Purpose: We wanted to investigate the effect of dominant kidney nephrectomy on the postoperative renal function and we wanted to determine the preoperative risk factors that influence the postoperative renal function in living donor nephrectomy. Materials and Methods: A total of 297 living kidney donors (159 males and 138 females) who underwent nephrectomy were included in this study. Renal function was measured by the serum creatinine levels and Tc-diethylenetriamine penta-acetic acid (DTPA) renal scanning. Using univariate and multivariate analyses, the following independent variables were evaluated to predict a postoperative serum creatinine level 1.5mg/dl or higher: removal of a functionally dominant kidney or a larger kidney according to the DTPA renal scan or CT, age, gender, body mass index (BMI), comorbidity, preoperative serum creatinine and the preoperative glomerular filtration rate (GFR). Results: Of the 297 subjects, 134 (55%) underwent donor nephrectomy on the left side, and 163 (45%) underwent donor nephrectomy on the right side. Univariate analysis showed that gender and the preoperative creatinine level were significantly associated with postoperative serum creatinine elevation (1.5mg/dl or higher) (p<0.05). Multivariate analysis showed that the preoperative creatinine level (p<0.001), the preoperative GFR (p=0.015) and removal of a functionally dominant kidney (p=0.049) were significant factors. The cut-off values from the receiver operating characteristics (ROC) curves were 1.0mg/dl for the preoperative creatinine level, 90.24ml/min/1.73m for the preoperative GFR, and 10.94% for the difference of the relative renal function on DTPA. Conclusions: The preoperative serum creatinine level and the preoperative GFR are critical predictive factors for renal function after living donor nephrectomy. The impact of removing a functionally dominant kidney on the postoperative renal function should be cautiously interpreted in patients where the function of the nondominant kidney is favored. (Korean J Urol 2008;49:37-42)
우리나라 경제의 허리라고 할 수 있는 중소기업의 지속적인 발전과 성장을 뒷받침하는 것은 국가경제정책의 중요한 한 축을 이룬다. 우리나라의 중소기업은 전체 기업의 99.9%를 차지하고 있고, 중소기업이 전체 근로자의 82.2%에 해당하는 근로자의 고용을 책임지고 있는 등 국민경제의 핵심적 존재로 부각되고 있다. 그런데 중소기업 경영자의 고령화가 급속하게 진행됨에 따라 중소기업의 승계문제가 현실적인 문제로 대두되고 있다. 기업승계의 최대 장애요인으로서 상속세 또는 증여세 부담의 과중을 지적하고 있는데, 이와 같은 기업승계에 따른 상속세 또는 증여세의 부담을 줄여주기 위하여 가업상속공제제도와 가업승계에 대한 증여세 과세특례제도를 마련하고 있다. 그러나 가업상속공제제도와 가업승계에 대한 증여세 과세특례제도는 적용요건, 사후관리요건 및 특례의 내용 등이 안고 있는 문제점으로 말미암아 그 이용실적이 매우 저조한 실정이다. 특히 가업상속공제제도와 가업승계에 대한 증여세 과세특례제도는 까다로운 적용요건과 엄격한 사후관리요건으로 인하여 ‘그림의 떡’ 또는 ‘허울 좋은 장식품’으로 전락되어 있다. 따라서 현행 가업승계세제를 다음과 같은 기본방향 아래 전반적으로 재설계하는 것이 바람직할 것으로 보인다. 첫째, 가업승계세제를 단순히 가업승계를 지원하는 세제라는 미시적 관점에서 국민경제적 입장에서 중소기업의 존속 및 발전을 지원하고 고용의 유지 및 창출을 지원하는 세제라는 거시적 관점으로 전환하여야 한다. 가업상속공제의 적용요건에서 요구하고 있는 10년 이상의 가업영위기간과 가업영위기간의 장단에 따라 설정하고 있는 200억원, 300억원 또는 500억원의 한도액에 관한 규정은 개선되어야 한다. 둘째, 기업승계는 상속승계보다는 증여승계가 훨씬 바람직하다. 기업승계의 실효성을 제고하고 경제를 보다 젊고 역동적으로 작동될 수 있도록 하기 위해서는 가업승계세제의 중심을 상속승계보다는 증여승계로 전환하여야 한다. 이에 발맞추어 가업승계세제가 재설계되어야 한다. 셋째, 최근의 세계경제는 기술 및 산업의 발전과 환경변화의 속도가 너무 빨라 기업이 이러한 발전과 변화의 속도를 따라가는 것이 쉽지 않다. 이와 같은 기술 및 산업의 발전과 경영환경의 변화에 탄력적으로 대응할 수 있도록 사후관리요건을 완화하여야 한다.Support for the continued development and growth of small and medium enterprise (SME), the backbone of the Korean economy, makes up an important axis of national economic policy. SME in Korea are as a core presence in the national economy, making up 99.9% of all companies. At the same time they are responsible for a large part of employment, making up 82.2% of all workers. However, the aging of SME executives is rapidly progressing, and with that the succession issue for SME has emerged as a large problem. The heavy burden of the inheritance tax and gift tax is often pointed out as the largest obstacle to company succession. In order to reduce the burden of such successions due to the inheritance tax and gift tax, a family business inheritance deduction system and special gift tax system for family business successions are provided. However, the family business inheritance deduction system and special gift tax taxation system for family business succession show very low usage due to problems in application requirements, aftercare requirements, and special case content. In particular, due to their stringent requirements and strict follow-up requirements, it can be said that the family business inheritance deduction system and special gift tax taxation system for family business succession are little more than pie in the sky in terms of practical use. As