Successful robotic kidney transplantation for surgeons with no experience in minimally invasive surgery: a single institution experience.

BACKGROUND: Robotic kidney transplantation (RKT) is a novel and welcomed innovation yielding good surgical outcomes. However, data on the feasibility and safety of performing RKT by surgeons with a lack of prior minimally invasive surgery (MIS) experience are limited. The authors aimed to evaluate the surgical and functional results of RKT and present the learning curves (LC) of RKT by a single surgeon with no prior experience in MIS. MATERIALS AND METHODS: This was a retrospective study of all RKT performed between November 2019 and April 2023 at Severance Hospital in Seoul, South Korea. The authors analyzed surgical and functional outcomes, as well as complication rates of RKT in comparison to open kidney transplantation (OKT). The authors evaluated LCs using the cumulative summation method to describe the number of cases associated with the competency of a single surgeon. RESULTS: A total of 50 patients who underwent RKT and 104 patients who underwent OKT were included in this study. In RKT group, the median surgical console time was 193 min (interquartile range, 172-222) and the median vascular anastomoses time was 38 min (35-44). Total operation time was 323 min (290-371) and rewarming time was 62.5 min (56.0-70.0) in RKT group compared to 210 min (190-239) and 25 min (21-30), respectively, in OKT group. Despite extended surgical durations with a robotic technique, both groups had comparable intraoperative and postoperative outcomes, as well as renal function. Estimated blood loss and post-transplant hospital stays were significantly lower in RKT group than in OKT group. LC analysis of RKT by the single surgeon revealed that surgical competence was achieved after 15 cases. CONCLUSION: Even if surgeons do not have prior experience with MIS, they can rapidly overcome the LC and safely perform RKT with adequate preparation and acquisition of basic robotic surgical techniques.

Robotic ureter reconstruction using the native ureter to treat long-segment ureteral stricture of the transplant kidney utilizing Indocyanine green: The first Korean experience.

PURPOSE: Ureteral strictures are a common complication after kidney transplantation. Open reconstruction is preferred for long-segment ureteral strictures that cannot be resolved endoscopically; however, it is known to have the potential to fail. We report 2 successful cases of robotic reconstruction surgery of a transplant ureter using the native ureter with the aid of intraoperative Indocyanine green (ICG). MATERIALS AND METHODS: Patients were placed in semi-lateral position. Using Da Vinci Xi, the transplant ureter was dissected, and the stricture site was identified. End-to-side anastomosis of the native ureter to the transplant ureter was performed. ICG was utilized to identify the course of the transplant ureter and confirm the vascularity of the native ureter. RESULTS: Case 1: A 55-year-old female underwent renal transplantation at another hospital. She had recurrent febrile urinary tract infections (UTIs) and a ureteral stricture requiring percutaneous nephrostomy (PCN). The PCN and ureteral stent were removed successfully after surgery. The patient had only 1 febrile UTI episode after surgery. Case 2: A 56-year-old female underwent renal transplantation at another hospital. She had acute pyelonephritis 1-month post-transplantation, and a long-segment ureteral stricture was identified. She developed a UTI with anastomosis site leakage in the early postoperative period, which resolved with conservative treatment. The PCN and ureteral stent were removed 6 weeks after surgery. CONCLUSIONS: Robotic surgery for managing long-segment ureteral stricture after kidney transplantation is safe and feasible. The use of ICG during surgery to identify the ureter course and its viability can improve the success.

Ultra-soft and highly stretchable tissue-adhesive hydrogel based multifunctional implantable sensor for monitoring of overactive bladder.

A highly stretchable and tissue-adhesive multifunctional sensor based on structurally engineered islets embedded in ultra-soft hydrogel is reported for monitoring of bladder activity in overactive bladder (OAB) induced rat and anesthetized pig. The use of hydrogel yielded a much lower sensor modulus (1 kPa) compared to that of the bladder (300 kPa), while the strong adhesiveness of the hydrogel (adhesive strength: 260.86 N/m) allowed firm attachment onto the bladder. The change in resistance of printed liquid metal particle thin-film lines under strain were used to detect bladder inflation and deflation; due to the high stretchability and reliability of the lines, surface strains of 200% could be measured repeatedly. Au electrodes coated with Platinum black were used to detect electromyography (EMG). These electrodes were placed on structurally engineered rigid islets so that no interfacial fracture occurs under high strains associated with bladder expansion. On the OAB induced rat, stronger signals (change in resistance and EMG root-mean-square) were detected near intra-bladder pressure maxima, thus showing correlation to bladder activity. Moreover, using robot-assisted laparoscopic surgery, the sensor was placed onto the bladder of an anesthetized pig. Under voiding and filling, bladder strain and EMG were once again monitored. These results confirm that our proposed sensor is a highly feasible, clinically relevant implantable device for continuous monitoring OAB for diagnosis and treatment.

