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RISS 인기검색어
- 검색키워드
- 저자 : Atsushi Fusegi (검색결과 3 건)
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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.
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Hiroyuki Kanao,Atsushi Fusegi,Makiko Omi,Ariane C. Youssefzadeh,Hidetaka Nomura,Koji Matsuo 대한부인종양학회 2023 Journal of Gynecologic Oncology Vol.34 No.3
The Laparoscopic Approach to Cervical Cancer (LACC) trial demonstrated that minimally invasive radical hysterectomy was inferior to the open approach [1]; this unexpected result could be attributed to the spillage of cancer cells [2]. Following the LACC trial, laparoscopic radical hysterectomy without an intrauterine manipulator upon completion of a vaginal cuff closure became the new standard treatment method [3]. However, the lack of intrauterine manipulator results in poor visualization and inadequate paracervical tissue resection. This study describes the no-look no-touch technique to address this difficulty. The core procedures in our no-look, no-touch laparoscopic radical hysterectomy are: (Step 1) Creation and closure of a vaginal cuff; (Step 2) Manipulation of the uterus without an intra-uterine manipulator; and (Step 3) Exposure of the paracervical tissues by the suspension technique. The patient eligibility for our procedure is as follows: 1) previously untreated cervical cancer (those who underwent diagnostic conization could be included); 2) clinical stage IA2, IB1, IB2, and IIA1 based on the 2018 International Federation of Gynecology and Obstetrics staging system; 3) histologically confirmed cervical cancer, including squamous cell carcinoma, adenocarcinoma, and adenosquamous carcinoma. The important indication for this procedure is in cases where the tumor is less than 4 cm in diameter. We previously reported that our no-look no-touch technique enables smooth performance of laparoscopic radical hysterectomy without worsening oncologic outcomes [4]. According to a recent systematic review and meta-analysis [5], minimally invasive radical hysterectomy with vaginal cuff closure is a safe treatment option; however, it involves a steep learning curve, which has impeded its increased application. This video will hopefully make minimally invasive radical hysterectomy with protective maneuvers against cancer cell spillage more accessible. Based on our experiences, we propose that our transvaginal cervical tumor-concealing no-look no-touch technique will mitigate the risk of surgical spill of tumor cells during minimally invasive radical hysterectomy. The informed consent for use of this video was taken from the patient.
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Hiroyuki Kanao,Yoichi Aoki,Atsushi Fusegi,Nobuhiro Takeshima 대한부인종양학회 2020 Journal of Gynecologic Oncology Vol.31 No.5
Objective: Previously, indications for laterally extended endopelvic resection (LEER) haveexcluded patients with sciatica because R0 resection has not been deemed possible [1]. Because laparoscopy optimizes visualization and thus provides for meticulous dissection, wehypothesized that R0 resection can be achieved by means of laparoscopic LEER in patientswith sciatica. This video article aimed to clarify the technical feasibility of laparoscopic LEERperformed for laterally recurrent previously irradiated cervical cancer with concomitant sciatica. Methods: We investigated technical feasibility of laparoscopic LEER performed as a salvagetherapy following abdominal radical hysterectomy and concurrent chemoradiotherapy ina patient suffering laterally recurrent cervical carcinoma with concomitant sciatica. Therecurrent tumor involved the right external and internal iliac artery and vein, ileocecum,rectosigmoid colon, right ureter, right obturator nerve, and right sciatic nerve, with aresulting fistula between the tumor and the rectosigmoid colon, and severe sciatica. Resection of all these structures was essential for achievement of R0 status, and suchresection means concomitant femoral bypass with prosthetic graft interposition andgastrointestinal/urinary tract resection. Results: Laparoscopic LEER with femoral-femoral artery bypass could be conductedwithout any postoperative complications. Pathological R0 resection could be achieved, andlocal recurrence could have been controlled. However, the patient died from liver and lungmetastasis at 1 year after this resection surgery. Conclusion: Laparoscopic LEER for a laterally recurrent previously irradiated cervical cancerwith concomitant sciatica was technically feasible, however, further study involving a greaternumber of patients and longer follow-up period is warranted to determine the stringentindications.
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