Minimally invasive radical hysterectomy and the importance of avoiding cancer cell spillage for early-stage cervical cancer: a narrative review

Atsushi Fusegi,Hiroyuki Kanao,Shiho Tsumura,Atsushi Murakami,Akiko Abe,Yoichi Aoki,Hidetaka Nomura 대한부인종양학회 2023 Journal of Gynecologic Oncology Vol.34 No.1

Radical hysterectomy is a standard surgery to treat early-stage uterine cervical cancer. The Laparoscopic Approach to Cervical Cancer (LACC) trial has shown that patients receiving minimally invasive radical hysterectomy have a poorer prognosis than those receiving open radical hysterectomy; however, the reason for this remains unclear. The LACC trial had 2 concerns: the learning curve and the procedural effects. Appropriate management of the learning curve effect, including surgeons’ skills, is required to correctly interpret the result of surgical randomized controlled trials. Whether the LACC trial managed the learning curve effect remains controversial, based on the surgeons’ inclusion criteria and the distribution of institutions with recurrent cases. An appropriate surgical procedure is also needed, and avoiding intraoperative cancer cell spillage plays an important role during cancer surgery. Cancer cell spillage during minimally invasive surgery to treat cervical cancer is caused by several factors, including 1) exposure of tumor, 2) the use of a uterine manipulator, and 3) direct handling of the uterine cervix. Unfortunately, these issues were not addressed by the LACC trial. We evaluated the results of minimally invasive radical hysterectomy while avoiding cancer cell spillage for early-stage cervical cancer. Our findings show that avoiding cancer cell spillage during minimally invasive radical hysterectomy may ensure an equivalent oncologic outcome, comparable to that of open radical hysterectomy. Therefore, evaluating the importance of avoiding cancer cell spillage during minimally invasive surgery with a better control of the learning curve and procedural effects is needed.

LOW TEMPERATURE CHARACTERISTICS OF POWER SEMICONDUCTOR DEVICES

Yoshishige Murakami,Toshifumi Ise,Atsushi Ishigami 전력전자학회 1995 ICPE(ISPE)논문집 Vol.1995 No.10

Characteristics of various power semiconductor devices, such as MOSFETs, IGBTs, SCRs and power diodes are discussed in this paper based on experimental and 2-dimen-sional device simulation results for temperature higher than liquid nitrogen(77K).

Endoscopy and Imaging Modalities/Basic Science of Gastrointestinal Disorders/Miscellaneous : Gastrointestinal Endoscopic Hemostasis: Are There Any Particular Strategies For Patients With Difficulty To Stop Bleeding?

( Shinya Oomori ),( Atsushi Ikehata ),( Aldhiko Murakami ) 대한소화기학회 2007 SIDDS Vol.9 No.-

Background/Aims: It is often hard to treat active (spuring or oozing) bleeding in the gastrointestinal tract. We aimed to investigate the clinical features and points of notices for patients with difficulty to stop bleeding. Methods: The total subjects were 606 patients, who were thought to suffer acute bleeding in the gastrointestinal tract and performed urgent endoscopy (418 panendoscopies and 188 colonoscopies). Of them, we noted the patients with Forrest type I bleeding (patient group A) and ones needed plural therapic endoscopy due to rebleeding (patient group C). The patients without Forrest type I bleeding and with only single endoscopic procedure were defined group B and group D, respectively. Between group A and B, and group C and D, we compared the following points: age, sex, regular medications (NSAIDs and anticoagulants), causal diseases, disease sites and methods of hemostasis. Results: The causal diseases were mainly hemorrhagic ulcers and post-EMR bleedings. In lower gastrointestinal tract bleeding. The frequencies of regular medication of anticoagulants were significantly higher in patients groups A and C than those in group B and D, respectively (p<0.05). As to hemostatic procedures, the frequency of plural treatments (combined pure ethanol injection, hemoclip, electrocoagulation, hypertonic saline or epinephrine injection etc.) was significantly higher in patients groups A than those in group B (P<0.05). There was one case who was performed an abdominal operation for hemostasis due to hemorrhagic duodenal ulcer. It was impossible for the case to secure enough visual field by endoscopy, owing to massive bleeding. Conclusions: In the endoscopic hemostasis, if one method is not effective, it is worth using plural methods together without sticking to only one method. And it is one of theimportant endowments for endoseopists to consult properly with surgeons about patients with difficulty to stop bleeding by endoscopic procedures.

Reappraisal of intergender differences in the urethral striated sphincter explains why a completely circular arrangement is difficult in females

Hiroshi Masumoto,Atsushi Takenaka,Jose Francisco Rodrí,guez-Vá,zquez,Gen Murakami,Akio Matsubara 대한해부학회 2012 Anatomy & Cell Biology Vol.45 No.2

To investigate why the development of a completely circular striated sphincter is so rare, we examined histological sections of 11 female and 11 male mid-term human fetuses. In male fetuses, the striated muscle initially extended in the frontal, rather than in the horizontal plane. However, a knee-like portion was absent in the female fetal urethra because, on the inferior side of the vaginal end, a wide groove for the future vestibule opened inferiorly. Accordingly, it was difficult for the developing striated muscle to surround the groove, even though there was not a great difference in width or thickness between the female vestibule and the male urethra. The development of a completely circular striated sphincter seems to be impossible in females because of interruption of the frontal plane by the groove-like vestibule. However, we cannot rule out the possibility that before descent of the vagina, the urethral striated muscle extends posteriorly.