Mitochondrial metabolic reprogramming by SIRT3 regulation ameliorates drug resistance in renal cell carcinoma.

Clear cell renal cell carcinoma (ccRCC) alters metabolic signals frequently, leading to mitochondrial dysfunction, such as increase of glycolysis and accumulation of lipid. Sirtuin3 (SIRT3) is a key factor for the regulation of both mitochondrial integrity and function. SIRT3 is downregulated and contributes in both cancer development and progression in ccRCC. The aim of this study is to investigate SIRT3-regulated mitochondrial biogenesis in ccRCC. SIRT3 overexpression alone reduced glucose uptake rate and enhanced membrane potential in mitochondria. ccRCC with overexpressed SIRT3 further improved the lethal effects when combined with anticancer drugs (Resveratrol, Everolimus and Temsirolimus). Cell viability was markedly decreased in a dose-dependent manner when treated with resveratrol or mTOR inhibitors in SIRT3 overexpressing ccRCC. In conclusion, SIRT3 improved mitochondrial functions in ccRCC through metabolic reprogramming. Mitochondrial reprogramming by SIRT3 regulation improves the sensitivity to anticancer drugs. The combination of SIRT3 and resveratrol functioned synergistically lethal effect in ccRCC.

Clinical Implications for da Vinci SP Partial Nephrectomy in High-Complexity Tumors: Propensity Score-Matching Analysis.

Purpose: To compare surgical outcomes between robot-assisted laparoendoscopic single-site (R-LESS) surgery using the da Vinci Si or Xi system and the da Vinci SP system for partial nephrectomy. Materials and Methods: From 2008 to 2020, 66 partial nephrectomies were performed using a single-site robotic approach: 44 used the da Vinci Xi or Si system (R-LESS group) and 22 used the da Vinci SP system (SP group). After 1:1 propensity score matching, surgical outcomes were compared between groups. Results: Median patient age was 51.5 years. Median tumor size was 2.1 cm and was not significantly different between groups. Median operation time was longer in the R-LESS group (R-LESS vs SP: 180 vs 155 minutes, p = 0.034), but median warm ischemic time was comparable between groups. Estimated blood loss was higher in the R-LESS group (R-LESS vs SP: 215 vs 20 mL, p < 0.001). Median operation time was significantly shorter in the SP group in patients with moderate- to high-complexity tumors (R-LESS vs SP: 200 vs 172 minutes, p = 0.035). Rates of trifecta achievement were similar between groups (63.6% in both groups, p = 1.00). Conclusions: R-LESS and da Vinci SP methods are both feasible approaches for single-site incision robotic partial nephrectomy. The da Vinci SP platform allows "true" single-site surgery without additional ports and provides a wider working space. It was associated with better performance than R-LESS partial nephrectomy. In complex tumors, operation time was shorter with SP partial nephrectomy than with R-LESS partial nephrectomy, suggesting that the SP method is especially advantageous for managing complex renal tumors.

The first robotic kidney transplantation in Korea: a case report.

Minimally invasive surgery reduces perioperative pain and morbidity, facilitating rapid recovery. However, the field of kidney transplantation has lagged in this regard, its customary open surgical techniques going nearly unchanged until recently. Robotic kidney transplantation (RKT) is a novel and welcomed innovation yielding good surgical outcomes. In Korea, the first RKT performed (November 2019) involved a 30-year-old man (body mass index, 22 kg/m2) with end-stage hypertensive nephrosclerosis. A left donor kidney from his 28-year-old sister was successfully transplanted using the daVinci Robotic Surgical System. Transperitoneal regional hypothermia (Vattikuti Urology Institute-Medanta technique) was also implemented across the main periumbilical incision (up to 6 cm). Total operative time was 260 minutes (cold ischemia, 34 minutes; rewarming, 54 minutes), with 50 mL of blood loss. There was immediate graft function, unencumbered by surgical complications (e.g., postoperative bleeding, leakage, or lymphocele). The patient was discharged on postoperative day 8, with serum creatinine at 1.27 mg/dL. RKT with regional hypothermia may be a viable, minimally invasive intervention that is safe and effective in select patients, showing good surgical results.

