Prevention of lymphocele development in gynecologic cancers by the electrothermal bipolar vessel sealing device

Naotake Tsuda,Kimio Ushijima,Kouichiro Kawano,Shuji Takemoto,Shin Nishio,Gounosuke Sonoda,Toshiharu Kamura 대한부인종양학회 2014 Journal of Gynecologic Oncology Vol.25 No.3

Objective: A number of new techniques have been developed to prevent lymphocele formation after pelvic lymphadenectomy in gynecologic cancers. We assessed whether the electrothermal bipolar vessel sealing device (EBVSD) could decrease the incidence of postoperative lymphocele secondary to pelvic lymphadenectomy. Methods: A total of 321 patients with gynecologic cancer underwent pelvic lymphadenectomy from 2005 to 2011. Pelvic lymphadenectomy without EBVSD was performed in 134 patients, and pelvic lymphadenectomy with EBVSD was performed in 187 patients. We retrospectively compared the incidence of lymphocele and symptoms between both groups. Results: Four to 8 weeks after operation, 108 cases of lymphocele (34%) were detected by computed tomography scan examination. The incidence of lymphocele after pelvic lymphadenectomy was 56% (75/134) in the tie ligation group, and 18% (33/187) in the EBVSD group. We found a statistically significant difference in the incidence of lymphocele between both groups (p<0.01). To detect the independent risk factor for lymphocele development, we performed multivariate analysis with logistic regression for three variables (device, number of dissected lymph nodes, and operation time). Among these variables, we found a significant difference (p<0.001) for only one device. Conclusion: Use of the EBVSD during gynecological cancer operation is useful for preventing the development of lymphocele secondary to pelvic lymphadenectomy.

Identification of appropriate cone length to avoid positive cone margin in high grade cervical intraepithelial neoplasia

Kouichiro Kawano,Naotake Tsuda,Shin Nishio,Koji Yonemoto,Kazuto Tasaki,Rurika Tasaki,Kimio Ushijima 대한부인종양학회 2016 Journal of Gynecologic Oncology Vol.27 No.5

Objective: To identify key factors for predicting positive cone margin and appropriate conelength. Methods: We retrospectively reviewed the margin status of patients who received conizationwith high grade cervical intraepithelial neoplasia, along with other factors such as patientage, parity, preoperative cytology, size of disease, type of transformation zone, and conelength from patient records. Cut-off value of cone length was analyzed in women youngerthan 40 years old because we design conization with minimum length especially forwomen who wish for future pregnancy. Cut-off value of cone length was defined as lengthcorresponds to estimated probability of positive cone margin equal to 0.1 by logisticregression analysis with variables selected by stepwise methods. Results: Among 300 patients, 75 patients had positive cone margin. Multivariable analysisrevealed that squamous cell carcinoma at preoperative cytology (p=0.001), 2 or morequadrant disease (p=0.011), and shorter cone length (p<0.001) were risk factors for positivecone margin. Stepwise methods identified cone length and size of lesion as importantvariables. With this condition, cut-off value of cone length was estimated as 15 mm in singlequadrant disease and 20 mm in 2 or more quadrant disease, respectively. Conclusion: We identified the independent risk factors of positive cone margin and identifiedthe cut-off value of cone length to avoid positive cone margin in women younger than 40years old. Conization should be performed not only according to colposcopic findingsincluding type of transformation zone but size of disease and cone length.

Trends and characteristics of fertility-sparing treatment for atypical endometrial hyperplasia and endometrial cancer in Japan: a survey by the Gynecologic Oncology Committee of the Japan Society of Obstetrics and Gynecology

Kimio Ushijima,Naotake Tsuda,Wataru Yamagami,Akira Mitsuhashi,Mikio Mikami,Nobuo Yaegashi,Takayuki Enomoto 대한부인종양학회 2023 Journal of Gynecologic Oncology Vol.34 No.3

Objective: The objective of this study was to examine the current trends in fertility-sparing (FS) treatment for young atypical endometrial hyperplasia (AEH) and endometrial cancer (EC) patients in Japan. Methods: This study was conducted by the Committee on Gynecologic Oncology of the Japan Society of Obstetrics and Gynecology (JSOG) in the 2017–2018 fiscal year. A nationwide, retrospective questionnaire-style survey—as performed. We collected the data of 413 patients from 102 JSOG gynecological cancer registered institutions. Results: FS treatment was performed with medroxyprogesterone (MPA) (87.2%) or MPA + metformin (11.6%). Pathological complete remission (CR) after initial treatment was achieved in 78.2% of patients. The significant clinicopathological factors correlated to CR after initial treatment were histology (AEH vs. endometrioid carcinoma grade 1 [ECG1]), body mass index (BMI) (<25 vs. ≥25 kg/m2), and treatment period (<6 vs. ≥6 months). ECG1, time to complete remission (TTCR) ≥6 months, maintenance therapy (−), and pregnancy (−) were associated with a significantly higher risk of recurrence on multivariate analysis. The total pregnancy rate was 47%, and the live birth rate was 40.1%. Patients who received infertility treatments showed a higher live birth rate (50.6%) than those who did not (7.7%). Conclusion: In this survey, we confirmed that FS treatment in Japan is centered on MPA alone and in combination with metformin, and that the treatment efficacy is similar to that reported in previous reports. A multicenter survey study in Japan showed FS treatment for young AEH and EC patients in compliance with the indications is feasible.

