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*

OBJECTIVETo evaluate the efficacy and safety of the WT-2009 chemotherapy protocol for Wilms' tumor (WT) in children.

METHODSThe clinical data of 34 children with newly-diagnosed WT between July 2009 and December 2013 were retrospectively analyzed. Among the 34 children, 2 died before treatment, 6 children did not accept therapy and 26 accepted the chemotherapy based on the WT-2009 chemotherapy protocol. Kaplan-Meier method was used to estimate the 2-year survival rate.

RESULTSThe pathological analysis revealed the favorable histology WT was common (88%, 30/34). The most common first manifestation was abdominal masses (56%, 19/34). Among the 26 patients who accepted the chemotherapy based on the WT-2009 protocol, complete remission was achieved in 24 cases (92%), partial remission was achieved in 1 case (4%), and disease relapse was found in 1 case (4%). Severe pulmonary infection occurred in 1 case in the course of treatment. The 2-year overall survival rate and event-free survival rate were 100% and 89.7% respectively.

CONCLUSIONSFavorable histology is most common pathological type in children with WT. The chemotherapy based on the WT-2009 protocol for WT can produce a favorable prognosis and a high tolerance.

Antineoplastic Agents ; adverse effects ; therapeutic use ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Kidney Neoplasms ; drug therapy ; mortality ; pathology ; Male ; Survival Rate ; Wilms Tumor ; drug therapy ; mortality ; pathology

OBJECTIVETo determine the effect of laparoscopic radiofrequency ablation of T1aN0M0 renal cell carcinoma (RCC) with regular follow-up.

METHODSAll patients underwent surgery from March 2006 to March 2009. Eight cases were solitary kidney. Twenty-two cases of left RCC and 18 cases of right RCC were diagnozed by ultrasonography and CT scanning.All of the cases were T1aN0M0 stage. No metastasis was found by iconography test. By ultrasound positioning, laparoscopic radiofrequency were performed on the renal tumor. All patients were followed up with eGFR and enhanced-CT.

RESULTSAll patients underwent laparoscopic radiofrequency ablation surgery successfully. The mean operation time was (101 ± 19) minutes and the mean blood loss was (90 ± 14) ml (no blood transfusion pre- and post-operation). During postoperative follow-up, enhanced CT revealed complete ablation in 39 cases (the success rate was 97.5%), and 1 residue tumor was confirmed by enhanced CT 7 days post operation. This patient was under close surveillance because of solitary kidney. No progression of the residue tumor was found during the follow-up. One case of recurrence was confirmed by enhanced CT in 6 month after operation. The 3-year recurrence rate was 2.5%. No further intervation was performed on this patient and no change was found in the recurrence area during the follow-up. Both 3-year total survival rate and 3-year cancer specific survival rate were 100%. The mean eGFR was (72 ± 9) ml/(min·1.73 m(2)) in 3 years after surgery. There was no significant difference between pre-and post-operation (P > 0.05).

CONCLUSIONMid-term follow-up results show the effectiveness and safety of laparoscopic radiofrequency ablation in the treatment for T1aN0M0 RCC and have no negative influence on the renal function.

Carcinoma, Renal Cell ; mortality ; surgery ; Catheter Ablation ; methods ; Female ; Follow-Up Studies ; Humans ; Kidney Neoplasms ; mortality ; surgery ; Laparoscopy ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; epidemiology ; 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