a result, it would seem to be desirable to redesign the current family business succession tax system across the board under the following basic directions. First, the family business succession tax system should move away from the micro taxation perspective that simply supports family business succession, to a macroscopic view that supports the survival and development of SME to maintain and create employment from the standpoint of the national economy. Family business inheritance deduction application requirements that require the family business to have run for 10 or more years, as well as the limits of 20 billion won, 30 billion won or 50 billion won, depending on age of the business, should be improved. Second, when it comes to business succession, gift succession is vastly preferable to inheritance succession. In order to boost the effectiveness of business succession and make the economy younger and allow it to run more dynamically, the center of the family business succession system should be shifted from inheritance succession to gifted succession. The family business succession tax system should be redesigned in line with this. Third, the global economy in recent times shows such rapidity in the development of technology and industry as well as environmental change that it is not easy for businesses to keep pace. Aftercare requirements should be relaxed in order to be able to flexibly respond to such technological and industrial developments and changes in the business environment.
Purpose: Robot-assisted radical cystectomy (RARC) optimizes patient recovery and has outcomes comparable with those of open surgery.This study aimed to compare the perioperative and oncologic outcomes of RARC in female and male patients.Materials and Methods: A retrospective cohort study of the Korean Robot-Assisted Radical Cystectomy Study Group database from 2007 to 2019 identified 749 patients (111 females and 638 males).Female were matched 1:1 to male by propensity score matching using a logistic regression.We compared perioperative outcomes, oncologic outcomes, and complications between the two groups.Results: The female group had comparable perioperative outcomes to the male group in terms of operation time, lymph node yield, positive surgical margin, blood transfusion rate, and hospitalization days.Complication rate and grade were not significantly different between the two groups.The most common complication was infection in female and gastrointestinal complications in male.We compared the 5-year overall, disease-specific, and recurrence-free survival of female and male: 58.2% vs. 68.0%(p=0.495),75.7% vs. 79.3%(p=0.645), and 40.8% vs. 53.5% (p=0.913),respectively.On multivariable analysis, T stage (>T2), postoperative complications, and positive surgical margin were prognostic factors of poor outcome.Sex was not an independent predictor of the three survivals.Conclusions: The current study suggests that RARC in female has comparable perioperative and oncologic outcomes to those in male.The complication rate of RARC in female was comparable to that in male, but the type of complications differed by sex.
The University of California, San Francisco, announced in 2011 Cancer of the Prostate Risk Assessment Postsurgical (CAPRA-S) score which included pathologic data, but there were no results for comparing preoperative predictors with the CAPRA-S score. We evaluated the validation of the CAPRA-S score in our institution and compare the result with the preoperative progression predictor, CAPRA score. Data of 130 patients were reviewed who underwent radical prostatectomy for localized prostate cancer from 2008 to 2013. Performance of CAPRA-S score in predicting progression free probabilities was assessed through Kaplan Meier analysis and Cox proportional hazards regression test. Additionally, prediction probability was compared with preoperative CAPRA score by logistic regression analysis. Comparing CAPRA score, the CAPRA-S score showed improved prediction ability for 5 yr progression free survival (concordance index 0.80, P = 0.04). After risk group stratification, 3 group model of CAPRA-S was superior than 3 group model of CAPRA for 3-yr progression free survival and 5-yr progression free survival (concordance index 0.74 vs. 0.70, 0.77 vs. 0.71, P < 0.001). Finally the CAPRA-S score was the more ideal predictor concerned with adjuvant therapy than the CAPRA score through decision curve analysis. The CPARA-S score is a useful predictor for disease progression after radical prostatectomy.
