Standardized analysis of complications after robot-assisted radical cystectomy: Korea University Hospital experience

편종현,김형근,김재윤,김승빈,조석,강성구,고영휘,천준,이정구,김제종,강석호 대한비뇨의학회 2015 Investigative and Clinical Urology Vol.56 No.1

Purpose: To analyze the complications after robot-assisted radical cystectomy (RARC) by use of a standardized reporting methodology by a single surgeon. Materials and Methods: We prospectively reviewed a maintained institutional database of 52 patients who underwent RARC to manage bladder cancer and were followed up in 3 months by a single surgeon at Korea University Medical Center from 2007 through 2014. All complications within 90 days of surgery were defined and categorized into 5 grades according to the Clavien-Dindo classification. Logistic regression analysis was used to identify predictors of complications. Results: Fifty percent of patients (26 of 52) experienced a complication of any grade <90 days after surgery, and 11 patients (21.2%) experienced a major complication. Complications were grouped in systems-based categories. Fifty complications occurred in 52 patients and hematologic complication (transfusion) was the most common (13 of 52). Wound dehiscence, anastomotic leakage, urinary tract obstruction, mechanical obstruction, and thromboembolism occurred as major complications. Mean estimated blood loss (EBL) was 247 mL and mean total operative time was 496 minutes. The mean number of lymph nodes harvested was 24.6, with 30.5 for extended dissection. EBL (over 300 mL), operative time, and method of urinary diversion were significant negative predictors of minor complications, whereas EBL (over 300 mL) was a significant negative predictor of major complications (p<0.05). Conclusions: The present results show that the complication rate reported by use of a standardized methodology after robotic radical cystectomy is still considerable although comparable to that of contemporary robot series. EBL, operative time, and diversion methods were predictors of complications.

전립선특이항원 및 전립선암 조기검진에 대한 대국민 인식조사 설문 결과

편종현(Jong Hyun Pyun),강석호(Seok Ho Kang),김지연(Ji Youn Kim),신재은(Jae Eun Shin),정인갑(In Gab Jeong),김종욱(Jong Wook Kim),노태일(Tae Il No),오종진(Jong Jin Oh),유지형(Ji Hyung Yu),정호석(Ho Seok Chung),전성수(Seong Soo Jeon) 대한비뇨기종양학회 2020 대한비뇨기종양학회지 Vol.18 No.1

Purpose: To assess awareness of prostate cancer and prostate cancer screening in high risk Korean men 40 years and older. Materials and Methods: The Korean Urological Oncology Society implemented an online survey of 600 men aged 40 years or older from July 30 to August 6, 2019 to ask questions about prostate cancer and screening. Results: Of the 600 respondents, 96.5% (579 of 600) were aware of prostate cancer and 49.8% (299 of 600) thought they were at risk. Men in their 60s, men with a family history and men with urological conditions were more concerned about prostate cancer. Most respondents (83.3%, 500 of 600) had never received prostate cancer screening. When asked why they had not, (multiple choices: first, second and third priority), the most common responses were: “They had no symptoms of prostate cancer”; “They were in good health”; “Cost burden of screening”; and “They thought screening was included in the National Health Examination Program.” Only 9.7% (58 of 600) were aware of prostate-specific antigen (PSA). After being informed about PSA, 97.7% (586 of 600) wanted it to be included in national cancer screening. Conclusions: In this survey, 96.5% of respondents were aware of prostate cancer, and 44.2% recognized the need for early screening. However, only 16.7% had received screening. Awareness of prostate cancer risks tended to be high in elderly people, people with a family history and people with urological conditions. The results also indicate that there is support for national-level management and early screening programs for prostate cancer.

Tumor-Specific Immunity Induced by Cryoablation in a Murine Renal Cell Carcinoma Model

김형근,편종현,조석,강성구,이정구,김제종,천준,박홍석,강석호 대한비뇨의학회 2014 Investigative and Clinical Urology Vol.55 No.12