Comparing Revo-i and da Vinci in Retzius-Sparing Robot-Assisted Radical Prostatectomy: A Preliminary Propensity Score Analysis of Outcomes.

Purpose: This study aims to compare perioperative and oncologic outcomes between matched cohorts of localized prostate cancer (PCa) operated on by the same surgeon using the da Vinci Si robot and the Revo-i robot. Materials and Methods: Nonmetastatic PCa patients undergoing Retzius-sparing robot-assisted laparoscopic radical prostatectomy (RS-RARP) from January 2016 to December 2020 were matched one-to-one (33:33) to da Vinci Si controls using propensity score matching according to the following covariates: age, American Society of Anesthesiology (ASA) score, body mass index, previous abdominal and endoscopic surgery, preoperative prostate specific antigen, prostate volume, Gleason grade group, tumor stage, and need for pelvic lymphadenectomy. Outcomes of interest were estimated blood loss, length of stay, complication rate, operative times, positive surgical margins, and biochemical recurrence at 6 months. Results: Both cohorts were similar in estimated blood loss, rate of margin positivity, and rate of complications. Length of stay was significantly shorter with the Revo-i cohort. The da Vinci robot showed faster console, suture, and total operation times. Positive margin rate and biochemical recurrence at 6 months were similar in both groups. Conclusion: Despite the longer suture, console, and operative time those in the da Vinci robot in the authors' institution, the Revo-i robot-assisted radical prostatectomy had equivalent short-term oncologic outcomes with the da Vinci standard.

Robot-assisted laparoendoscopic single-site upper urinary tract surgery with da Vinci Xi surgical system: Initial experience.

Purpose: The da Vinci Xi robot surgical system was newly released with several upgrades and modifications made to its previous Si platform; to further enhance the capabilities to carry out minimally invasive surgery. This study aimed to evaluate the intraoperative and postoperative outcomes of robot laparoendoscopic single-site surgery performed with the da Vinci Xi system. Materials and Methods: Retrospective chart review of patients undergoing of robot laparoendoscopic single-site by a single surgeon using the Xi single-site platform from November 2016 and May 2019. For the da Vinci Xi system, multichannel port and "Lap Single Vision" port access platform were placed through a single periumbilical incision. Results: Fourteen patients underwent single-site surgery with benign cases (n=9) and partial nephrectomy cases (n=5). Among surgeries for the partial nephrectomy patients, one case of conversion to multiport robotic surgery occurred due to difficulty of tumor resection. Other major intraoperative complication, renal vein injury, was occurred in a patient who underwent a pyelolithotomy. The patient required a blood transfusion however, we were able to repair the vascular injury using prolene suture without additional port placement and open conversion. In our series, there were no conversions to open. The postoperative course was uneventful in all patients; only Clavien-Dindo III complications occurred. Conclusions: Our preliminary experience with robot laparoendoscopic single-site surgery using the da Vinci Xi system demonstrated feasibility and safety in selected patients. Further studies with a greater number of patients in multiple settings will help to fully elucidate the role of da Vinci Xi surgical system in single-site surgery.

Retroperitoneal single-site robot-assisted partial nephrectomy using Lapsingle Vision advanced access platform: initial three case reports.

Robot-assisted partial nephrectomy is currently the standard for treatment of small renal mass. Recently, robot-assisted single site surgery has been introduced. However, there have been few reports of retroperitoneal approaches. Herein, we report initial case series of retroperitoneal single-site robot-assisted partial nephrectomy using the da Vinci Xi surgical system using the Lapsingle Vision advanced access platform. Three patients have undergone retroperitoneal single-site robot-assisted partial nephrectomy due to incidental finding of renal mass. Operation duration, estimated blood loss, warm ischemia time, estimated glomerular filtration rate (eGFR) change, and complication were evaluated. Renal cell carcinoma of the two clear cell type and one chromophobe was diagnosed based on the pathological examination. Initial two cases were successfully completed with minimal bleeding and warm ischemic time within 25 minutes. The last 3rd case has been converted to multiport operation due to limited retroperitoneal space and difficulty in managing upper pole renal mass. Retroperitoneal single-site robot-assisted partial nephrectomy is a feasible treatment modality for treatment of posterior or lateral renal masses. Additional cases are needed to confirm the safety and efficacy of this technique.

