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남종길,차창석,정문기 대한비뇨의학회 2004 Investigative and Clinical Urology Vol.45 No.11
Purpose: Although a radical nephrectomy is the mainstay in the surgical management of renal cell carcinomas, a partial nephrectomy is indicated in certain situations where a radical nephrectomy would render the patients in a state of renal insufficiency. Furthermore, the indications are being expanded to include incidentally found small unilateral renal cell carcinomas with a normal contralateral kidney. Therefore, the outcomes between patients treated with partial and radical nephrectomies for renal cell carcinomas were compared. Materials and Methods: Between January 1997 and March 2004, 171 nephrectomy operations were performed as curative treatments for renal masses at the urooncology department of our hospital. The study group was composed of 93 and 32 cases of radical and partial nephrectomies, respectively, with a final pathologic diagnosis of a renal cell carcinoma. The operations for renal cell carcinomas were performed by the same surgeon. The survival rate, time of local recurrence, complication and outcomes were compared and the records of 125 patients who underwent a nephrectomy for a renal cell carcinoma were retrospectively reviewed. Results: The overall mean postoperative follow-up was 25.9, ranging from 2 to 72 months. All the long-term outcomes of a partial nephrectomy for renal cell carcinoma were comparable to those of a radical nephrectomy, especially for localized renal cell carcinomas. Conclusions: A partial nephrectomy could be a better treatment option for localized renal cell carcinomas in appropriately selected cases with normal contralateral kidneys as well as in the absolute indication, with comparable outcomes to a radical nephrectomy, but the more groups and a long-term follow up are required if a partial nephrectomy is to become the standard operation for localized renal cell carcinoma treatment. (Korean J Urol 2004;45:1100-1105)
박현철,남종길,김태남,방성익,차창석,정문기 대한비뇨의학회 2004 Investigative and Clinical Urology Vol.45 No.9
Purpose: Radical cystectomy with pelvic lymphadenectomy is an effective therapeutic modality in invasive bladder cancer. The development of another technique for a radical cystectomy for the early recovery and reduction of complications was attempted. Materials and Methods: Between March 1997 and June 2003, an extraperitoneal radical cystectomy was attempted in 18 patients with invasive bladder cancer(pT1-pT4). Not only standard or extended pelvic lymphadenectomy, but also re-positioning of the ureter to the opposite side, could be performed extraperitoneally. An intestinal segment could be taken out through a small window within the peritoneum and manipulated as desired. The clinical safety and complications of other surgical approaches for radical cystectomy were also investigated. Results: The procedure was successful in 15 of the 18 patients(4 studer pouches, 3 ileal conduits and 8 ureterocutaneostomies). Failure to peel out the peritoneum occurred in 3 cases, 1 each due to technical difficulties, tumor invasion at the bladder dome and adhesion due to a previous radical prostatectomy. Complications occurred in 8 cases(53.1%). The intestinal obstruction progressed in 1 case(12.5%) due to a high positioned mesentery of the Studer pouch. There were no significant gastrointestinal complications in any of the 8 patients that underwent the extraperitoneal radical cystectomy with ureterocutaneostomy. Conclusions: An extraperitoneal radical cystectomy seems to reduce the gastrointestinal complications and be worthwhile in certain cases with advanced bladder cancer. Despite the visual limitation, it is an acceptable surgical technique compared to the conventional transperitoneal methods. (Korean J Urol 2004;45:890-896)