Introduction: In this retrospective multicentre study, we compared the clinicohistological characteristics of renal cell carcinoma (RCC) between pediatric and adult patients. Methods: Data for patients who underwent radical or partial nephrectomy for RCC between 1988 and 2014 at multiple institutions were collected. Patients were divided into 2 groups according to age at diagnosis: pediatric patients (age ≤18 years) and adult patients (age ≥40 years). The groups were compared for clinical and pathologic variables, and survival analysis was performed. Results: The median follow-up period was 64 (range: 30-91) months for pediatric patients versus 44 (range: 19-59) months for adult patients (p = 0.026). Pediatric patients were mostly female (p = 0.003), had symptoms at presentation (p < 0.001), and had a high-stage tumour (p = 0.014) than adult patients. Among the symptomatic patients, gross hematuria was the most common symptom. The median tumour size was not different between groups. Regarding histologic types, pediatric patients had more papillary tumours (p < 0.001), more unclassified tumours (p < 0.001), and fewer clear cell carcinomas (p < 0.001). Five-year cancer-specific survival rates were 85% and 87.4% in pediatric and adult patients, respectively (log rank p = 0.901). Recurrence-free survival was better in adult patients, although this did not reach statistical significance (log rank p = 0.272). This study has several limitations, including its retrospective nature and the relatively small number of pediatric RCC cases. Conclusion: RCC in children is rare and is characterized by features that differ from those in adult RCC. Prognosis did not differ between groups.
Nephrectomy is performed for the treatment of kidney cancer or for the purpose of kidney transplantation. Generally, kidney function decreases after nephrectomy. It is well known that the incidence of cardiovascular disease increases and ultimately the mortality rate increases when kidney function decreases. Therefore, when renal mass is detected, partial nephrectomy (PN) is preferred over radical nephrectomy (RN) to preserve kidney function as much as possible. However, recent studies have shown that PN does not have a survival benefit in all patients compared to RN. Meanwhile, numerous studies for living kidney donors showed that kidney donation itself did not increase the risk of diabetes, high blood pressure, cardiovascular disease, and mortality. However, recent studies have shown that kidney donors have higher incidence of cardiovascular disease and higher mortality rates than the general populations. It is yet difficult to find a conclusion in these debates. We have to make a clinical decision rest on the balance of potential benefits and harms of competing treatments, personalized to the individual patient.
Advances in cancer surgery have enabled more delicate resection of tumors and have minimized harm to patients. Technological progress in minimally invasive surgery has resulted in significant benefits for patients, such as reduced blood loss and postoperative pain, decreased postoperative morbidity, shorter duration of hospital stay, and early return to normal activities. Robotic surgery is rapidly replacing conventional laparoscopic surgery in the abdominopelvic field. In particular, the clinical application of robotic surgery has expanded from malignancies to benign diseases in urology. Although the definite advantages of robotic surgery have been controversial, several studies have reported that robotic surgery has more benefits than conventional laparoscopic or open surgery. However, the cost is a serious issue because robotic surgery is not covered by the national health service. It is also generally more expensive than other minimally invasive surgeries, especially in Korea. Although conventional laparoscopic surgery has a steeper learning curve than robotic surgery, it still has the potential to treat patients who require this type of surgery and utilize the national health service. Radical cystectomy is the standard treatment for muscle-invasive bladder cancer, and diverse surgical procedures have been performed for urinary 117 KJUO
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