Jong Ha Hwang

The incidence of urologic complications requiring urologic procedure in radical hysterectomy and difference between abdominal radical hysterectomy and laparoscopic radical hysterectomy

To evaluate the incidence of urologic complications requiring a urologic procedure during the perioperative period and compare the differences between abdominal radical hysterectomy (ARH) and laparoscopic radical hysterectomy (LRH). We identified all Korean women who underwent radical hysterectomy (RH) between January 2006 and December 2019 using the National Health Insurance Service database. Complications requiring surgical intervention-based urologic procedures between ARH and LRH were investigated. A total of 12,068 patients were classified into the ARH group and 8,837 patients were classified into the LRH group. Urologic complications requiring urologic procedures occurred in 1,546 of 20,905 patients (7.40%) who underwent RH. The most common urologic procedure was double-J insertion (R326, 5.18%), followed by bladder repair (R3550, 0.90%). There was no significant difference in urologic complications requiring urologic procedures between the ARH and LRH groups (odds ratio [OR]=1.027; 95% confidence interval [CI]=0.925-1.141; p=0.612). The incidence of bladder repair (R3550) was significantly higher in patients who underwent LRH (OR=1.620; 95% CI=1.220-2.171; p<0.001). Urologic complications requiring urologic procedures were statistically higher in the LRH group during the first half (OR=1.446; 95% CI=1.240-1.685; p<0.001), but more in the ARH group during the second half (OR=0.696; 95% CI=0.602-0.804; p<0.001) of the study period. There was no difference of urologic complications between ARH and LRH with regard to urologic procedures. The incidence of urologic procedures decreases with time in patients who underwent LRH.

Clinical characteristics and survival outcome of vulvar cancer in South Korea: A nationwide study from the Cancer Public Library Database

Abstract Objective Vulvar cancer, although rare, presents clinical challenges due to diverse histological subtypes and varying prognoses. This study aimed to examine the clinical characteristics and survival outcomes of vulvar cancer in South Korea. Methods A retrospective cohort study was conducted using data from the Cancer Public Library Database, which includes information from the Korea National Cancer Incidence Database, Statistics Korea, and National Health Insurance databases. The study analyzed data from South Korean women diagnosed with vulvar cancer between 2014 and 2016. Results Out of 1242 initial patients, 292 met the inclusion criteria. The untreated group ( n  = 62) had a higher proportion of patients aged 80 and above (35.5%) and a higher mean Charlson Comorbidity Index (CCI) score compared to the treatment group ( n  = 230). The treatment group showed significantly higher survival probability (adjusted HR 0.358, 95% CI: 0.24–0.54) compared to the untreated group. Surgical intervention alone reduced mortality risk significantly (adjusted HR 0.20, 95% CI: 0.12–0.33), particularly among those diagnosed at an earlier clinical stage. Histologically, basal cell carcinoma had the highest survival probability with a significantly lower mortality risk than squamous cell carcinoma (adjusted HR 0.11, 95% CI: 0.02–0.82). Adenocarcinoma also showed improved survival outcomes (adjusted HR 0.42, 95% CI: 0.19–0.94). Conclusion The study emphasizes the importance of early diagnosis and surgical treatment in improving survival outcomes for vulvar cancer patients. It also highlights the need to consider demographic and clinical factors in treatment planning and calls for region‐specific studies to address unique epidemiological patterns.

Implementation rate and related factors of confirmatory tests following an abnormal Pap smear: a nationwide study from the National Health Insurance

This study aims to investigate the implementation rate and influencing factors of confirmatory tests for women with abnormal cervical cytology results in the Korean nationwide cervical cancer screening program. The National Health Insurance Service (NHIS) database was utilized to identify all Korean women who have participated in the Korean nationwide cervical cancer screening program from January 2011 and December 2021 using the NHIS database. Multiple logistic regression analysis was performed to estimate the multivariate odds ratio and evaluate the patients' characteristics. The rate of abnormal Papanicolaou (Pap) smears showed an initial increase from 2011 to 2015 and subsequently reached a plateau after 2016. When examining specific subcategories, cases of atypical squamous cells of undetermined significance (ASC-US) increased from 28,546 cases (1.1%) in 2011 to 62,850 cases (1.7%) in 2021. In contrast, cases of HSIL and SCC declined from 3,535 cases (0.14%) to 2,763 cases (0.07%) and from 383 cases (0.01%) to 179 cases (0.005%), respectively. Furthermore, the implementation rate of confirmatory tests for women with abnormal cytology increased from 8,865 cases (21.0%) in 2011 to 39,045 cases (51.2%) in 2021. Regarding the specific subcategory of ASC-US, the number of confirmatory tests exhibited a substantial increase from 4,101 cases (14.4%) in 2011 to 30,482 cases (48.5%) in 2021. For SCC, there was no significant change, with 216 cases (56.4%) in 2011 and 102 cases (57.0%) in 2021. The implementation rate of confirmatory tests was found to be significantly associated with results of abnormal Pap smear, age, and residence. Notably, economic status did not emerge as a significant factor affecting the likelihood of undergoing confirmatory tests. The severity of abnormal Pap smear results is a reliable indicator of the probability of undergoing a confirmatory test. Additional endeavors are required to improve the implementation rate among women who have received abnormal Pap smear results.

Comparison of survival outcomes between robotic and laparoscopic radical hysterectomies for early-stage cervical cancer: a systemic review and meta-analysis

Survival outcomes of robotic radical hysterectomy (RRH) remain controversial. Therefore, we performed a meta-analysis to evaluate survival outcomes between RRH) and laparoscopic radical hysterectomy (LRH) in patients with early-stage cervical cancer. Studies comparing between RRH and LRH published up to November 2022 were systemically searched in the PubMed, Cochrane Library, Web of Science, ScienceDirect, and Google Scholar databases. Manual searches of related articles and relevant bibliographies of the published studies were also performed. Two researchers independently extracted data. Studies with information on recurrence and death after minimally invasive radical hysterectomy were also included. The extracted data were analyzed using the Stata MP software package version 17.0. Twenty eligible clinical trials were included in the meta-analysis. When all studies were pooled, the odds ratios of RRH for recurrence and death were 1.19 (95% confidence interval [CI]=0.91-1.55; p=0.613; I²=0.0%) and 0.96 (95% CI=0.65-1.42; p=0.558; I²=0.0%), respectively. In a subgroup analysis, the quality of study methodology, study size, country where the study was conducted, and publication year were not associated with survival outcomes between RRH and LRH. This meta-analysis demonstrates that the survival outcomes are comparable between RRH and LRH. International Prospective Register of Systematic Reviews Identifier: CRD42023387916.