Purpose: To evaluate tumor-specific immunity and define the mechanisms involved in the cryoimmunologic response, we compared the tumor control efficacy and immunologic responses of cryoablation with those of surgical excision in a tumor rechallenge model. Materials and Methods: Sixty BALB/c mice with RENCA tumors that were generated in the left flank area underwent cryoablation or radical excision. The mice successfully treated were rechallenged with RENCA or an undifferentiated colon carcinoma cell line, CT26, in the contralateral right flank area. The recurrence rate after tumor rechallenge in each group was then observed. To assess the immunologic response of each treatment modality, fluorescent-activated cell sorting (FACS) analysis and a cytotoxicity assay using 51Cr release were performed. Results: After reinoculation of the RENCA cells, the rate of tumor growth was significantly higher in the surgical excision group than in the cryoablation group (94.4% vs. 11.1%, p=0.001). In the cryoablation group, the tumor growth rate was significantly increased after rechallenge of CT26 cells compared with RENCA (94.1% vs. 11.1%, p=0.001). The cryoablation group showed an elevated CD3, CD4, CD8 T, and natural killer cell count in the FACS analysis and also showed significantly increased cytotoxicity in the 51Cr release assay compared with the excision group. Conclusions: These results showed that cryoablation, compared to surgical resection, was more effective in preventing tumor growth after rechallenge with RENCA cells and that this response was tumor-specific, because the CT26 cells did not have the same effect.

Oncological and functional outcomes of robot-assisted radical cystectomy in bladder cancer patients in a single tertiary center: Can these be preserved throughout the learning curve?

태종현,편종현,심지성,조석,강성구,고영휘,천준,이정구,강석호 대한비뇨의학회 2019 Investigative and Clinical Urology Vol.60 No.6

Purpose: To evaluate the overall and segmental oncological and functional outcome of robot-assisted radical cystectomy (RARC) during the learning curve. Materials and Methods: From August 2007 to November 2017, a total of 120 bladder cancer patients were treated with RARC in a single-tertiary hospital. These were divided into three groups of 40 consecutive cases. Overall and subgroup analysis of each group was used to evaluate oncological and functional outcomes throughout the learning curve. Results: Among the 120 RARC cases, 42, 73, and 5 patients received extracorporeal urinary diversion (ECUD), intracorporeal urinary diversion (ICUD), and ureterocutaneostomy, respectively. There was a transition from ECUD to ICUD during the learning curve. The positive surgical margin rate was 0.8%. The mean lymph node yield for the standard and extended pelvic lymph node dissection was 12.5 and 30.1, respectively, and increased to 19.8 and 31.2 and further to 20.0 and 37.9, respectively, with each additional series of 40 cases. The 5-year overall survival and 3-year recurrence-free survival rates were 86.6% and 81.4%, respectively. The 1-year daytime continence rate was 75.7%, while the nighttime continence rate was 51.4%. The potency preservation rate was 66.7% (n=8) with or without phosphodiesterase-5 inhibitors (PDE5-I) at 1 year and 33.3% without PDE5-I (n=4). Conclusions: RARC results in comparable oncological and functional outcomes to open radical cystectomy. In addition, the oncological and functional outcomes were well maintained throughout the learning curve. ECUD transition to ICUD was safe and did not compromise oncological or functional outcome.

Renal cryoablation of small renal masses: A Korea University experience

김형근,편종현,김재윤,김성빈,조석,강성구,이정구,김제종,천준,강석호 대한비뇨의학회 2015 Investigative and Clinical Urology Vol.56 No.2

Purpose: To evaluate the perioperative, functional, and oncological outcomes of renal cryoablation (RC) of small renal masses(SRMs) performed in Korea University Hospital. Materials and Methods: We reviewed an Institutional Review Board-approved database of 70 patients who underwent RC andwere followed up for a minimum of 3 months by a single surgeon in Korea University Hospital from August 2007 to May 2014. Among these patients, 68 patients (79 renal masses) were enrolled in our research. We evaluated perioperative, functional, and oncologicoutcomes of RC. Results: A total of 68 patients (79 renal masses) underwent RC in our institution. The mean age of the patients was 62.0 years. Themean tumor size was 2.25 cm. Among the 59 patients who underwent laparoscopic surgery, only 1 patient (1.47%) was convertedto open surgery. No other perioperative complications occurred. The mean preoperative and 1-month postoperative estimatedglomerular filtration ratio (eGFR) were 71.8 and 68.3 mL/min/1.73 m2, respectively (p=0.19). The mean 1-year postoperative eGFRwas 65.0 mL/min/1.73 m2 (p=0.25). The mean follow-up period was 59.76 months (range, 3–119 months). Local tumor recurrenceoccurred in eight tumors (15.4%; a total of 52 renal cell carcinomas). Concerning treatment in the patients with recurrence, five patientsunderwent re-treatment and three patients are under active surveillance. None of the eight patients who experienced localrecurrence had additional recurrence or tumor progression during the follow-up period. In our study, the recurrence-free rate was83.0% and the cancer-specific survival rate was 100%. Moreover, the 5- and 10-year overall survival rates were both 100%. Conclusions: Long-term experience with RC in our institution demonstrates that RC is a safe and effective treatment for patientswith SRMs.