Review : Epithelial borderline ovarian tumor: Diagnosis and treatment strategy

( Kimio Ushijima ),( Kouichiro Kawano ),( Naotake Tsuda ),( Shin Nishio ),( Atsumu Terada ),( Hiroyuki Kato ),( Kazuto Tasaki ),( Ken Matsukuma ) 대한산부인과학회 2015 Obstetrics & Gynecology Science Vol.58 No.3

Epithelial borderline ovarian tumors (BOT) are distinctive from benign tumors and carcinoma. They occur in younger women more often than carcinoma, and there is some difficulty making correct diagnosis of BOT. Two subtypes of BOT, serous and mucinous borderline tumor have different characteristics and very different clinical behavior. Serous borderline tumor (SBT) with micropapillary pattern shows more incidence of extra ovarian disease and often coexists with invasive implant. SBT with micropapillary pattern in advanced stage has showed a worse prognosis than typical SBT. Huge mucinous borderline tumors have histologic heterogeneity, and the accuracy of frozen section diagnosis is relatively low. Extensive sampling is required to reach a correct pathological diagnosis. Mucinous adenoma (intestinal type) also runs the risk of recurrence after cystectomy, or intraoperative rupture of cyst. Laparoscopic procedure for BOT has not increased the risk of recurrence. Fertility preserving procedures are generally accepted, except in advanced stage SBT with invasive implants. Only cystectomy shows a significant risk of recurrence. Re-staging surgery and full staging surgery is not necessary for all BOT. We should not attempt to treat them uniformly, by the single diagnosis of “borderline tumor”. It depends on histologic type. Close communication with the pathologist is necessary to gain more detail and ask more pathological samples in order to make the optimal treatment strategy for each individual patients.

Concurrent chemoradiotherapy with low-dose daily cisplatin for high risk uterine cervical cancer: a long-term follow-up study

Kimio Ushijima,Keizo Fujiyoshi,Kouichiro Kawano,Naotake Tsuda,Shin Nishio,Hidehiro Eto,Toshiharu Kamura 대한부인종양학회 2013 Journal of Gynecologic Oncology Vol.24 No.2

Objective: To evaluate the clinical efficacy of concurrent chemoradiotherapy (CCRT) using daily low-dose cisplatin for cervical cancer. Methods: Fifty-one patients with locally advanced cervical cancer (FIGO stage IB2, bulky IIA, IIB-IVA) who were treated with CCRT as primary therapy at Kurume University Hospital between 2000 and 2007 were retrospectively reviewed. CCRT consisted of 5 mg/m2/day of cisplatin 5 days per week, and external beam radiotherapy (EBRT) administrated to whole pelvis to 45-50.6 Gy. High-dose-rate intracavitary brachytherapy was delivered in a single dose of 4-5 Gy at point A, once a week after 20-30 Gy of EBRT. Results: The median follow-up duration was 42 months (range, 5 to 116 months). The overall response rate was 94.1%. Five year overall survival rate was 71.5% and 46.2% in stage I or II, and stage III or IVA, respectively. During follow-up period, 30 recurrences (58.8%) were found, the local failure rate was 39%, and distant failure rate was 35.2%, and both (local and distant) were 15.7%. Hematological toxicities were the most frequent acute toxicities. Grade 3 and 4 neutropenia was observed in 37.3%. Late intestinal toxicities appeared in 7 cases (13.7%), which occurred between 6 and 114 months after treatment. Four cases required bowel surgery. Conclusion: CCRT using daily low-dose cisplatin was tolerable and showed favorable initial response as the primary therapy for locally advanced uterine cervical cancer. But there was no remarkable long-term benefit for patients’ survival or local disease control in this study. The incidence of late intestinal toxicity still requires further investigation.

Review : Controversies Surrounding Type Iii Radical Abdominal Hysterectomy And Its Procedure Using New Instruments

( Kimio Ushijima ),( Shuji Takemoto ),( Kouichiro Kawano ),( Shin Nishio ),( Atsumu Terada ),( Naotake Tsuda ),( Gonosuke Sonoda ),( Syun Ichiro Ota ),( Toshiharu Kamura ) 대한산부인과학회 2012 Obstetrics & Gynecology Science Vol.55 No.4

Type III radical abdominal hysterectomy (RAH) is standard care for early stage cervical cancer. For the past few decades, there has been a remarkable shift from surgery to radiation, in the treatment choice for stage 1b2 and 2b cervical cancer in Japan. It is still controversial, however because some of those cases recommended RAH as a suitable treatment strategy. About 8% to 10% of RAH are abandoned because of tumor status. Recent preoperative screening cannot always detect them preoperatively. Various kinds of new surgical instruments, such as bipolar scissors and the electro vessel sealing system LigaSure have contributed to reducing the operation time and blood loss, in performing RAH. Furthermore, various kinds of devices are on the market. Surgeons should choose suitable instruments depending on the state of the disease and the patient.