To directly compare the outcome of laparoscopic radical prostatectomy (LRP) with robot-assisted laparoscopic prostatectomy (RALP) performed by a single laparoscopic surgeon with intermediate experience-one who is between a novice and an expert.Consecutive 106 patients with prostate cancer who were treated with radical prostatectomy (62 with LRP and 44 with RALP) were included. The preoperative characteristics, the perioperative surgical outcomes, and the functional outcomes were compared between the two groups.The mean operative time was longer in the RALP group (371 min vs 308 min, P = 0.00), conceivably because of more nerve-sparing procedures (84% vs 57%). The other perioperative parameters, including the surgical margin, were comparable, except for two major complications (rectourethral fistula and ureteral injury) in the LRP group. The RALP group recovered continence faster than those in the LRP, but the eventual continence rate at 12 months was similar (95% for LRP vs 94.4% for RALP, P = 1.00). The potency rate ≥ 6 months postsurgery was 47.6% in the LRP group and 54.5% in the RALP group (P = 0.65).RALP was beneficial for the earlier recovery of continence, although LRP and RALP had comparable safety and efficacy as minimally invasive surgery for prostate cancer when performed by a laparoscopic surgeon with intermediate experience. Long-term follow-up data are needed for further evaluation of oncologic and functional outcomes for both techniques.
Background: Transurethral resection of the prostate (TURP) is the gold-standard treatment for benign prostatic hyperplasia (BPH). However, laser surgery techniques (e.g., photoselective vaporization of the prostate (PVP), holmium laser, thulium laser enucleation of the prostate (HoLEP or ThuLEP)), and minimally invasive treatment options (e.g., UroLift) are increasingly replacing TURP. This study seeks to report the annual incidence, management trends, and costs of BPH procedures in the U.S. Methods: Data analyses of U.S. health insurance claims from 2004 to 2017, collected from the de-identified Optum Clinformatics Claims Database, were performed to determine the number of BPH patients and the treatment selected. Results: A total of 51,448 patients underwent BPH procedures from 2004 to 2017. There was a significant increase in the annual rate from 770 in 2004 to 6571 in 2017. The mean patient age (±SD) increased from 67.6 years old (±8.4) in 2004 to 73.4 years old (±8.4) in 2017. More than 60% of patients underwent cystourethroscopy and a post-void residual urine check for workup prior to surgical management. TURP was the most-common, and PVP was the second-most-common BPH procedure. Medical and total treatment costs increased, while the detection rate of prostate cancer after BPH surgery gradually decreased from 19.87% in 2004 to 5.78% in 2017. Conclusions: Our study demonstrates a recent trend in BPH management that replaces the traditional TURP technique with alternative methods. Due to rising costs, future studies should assess whether these newer methods are cost effective over the long term.
Targeted therapy for metastatic renal cell carcinoma (mRCC) treatment requires the identification of clinically important factors that can predict the therapeutic effect. We retrospectively investigated the prognostic roles of pre-treatment sarcopenia and relative dose intensity during the initial two cycles (2c-RDI) of sunitinib treatment in patients with mRCC. In total, 41 (52.6%) patients were classified as having sarcopenia and 16 (20.5%) patients were classified with low 2c-RDI at <75%. The mean dose reduction during sunitinib treatment was higher for sarcopenic than for non-sarcopenic patients. The median progression-free survival (PFS) and overall survival (OS) were significantly shorter in sarcopenic patients with low 2c-RDI (n = 14, 17.9%) than in non-sarcopenic patients with high 2c-RDI (n = 35, 44.9%). Multivariate analysis identified sarcopenia and low 2c-RDI as poor prognostic factors for PFS and OS. Our findings provide new insights into the prognostic role of sarcopenia and 2c-RDI for targeted therapy in mRCC.
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