Concurrent and predictive validation of robotic simulator Tube 3 module

김재윤,김승빈,편종현,김형근,조석,이정구,김제종,천준,강석호,강성구 대한비뇨의학회 2015 Investigative and Clinical Urology Vol.56 No.11

Purpose: We previously described a new procedure specific module (Tube 3) to allow the practice of vesicourethral anastomosis after robot-assisted radical prostatectomy. Herein, we report a predetermined proficiency level of Tube 3 and preliminary validation to explore whether this new module can lead to performance improvement in the da Vinci system. Materials and Methods: Eight urology residents and three urology fellows performed the Tube 3 module 1 hour daily for 7 days. The learning curve was depicted through a scatterplot and the stable point was identified through the cumulative sum chart. Concurrent and predictive validations were performed with the da Vinci system. The mean time to complete the task and end product rating score between Tube 3 training group and no Tube 3 training group were compared. Results: Concerning the learning curve, about 41 repetitions comprising about 5 hours were needed to achieve this stable point when the mean time to complete Tube of 384 seconds was set as a target. With regarding to the concurrent and predictive validation, there significant differences were evident in the mean time to complete 16 needle passages and the vesicourethral anastomosis and the end product rating score. Conclusions: The virtual reality (VR) simulator can yield sufficient improvement in technical performance in Tube 3 within 5 hours. The acquired proficiency can be transferable to the vesicourethral anastomosis using the da Vinci system.

결핵성 림프절염 및 척추결핵과 동반된 비뇨생식기 결핵

함병국,노태일,편종현,신수환,심지성,배재현 대한요로생식기감염학회 2012 Urogenital Tract Infection Vol.7 No.2

When the infection occurs in other parts of the body it is called extrapulmonary tuberculosis. About 15% of tuberculosis cases are extrapulmonary. Tuberculous lymphadenitis is the most commonly occurring form of extrapulmonary tuberculosis, and skeletal tuberculosis most often involves the spine, followed by tuberculous arthritis in weight-bearing joints and extraspinal tuberculous osteomyelitis. Genitourinary tuberculosis contributes to 10-20% of extrapulmonary tuberculosis. A 59 year old woman was admitted with lower back pain and lower urinary tract symptoms. A CT scan showed focal enhancing wall thickening in the left proximal ureter with left hydronephrosis and multiple enlarged lymph nodes. The Radiologic and pathologic diagnosis revealed genitourinary tuberculosis with the other extrapulmonary tuberculosis.

Oncologic Outcomes and Predictive Factors for Recurrence Following Robot-Assisted Radical Cystectomy for Urothelial Carcinoma: Multicenter Study from Korea

심지성,권태균,나군호,이영구,이지열,정병창,김재윤,편종현,강성구,강석호 대한의학회 2017 Journal of Korean medical science Vol.32 No.10

The aim of our study was to evaluate intermediate-term oncologic outcomes, predictive factors for recurrence, and recurrence patterns in a multicenter series of patients treated with robot-assisted radical cystectomy (RARC) for urothelial carcinoma (UC) of the bladder. Between 2007 and 2015, 346 patients underwent RARC at multiple tertiary referral centers in Korea. Descriptive statistics were used for demographics and perioperative variables. Survival and recurrence were estimated with Kaplan-Meier analysis. Logistic regression models were used to determine predictors of recurrence. Median follow-up was 33 months (interquartile range [IQR], 7–50). The numbers of patients with organ-confined and lymph node (LN)-positive disease were 237 (68.4%) and 68 (19.7%), respectively. LN density (1–20 vs. > 20) was 13.6% and 6.1%, with a median of 17 nodes removed (IQR, 9–23). In logistic regression analysis, type of LN dissection, and pathologic tumor stage were significant predictors of cancer recurrence and death from cancer. Local, distal recurrence and secondary UC occurred in 7 (2.0%), 53 (15.3%), and 4 (1.2%) patients, respectively. The 5-year overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) were 78%, 84%, and 73%, respectively. At last follow-up, RFS for extended pelvic LN dissection vs. standard pelvic LN dissection was 70% and 47% (P = 0.038). In addition, at last follow-up, LN density (0 vs. 1–20 vs. over 20) was 67%, 41%, and 29%, respectively (P < 0.001). Patients undergoing RARC in this multi-institutional cohort demonstrated intermediate-term oncologic outcomes, predictive factors for recurrence, and recurrence patterns that were not unusual.