Establishment of patient-derived three-dimensional organoid culture in renal cell carcinoma.

Purpose: Renal cell carcinoma is a heterogeneous kidney cancer, and over 403,000 cases were reported worldwide in 2018. Current methods for studying renal cell carcinoma are limited to two-dimensional (2D) culture of primary cell lines and patient-derived xenograft models. Numerous studies have suggested that 2D culture poorly represents the diversity, heterogeneity, and drug-resistance of primary tumors. The time and cost associated with patient-derived xenograft models poses a realistic barrier to their clinical utility. As a biomimetic model, patient-derived three-dimensional (3D) organoid culture can overcome these disadvantages and bridge the gap between in vitro cell culture and in vivo patient-derived xenograft models. Here, we establish a patient-derived 3D organoid culture system for clear cell renal cell carcinoma and demonstrate the biomimetic characteristics of our model with respect to both primary kidney cancer and conventional 2D culture. Materials and Methods: Normal renal tissues and tumor tissues were collected from patients with clear cell renal cell carcinoma. The dissociated cells were cultured as conventional 2D culture and 3D organoid culture. The biomimetic characteristic of the two cultures were compared. Results: Compared with 2D culture, the 3D organoid cultures retained the characteristic lipid-rich, clear cell morphology of clear cell renal cell carcinoma. Carbonic anhydrase 9 and vimentin were validated as biomarkers of renal cell carcinoma. Expression of the two validated biomarkers was more enhanced in 3D organoid culture. Conclusions: Patient-derived 3D organoid culture retains the characteristics of renal cell carcinoma with respect to morphology and biomarker expression.

True Single-Site Partial Nephrectomy Using the SP Surgical System: Feasibility, Comparison with the Xi Single-Site Platform, and Step-By-Step Procedure Guide.

Background: Robotic laparoendoscopic single-site (LESS) partial nephrectomy is not widely used because of its limitations, and true single-site surgery has not previously been possible. To investigate the feasibility of partial nephrectomy using the novel SP surgical system, compare perioperative outcomes using this system and the previous Xi single-site platform (XiSSP), and describe how true single-site partial nephrectomy is possible with the SP system. Methods: Retrospective chart review of patients undergoing robotic partial nephrectomy by a single surgeon using the SP surgical system or XiSSP from December 14, 2016 to June 14, 2019. For the SP system, a GelPOINT access platform was placed through a single periumbilical incision. A 25-mm multichannel robotic port and assistant's ports were placed in the GelSeal cap. No additional incisions were required for the assistant or liver traction. The primary outcomes were intraoperative and postoperative complications. Results: Fourteen patients underwent single-site partial nephrectomy with the SP surgical system (n = 9) or XiSSP (n = 5). No limitations were noted for accessing tumors in the upper aspect of the kidney using the SP system. One case of tumor fracture occurred with the SP system, and one case of conversion to multiport robotic surgery occurred with the XiSSP. The postoperative course was uneventful in all patients; only Clavien-Dindo 1 complications occurred. Conclusions: True single-site partial nephrectomy was performed safely with the SP surgical system. The SP system resolved many limitations associated with LESS and the XiSSP.

Prolyl hydroxylase-3 is a novel renal cell carcinoma biomarker.

