariate analyses indicated that tumor size, M stage, and p53 expression were independent prognostic factors for cancer-specific survival. The COX-2 expression was not an independent factor. These results show that the increased expression of p53 was associated with metastasis and a worse prognosis in conventional RCC, which suggests that p53 might have played an important role in the progression of conventional RCC. The increased expression of COX-2 was associated only with tumor size, but may not be an important prognostic factor in conventional RCC. No association was observed between COX-2 overexpression and p53 positivity in conventional RCC.
Carcinoma, Renal Cell/*metabolism/mortality/pathology ; Humans ; Kidney Neoplasms/*metabolism/mortality/pathology ; Prognosis ; Prostaglandin-Endoperoxide Synthase/*metabolism ; Protein p53/*metabolism ; Tumor Markers, Biological/*metabolism

OBJECTIVETo study the characteristics, diagnosis,treatment and prognosis of incidental renal cell carcinoma(RCC).

METHODS109 cases of incidental RCC treated in 20 years were analyzed retrospectively and compared with 247 cases of non-incidental RCC.

RESULTSThe age, sex and side between incidental RCC and non-incidental RCC were not significant (P > 0.05). Compared to the non-incidental RCC,the diameter of incidental RCC [(4.1 +/- 1.7) cm] was smaller and its stage was lower (P < 0.01). Ultrasonography and CT can improve the detection rate of incidental RCC significantly, and operation is more effective for incidental RCC than for non-incidental RCC (P < 0.01). The 3 and 5 year cancer specific survival rates in patients with incidental RCC were higher than those of non-incidental RCC(P < 0.01). The detection rate of incidental RCC was higher from 1990 to 1999 (39.3%) than from 1980 to 1989 (15.6%) (P < 0.01).

CONCLUSIONSIncidental RCC is not another type of RCC, but a developing stage of RCC without appearance of a symptoms. Ultrasonography and CT are important to diagnose incidental RCC. Low pathological stage, small size, early diagnosis, and radical nephrectomy indicate better prognosis of incidental RCC.

Adult ; Aged ; Carcinoma, Renal Cell ; diagnosis ; mortality ; therapy ; Female ; Humans ; Kidney Neoplasms ; diagnosis ; mortality ; therapy ; Male ; Middle Aged ; Prognosis ; Tomography, X-Ray Computed

Adult ; Aged ; Carcinoma, Renal Cell ; complications ; mortality ; Humans ; Kidney Neoplasms ; complications ; mortality ; Male ; Neoplastic Cells, Circulating ; Prognosis ; Thrombosis ; etiology ; Vena Cava, Inferior