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RISS 인기검색어
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- 저자 : Nobuhiro Takeshima (검색결과 4 건)
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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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Hiroyuki Kanao,Koji Matsuo,Yoichi Aoki,Terumi Tanigawa,Hidetaka Nomura,Sanshiro Okamoto,Nobuhiro Takeshima 대한부인종양학회 2019 Journal of Gynecologic Oncology Vol.30 No.3
Objectives: Intraoperative tumor manipulation and dissemination may possibly compromise survival of women with early-stage cervical cancer who undergo minimally-invasive radical hysterectomy (RH). The objective of the study was to examine survival related to minimallyinvasive RH with a “no-look no-touch” technique for clinical stage IB1 cervical cancer. Methods: This retrospective study compared patients who underwent total laparoscopic radical hysterectomy (TLRH) with no-look no-touch technique (n=80) to those who underwent an abdominal radical hysterectomy (ARH; n=83) for stage IB1 (≤4 cm) cervical cancer. TLRH with no-look no-touch technique incorporates 4 specific measures to prevent tumor spillage: 1) creation of a vaginal cuff, 2) avoidance of a uterine manipulator, 3) minimal handling of the uterine cervix, and 4) bagging of the specimen. Results: Surgical outcomes of TLRH were significantly superior to ARH for operative time (294 vs. 376 minutes), estimated blood loss (185 vs. 500 mL), and length of hospital stay (14 vs. 18 days) (all, p<0.001). Oncologic outcomes were similar between the 2 groups, including disease-free survival (DFS) (p=0.591) and overall survival (p=0.188). When stratified by tumor size (<2 vs. ≥2 cm), DFS was similar between the 2 groups (p=0.897 and p=0.602, respectively). The loco-regional recurrence rate following TLRH was similar to the rate after ARH (6.3% vs. 9.6%, p=0.566). Multiple-pelvic recurrence was observed in only 1 patient in the TLRH group. Conclusion: Our study suggests that the no-look no-touch technique may be a useful surgical procedure to reduce recurrence risk via preventing intraoperative tumor spillage during TLRH for early-stage cervical cancer.
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Yuji Ikeda,Akiko Furusawa,Ryo Kitagawa,Aya Tokinaga,Fuminori Ito,Masayo Ukita,Hidetaka Nomura,Wataru Yamagami,Hiroshi Tanabe,Mikio Mikami,Nobuhiro Takeshima,Nobuo Yaegashi 대한부인종양학회 2016 Journal of Gynecologic Oncology Vol.27 No.3
Objective: Although radiation therapy (RT) and concurrent chemoradiotherapy (CCRT)are the global standards for adjuvant therapy treatment in cervical cancer, many Japaneseinstitutions choose chemotherapy (CT) because of the low frequency of irreversible adverseevents. In this study, we aimed to clarify the trends of adjuvant therapy for intermediate/highriskcervical cancer after radical surgery in Japan. Methods: A questionnaire survey was conducted by the Japanese Gynecologic OncologyGroup to 186 authorized institutions active in the treatment of gynecologic cancer. Results: Responses were obtained from 129 facilities. Adjuvant RT/CCRT and intensitymodulatedRT were performed in 98 (76%) and 23 (18%) institutions, respectively. On theother hand, CT was chosen as an alternative in 93 institutions (72%). The most commonregimen of CT, which was used in 66 institutions (51%), was a combination of cisplatin/carboplatin with paclitaxel. CT was considered an appropriate alternative option to RT/CCRTin patients with risk factors such as bulky tumors, lymph node metastasis, lymphovascularinvasion, parametrial invasion, and stromal invasion. The risk of severe adverse events wasconsidered to be lower for CT than for RT/CCRT in 109 institutions (84%). Conclusion: This survey revealed a variety of policies regarding adjuvant therapy amonginstitutions. A clinical study to assess the efficacy or non-inferiority of adjuvant CT iswarranted.
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