Purpose: The aim of this study was to determine the suitability of serum prolyl hydroxylase-3 (PHD3) as a diagnostic or monitoring biomarker of renal cell carcinoma (RCC). Materials and Methods: Between October 2013 and March 2015, we prospectively recruited study participants. The RCC group consisted of 56 patients who underwent radical or partial nephrectomy. The control group included 56 healthy kidney donors and 13 patients with benign renal masses. Blood from the RCC patients was sampled prior to surgery and again 1 and 3 months after the operation. Serum PHD3 levels were measured via enzyme-linked immunosorbent assay and compared between RCC patients and controls. Results: RCC patients had higher serum PHD3 levels than controls (0.79±0.17 ng/mL vs. 0.73±0.09 ng/mL, p=0.023), with an area under curve (AUC) of 0.668. With a cutoff value of 0.761 ng/ml, the sensitivity, specificity, positive predictive value, and negative predictive value were 66.1%, 68.1%, 28.8%, and 37.3%, respectively. No significant difference in PHD3 level was observed between healthy kidney donors and patients with benign renal masses. The predictive performance of PHD3 was improved in subgroup analyses of RCC patients with a tumor size >2 cm (n=40) or clear-cell histology (n=44), with AUCs of 0.709 and 0.688, respectively. Among 37 patients with PHD3 levels greater than the cutoff value of 0.761 ng/mL, the postoperative PHD3 levels at 1 and 3 months were significantly lower than the preoperative PHD3 levels (both p<0.001). Conclusions: Serum PHD3 represents a novel RCC biomarker that shows acceptable diagnostic performance.

Investigation of Systolic Blood Pressure, Diastolic Blood Pressure, and Pulse Pressure in Living Kidney Donors After Donor Nephrectomy.

Kidney transplants from living donors have increased, but few studies have examined the long-term risks of live donor nephrectomy. This is the first study to report the blood pressure (BP) changes associated with cardiovascular disease and linked to chronic kidney disease (CKD) 1 year after live donor nephrectomy. This study examined a prospective cohort of patients who underwent donor nephrectomy between March 1, 2006, and December 31, 2016, at the Severance Hospital, Seoul, South Korea. CKD was defined as a glomerular filtration rate (GFR) of < 60 mL/min/1.73m2. Patients with a history of hypertension or CKD or an estimated GFR < 60 mL/min/1.73m2 were excluded; those examined after 1 year post-nephrectomy were included in the study population. Among 420 patients who underwent donor nephrectomy, 137 (32.6%) developed a first-time onset of a GFR < 60 mL/min/1.73m2 by the first year after surgery. After propensity score-matching the age, systolic BP (P < .001) and pulse pressure (P = .006) were significantly associated with the groups with newly developed CKD. Systolic BP and pulse pressure decreased significantly at 1 year after donor nephrectomy. These differences decreased after donor nephrectomy, possibly lowering the risk of cardiovascular disease.

Yearly Trends of Chronic Kidney Disease III Progressions in Living Kidney Donors.

PURPOSE: We aim to see the rate of progression to chronic kidney disease stage III after living donor nephrectomy in a single institution annually. METHODS: Between May 2006 and July 2017, a total of 753 living kidney donors who were followed up more than 6 months were enrolled in the study. We divided normal function vs chronic kidney disease III at 6 months postoperatively. We compared the incidence rate of chronic kidney disease stage III annually. For analysis, the entire period was divided into Era 1 (2006-2008), Era 2 (2009-2011), Era 3 (2012-2014), and Era 4 (2015-2017). RESULTS: During the period, the incidence of chronic kidney disease stage III was 258 living donors (34.3%). The prevalence of chronic kidney disease stage III was 39.3%, 36.6%, 35.5%, and 29.3% in Era 1, Era 2, Era 3, and Era 4, respectively. The rate of chronic kidney disease stage III incidence serially decreased as the era passed (P = .046). There was no difference in age, smoking status, drinking status, body mass index, preoperative cholesterol, and uric acid among the eras. However, preoperative estimated glomerular filtration rate was 90.86 (SD, 4.12), 94.47 (SD, 16.62), 103.82 (SD, 0.68), and 105.66 (SD, 19.57) mL/min/1.73 m2 in Era 1, Era 2, Era 3, and Era 4, respectively (P = .001). CONCLUSIONS: The incidence of chronic kidney disease stage III in living kidney donors for the last 3 years (Era 4) has decreased compared with the past (Era 1 and 2). The reason for this might be the effect of the change in the living donor guideline. Also, pre- and postoperative management method had an effect on renal function at 6 months.

Pure single-site robot-assisted pyeloplasty with the da Vinci SP surgical system: Initial experience.

