Investig Clin Urol.  2019 May;60(3):184-194. 10.4111/icu.2019.60.3.184.

Trends in clinical, operative, and pathologic characteristics of surgically treated renal mass in a Korean center: A surgical series from 1988 through 2015

• Kang HW
• Seo SP
• Kim WT
• Yun SJ
• Lee SC
• Kim WJ
• Hwang EC
• Kang SH
• Hong SH
• Chung J
• Kwon TG
• Kim HH
• Kwak C
• Byun SS
• Kim YJ
• KORCC (KOrean Renal Cell Carcinoma) Group

• KMID: 2444273
• DOI: http://doi.org/10.4111/icu.2019.60.3.184

Abstract

PURPOSE
To analyze trends over a period of 28 years in the clinical, operative, and pathologic characteristics of patients with a renal mass who underwent surgical resection in Korea.
MATERIALS AND METHODS
Consecutive patients (n=6,231) with a renal mass who underwent surgical resection at eight Korean institutions between 1988 and 2015 were reviewed. Patients were assigned to one of three groups according to the date of surgery: group 1, 1988-1999; group 2, 2000-2009; and group 3, 2010-2015.
RESULTS
Age at the time of surgery, body mass index, smoking status, incidence of diabetes and hypertension, and the number of incidentally identified renal masses increased significantly over time. The proportion of patients undergoing partial nephrectomy (PN) or minimally invasive surgery (MIS) increased sharply during the last two time periods. From 2010, the rate of robot-assisted nephrectomy rose sharply, occurring in 37.8% of MIS cases. Benign pathology was identified in 1.8% and 5.2% of cases in the middle and last periods, respectively; angiomyolipoma was the most common pathology. In later years, tumors were more often localized, although tumor grade increased. Sub-group analysis of small renal masses ≤4 cm revealed similar trends in operative and pathologic characteristics over time.
CONCLUSIONS
Between 1988 and 2015, there was a substantial change in the clinical, operative, and histological characteristics of patients who underwent resection of a renal mass in Korea. The most notable changes were stage migration towards localized disease and widespread use of PN and MIS.

Keyword

Carcinoma, renal cell; Minimally invasive surgical procedures; Nephrectomy; Pathology, surgical

MeSH Terms

Angiomyolipoma
Body Mass Index
Carcinoma, Renal Cell
Humans
Hypertension
Incidence
Korea
Minimally Invasive Surgical Procedures
Nephrectomy
Pathology
Pathology, Surgical
Smoke
Smoking
Smoke

Figure

• 

  Fig. 1 Annual trends in the type of surgical procedure used for patients with a renal mass in Korea (between 1988 and 2015). (A) Percentage of partial nephrectomy (PN) cases relative to the total number of surgical cases. (B) Percentage of minimally invasive surgery (MIS) cases relative to the total number of surgical cases. (C) Percentage of MIS cases relative to the total number of surgical cases in patients who underwent PN. (D) Percentage of MIS cases relative to the total number of surgical cases in patients who underwent radical nephrectomy (RN). (E) Utilization of MIS techniques. HALS, hand-assisted laparoscopic surgery; LESS, laparo-endoscopic single-site surgery.

• 

  Fig. 2 Annual utilization of robot-assisted laparoscopic nephrectomy. Data show the number of patients per year managed using this technique. RN, radical nephrectomy; PN, partial nephrectomy.

• 

  Fig. 3 Annual trends in pathologic variables of patients with a surgically treated renal mass between 1988 and 2015. (A) Incidence of benign pathology relative to total number of surgical cases. (B) Pathologic staging. (C) Fuhrman nuclear grading. (D) Histologic distribution of renal cell carcinoma (RCC) tumors.

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