Laparoscopic resection surgery for malignant transformation of extragonadal endometriosis by the “pincer” approach

Hiroyuki Kanao,Mai Nishimura,Atsushi Murakami 대한부인종양학회 2022 Journal of Gynecologic Oncology Vol.33 No.3

Up to 1% of women with endometriosis develop endometriosis-associated neoplasms [1]. Most endometriosis-associated malignant tumors develop from the ovarian endometriomas, whereas those developing from extragonadal lesions are extremely rare, estimated at 0.2% [2]. Because they are uncommon, a treatment protocol for the malignant transformation of extragonadal endometriosis lesions has not been clearly defined. When the lesion is confined to the site of origin and R0 resection is achieved, the 5-year survival rate is between 82% and 100%; therefore, complete resection should be performed [3]. The patient inthis video had previously undergone hysterectomy, bilateral salpingo-oophorectomy, left nephrectomy, and low-anterior resection of the rectum due to severe endometriosis. Ten years after the surgery, the patient had a 6 cm endometrioid adenocarcinoma developing from the residual endometriosis lesion at the left uterosacral ligament that involved the bladder, left ureter, and rectum. In this case, the tumor was attached to the pelvis due to infiltration of the left sacrospinous ligament. To completely remove the tumor, we used laterally extended endopelvic resection with abdominoperineal resection of the rectum. We used the laparoscopic-perineal-laparoscopic approach (pincer approach) because improved visualization of the left sacrospinous ligament increases the probability of achieving complete resection [4]. Pathological R0 resection was achieved without intraoperative or postoperative complications. Thus, for tumors that are firmly attached to the pelvic floor, the pincer approach can be useful for achieving R0 resection. The informed consent for use of this video was taken from the patient.

A System Concept for EFD/CFD Integration

Shigeya Watanabe,Shigeru Kuchi-ishi,Hiroyuki Kato,Takeshi Aoyama,Keiichi Murakami,Atsushi Hashimoto,Naoyuki Fujita,Yuichi Matsuo 한국항공우주학회 2008 한국항공우주학회 학술발표회 논문집 Vol.- No.-

A trail towards integration of EFD (Experimental Fluid Dynamics) and CFD (Computational Fluid Dynamics), that is. the development of a system called Digital/Analog Hybrid Wind Tunnel, is introduced. The aim of the system is to improve efficiency, accuracy, and reliability of aerodynamic characteristics evaluation in aerospace vehicle developments through mutual support between EFD and CFD. The function of the system consists of optimization of test planning utilizing pretest CFD calculations, an accurate correction of the wind tunnel wall and support interaction effects through CFD, CFD data refinement based on EFD data, the most probable aerodynamic characteristics estimation based on both EFD and CFD data, database including EFD and CFD data at an identical condition, and so forth. Key technical challenges in the system development, such as an automatic grid generation and high-speed solver development for CFD, a highly efficient data reduction technique for image measurement data. and techniques integrating EFD and CFD. are addressed.

Five-Year Survival of Alpha-Fetoprotein-Producing Gastric Cancer with Synchronous Liver Metastasis: A Case Report

Koneri, Kenji,Hirono, Yasuo,Fujimoto, Daisuke,Sawai, Katsuji,Morikawa, Mitsuhiro,Murakami, Makoto,Goi, Takanori,Iida, Atsushi,Katayama, Kanji,Yamaguchi, Akio The Korean Gastric Cancer Association 2013 Journal of gastric cancer Vol.13 No.1

Alpha-fetoprotein-producing gastric cancer is associated with poor prognosis because of frequent liver and lymph node metastasis. We present a case with synchronous liver metastasis who survived for 5 years. A 69-year-old man with upper abdominal pain was referred to our hospital. Gastrointestinal endoscopy revealed a Borrmann II-like tumor in the lower part of the stomach. Computed tomography revealed a tumor in the left lobe of the liver. Serum alpha-fetoprotein levels were markedly increased. We performed distal gastrectomy after administering oral tegafur/gimeracil/oteracil potassium and administered hepatic intra-arterial cisplatin injection. Liver metastasis showed partial response on computed tomography. Despite left hepatic lobectomy, further metastases to the liver and mediastinal lymph nodes became difficult to control. After sorafenib tosylate administration, stabilization of the disease was observed for 4 months. We conclude that hepatic intra-arterial chemotherapy and oral administration of sorafenib tosylate may potentially improve the prognosis in such cases.

Five-Year Survival of Alpha-Fetoprotein–Producing Gastric Cancer with Synchronous Liver Metastasis: A Case Report

Kenji Koneri,Yasuo Hirono,Daisuke Fujimoto,Katsuji Sawai,Mitsuhiro Morikawa,Makoto Murakami,Takanori Goi,Atsushi Iida,Kanji Katayama,Akio Yamaguchi 대한위암학회 2013 Journal of gastric cancer Vol.13 No.1

Alpha-fetoprotein–producing gastric cancer is associated with poor prognosis because of frequent liver and lymph node metastasis. We present a case with synchronous liver metastasis who survived for 5 years. A 69-year-old man with upper abdominal pain was referred to our hospital. Gastrointestinal endoscopy revealed a Borrmann II-like tumor in the lower part of the stomach. Computed tomography revealed a tumor in the left lobe of the liver. Serum alpha-fetoprotein levels were markedly increased. We performed distal gastrectomy after administering oral tegafur/gimeracil/oteracil potassium and administered hepatic intra-arterial cisplatin injection. Liver metastasis showed partial response on computed tomography. Despite left hepatic lobectomy, further metastases to the liver and mediastinal lymph nodes became difficult to control. After sorafenib tosylate administration, stabilization of the disease was observed for 4 months. We conclude that hepatic intra-arterial chemotherapy and oral administration of sorafenib tosylate may potentially improve the prognosis in such cases.