Purpose: Laparoendoscopic single-site surgery (LESS) reduces the limited invasiveness of conventional laparoscopy while providing superior cosmetic results. However, LESS remains a challenging surgical technique, even in robotic surgery, primarily due to the lack of triangulation and limited instrument movement. The da Vinci SP surgical system (Intuitive Surgical) was recently introduced to overcome these limitations. We describe our initial experience with pure single-site robot-assisted pyeloplasty (RAP) for ureteropelvic junction obstruction (UPJO) using the da Vinci SP surgical system. Materials and Methods: Three consecutive patients who were diagnosed with UPJO underwent RAP with the da Vinci SP surgical system from December 2018 to February 2019 at our institution. The surgical technique involved reproducing the steps of multi-port RAP. A 30-mm umbilical incision was made and the GelPOINT was inserted. The multichannel robotic port and the assistant's port were placed through the GelSeal cap. In all patients, Anderson-Hynes dismembered pyeloplasty was performed. The ureteral double J stent was inserted antegrade, and the drain was not placed. Results: The procedures were successfully completed using a pure single-site approach. There was no need for additional port placement or conversion to laparoscopic or open surgery. Total operative time in the three patients was 139, 180, and 213 minutes, respectively. No intraoperative complications occurred, and blood loss was minimal. The postoperative course of all patients was uneventful with no complications greater than Clavien-Dindo grade I surgical complications. Conclusions: Pure single-site RAP using the da Vinci SP surgical system is feasible and safe.

DNA Damage Response Pathway Alteration in Locally Advanced Clear-Cell Renal-Cell Carcinoma Is Associated With a Poor Outcome.

BACKGROUND: Advanced clear-cell renal-cell carcinoma (ccRCC), which is the most common subtype of kidney cancer, is considered to be lethal despite recent advancements in therapeutic agents. The benefit of adjuvant or neoadjuvant therapy with currently available agents remains controversial. We investigated the clinical implications of DNA damage response (DDR) pathway for locally advanced ccRCC. PATIENTS AND METHODS: Localized ccRCC cases were selected from the Provisional TCGA (The Cancer Genome Atlas) database. Presence of mutation or copy-number alteration of DDR pathway-related genes were evaluated. Disease-free survival and overall survival according to disease progression were evaluated. RESULTS: From TCGA database, 312 cases were identified of a localized ccRCC with full data on mutation and copy-number alteration. Alteration in the DDR pathway was present in 25.0% of cases. Female subjects were more likely to have alterations in the DDR pathway (34.6% vs. 48.7%, P = .026). DDR pathway alteration was associated with decreased disease-free survival in cases of locally advanced T3-4 disease (median, 123.7 vs. 23.0 months, T3 and T4 disease, P = .031). The association was more prominent in cases of T3a disease (normal group median not reached, altered group median 17.7 months, P < .001). DDR pathway alteration was an independent factor predicting a shorter disease-free survival on Cox regression analysis (odds ratio = 4.41; 95% confidence interval, 1.47∼13.28; P = .008). CONCLUSION: Alteration in the DDR pathway was associated with increased recurrence in locally advanced ccRCC, and investigation of therapeutic agents targeting the DDR pathway for this population should be considered.

Prospective assessment of urinary neutrophil gelatinase-associated lipoprotein in living kidney donors: toward understanding differences between chronic kidney diseases of surgical and medical origin.

OBJECTIVES: To evaluate the clinical implications of postoperative urinary neutrophil gelatinase-associated lipoprotein (NGAL) changes and the association between urinary NGAL (uNGAL) and renal function in living kidney donors. SUBJECTS, PATIENTS AND METHODS: We included 76 healthy adults who underwent donor nephrectomy between December 2013 and November 2014. Perioperative serum creatinine (sCr), uNGAL, serum NGAL (sNGAL), and urinary microalbumin were prospectively measured until 6 months postoperatively. Patients with chronic kidney disease (CKD) due to medical disorders who visited our outpatient clinic during the same period were included for comparison. RESULTS: The mean (SD) preoperative uNGAL of donors was 5 (5.17) ng/mL. uNGAL (corrected for urinary creatinine) was maximal at 1-2 days postoperatively, decreased on postoperative day 3, and stabilised by 7 days after surgery. Postoperative uNGAL was not associated with sex, age, or preoperative renal function. When corrected for sNGAL to compensate for the systemic increase in NGAL with major surgery, uNGAL on days 1-3 postoperatively was negatively correlated with sCr. Postoperatively, donor uNGAL remained higher than preoperatively for up to 6 months but was significantly lower than in patients with medical CKD with similar glomerular filtration rates. CONCLUSION: Acute kidney injury due to hyperfiltration of remnant kidney after donor nephrectomy was maximal within 1-2 days postoperatively. The rise in uNGAL during this period in donors was negatively correlated with postoperative sCr levels. Decreased renal function after nephrectomy differs from that of medical CKD.