Initial Experience of Transperineal Biopsy After Multiparametric Magnetic Resonance Imaging in Korea; Comparison With Transrectal Biopsy

윤성구,진현중,태종현,노태일,김재윤,편종현,심지성,강성구,천준,이정구,김제종,성득제,이관희,강석호 대한비뇨기종양학회 2018 대한비뇨기종양학회지 Vol.16 No.3

Purpose: The aim of this study is to confirm the detection rate of transperineal biopsy after multiparametric magnetic resonance imaging (mpMRI) and compared it to that of transrectal biopsy. We also examined the role of mpMRI and the rate of complications for each method. Materials and Methods: In a retrospective study, we analyzed 147 patients who underwent mpMRI before prostate biopsy because of elevated serum prostate-specific antigen and/or abnormal digital rectal examination findings at Korea University Hospital, Seoul, Korea from March 2017 to April 2018. Regions on the mpMRI that were suggestive of prostate cancer were categorized according to the Prostate Imaging–Reporting and Data System (PI-RADS v2). For transperineal biopsy, a 20-core saturation biopsy was performed by MRI-TRUS cognitive or fusion techniques and a 12-core biopsy was performed in transrectal biopsy. Results: Sixty-three and 84 patients were enrolled in transperineal group and transrectal group, respectively. The overall detection rate of prostate cancer in transperineal group was 27% higher than that in transrectal group. Classification according to PI-RADS score revealed a significant increase in detection rate in all patients, as the PI-RADS score increased. Frequency of complications using the Clavien-Dindo classifications revealed no significant differences in the total complications rate, but two patients in transrectal group received intensive care unit care due to urosepsis. Conclusions: Our results confirmed that transperineal biopsy is superior to transrectal biopsy for the detection of prostate cancer. From the complication point of view, this study confirmed that there were fewer severe complications in transperineal biopsy.

Do patients benefit from total intracorporeal robotic radical cystectomy?: A comparative analysis with extracorporeal robotic radical cystectomy from a Korean multicenter study

심지성,권태균,나군호,이영구,이지열,정병하,편종현,강성구,강석호 대한비뇨의학회 2020 Investigative and Clinical Urology Vol.61 No.1

Purpose: This study aimed to compare complications, perioperative parameters, and oncologic outcomes between robot-assisted radical cystectomy (RARC) with extracorporeal urinary diversion (ECUD) and RARC with intracorporeal urinary diversion (ICUD). Materials and Methods: Between 2007 and 2017, 362 patients who underwent RARC with ECUD or ICUD at multiple tertiary referral institutions were assessed. The primary endpoints were complication rates. The secondary outcomes were perioperative recovery parameters and oncological outcomes including estimated recurrence-free survival (RFS) and recurrence pattern between the 2 groups. Additionally, the complication rates of 2 expert surgeons with experience of >100 RARCs were analyzed. Results: The ICUD group showed lower overall, gastrointestinal, and genitourinary complications (p=0.001, p=0.036, and p=0.036, respectively) than the ECUD group. Concerning perioperative outcomes, the ICUD group had a significantly longer operation time (p=0.002), although recovery parameters such as time to flatus passage, oral intake, and length of hospital stay were significantly shorter in this group (p=0.001, p<0.001, and p<0.001, respectively). There was no difference in oncologic outcomes such as positive margin rate (p=0.944) and 2-year RFS (p=0.496), and in the recurrence pattern between groups. In the comparison of the expert surgeons' complication rates, the major and total complication rates did not show differences (p=0.814 and p=0.102, respectively) while the minor complication rates were lower in the ICUD group (p=0.058). Conclusions: This multi-institutional cohort study demonstrated the benefits of the ICUD approach, as indicated by lower complication rates and better recovery parameters, although the oncological results were similar to those of ECUD.