Clinical validation of serum endocan (ESM-1) as a potential biomarker in patients with renal cell carcinoma.

To determine the suitability of serum endocan (ESM-1) levels for diagnosing and monitoring renal cell carcinoma (RCC), we measure serum ESM-1 levels in 56 RCC patients who had undergone radical or partial nephrectomies and 56 age- and sex-matched healthy kidney donors. Measurements were made before and 1 month and 3 months after surgery. The areas under the curve (AUCs) were determined from receiver operating characteristic (ROC) analyses. RCC patients had higher mean serum ESM-1 levels than control subjects (0.59 ± 0.07 vs. 0.52 ± 0.08 ng/mL, P < 0.001), with an AUC of 0.721 (95% CI: 0.628-0.817). In patients with tumors larger than 2 cm (n = 40) and those with clear-cell histology (n = 44), the AUCs for ESM-1 were 0.771 and 0.721, respectively. In control subjects, serum ESM-1 levels were higher in older (>50 years) individuals (P < 0.001). Among the study cohort, the AUCs for ESM-1 were 0.813 in individuals 50 years of age or younger (n = 55) and 0.637 in individuals older than 50 years (n = 57). In RCC patients, serum ESM-1 levels were reduced 1 month (P = 0.047) and 3 months (P = 0.009) after surgery. These results suggest serum ESM-1 can serve as a serologic biomarker for diagnosing and monitoring RCC, particularly in patients younger than 50 years.

Epidemiology of prostate cancer in South Korea.

BACKGROUND: Prostate cancer (PCa) is the second most frequently diagnosed cancer in male. In South Korea, PCa incidence has increased significantly, while its mortality rate has decreased steadily. To optimize the distribution of public medical resources, it is essential to analyze the contemporary epidemiology of PCa. METHODS: National population data from the National Health Insurance Statistical Yearbook and the annual report of national cancer registration and statistics in Korea were assessed. From the data, the incidence, prevalence, and mortality rates of PCa were calculated. The data were presented with reference to other types of cancers occurring in various countries from different continents. RESULTS: From 2007 to 2013, PCa incidence doubled (from 5,516 per year to 10,855 per year), while its prevalence in Korean men tripled (from 18,830 to 51,411) during the same period. The mortality rate increased slightly, from 4.2 in 2000 to 5.9 in 2007 and 6.0 in 2013 (per 100,000, age adjusted). PCa incidence increased significantly faster in men aged < 70 years than in the older age group. CONCLUSION: PCa prevalence in South Korea has increased significantly, mainly due to the rise in its incidence. As the country is facing major changes, including westernization of dietary habits and rapid population aging, its prevalence would continue to increase in near future.

Surgical experience with retroperitoneal liposarcoma in a single korean tertiary medical center.

PURPOSE: This is a report of the surgical treatment and prognosis of retroperitoneal liposarcoma (RPLS) in Koreans. MATERIALS AND METHODS: Nineteen patients treated for RPLS between July 1, 1984, and March 31, 2009, were included. Patient demographics, histopathologic subtypes, survival rate, disease recurrence rate and interval, and adjuvant therapy were reviewed and analyzed. RESULTS: Of the 19 patients diagnosed with RPLS, 26.3% presented with well-differentiated RPLS, 10.5% with dedifferentiated RPLS, 15.8% with myxoid/round cell type, and 47.4% with mixed-type liposarcoma. The mean follow-up period was 66.8 months (range, 6 to 165 months). Primary RPLS was treated in 17 patients. Nine patients (52.9%) had recurrent disease, and recurrence developed at a mean of 47.7 months after primary or repeated surgical treatment. The overall survival rate was 84.2% during a mean follow-up of 66.8 months. The 3- and 5-year survival rates were 86.9%, and the 10-year survival rate was 69.5%. The recurrence interval was significantly shorter in recurrent RPLS cases (p=0.023). The mean growth rate of locally recurrent tumors was 0.34 cm per month. CONCLUSIONS: The survival rates reported here were higher than in previous studies. Locally recurrent tumors presented with a low growth rate, which may have contributed to the relatively high survival rate. A high prevalence of mixed-type RPLS was also noted, and its cause and prognosis require further research.