Yutaro Sasaki, Kyotaro Fukuta, Tetsuhiro Yano, Mitsuki Nishiyama, Saki Kobayashi, Ryoei Minato, Kei Daizumoto, Ryotaro Tomida, Yoshito Kusuhara, Tomoya Fukawa, Kunihisa Yamaguchi, Yasuyo Yamamoto and Junya Furukawa : Vas Guide: a novel device for looping blood vessels in robot-assisted surgery., Surgical Endoscopy, 2025.
(要約)
Looping blood vessels in robot-assisted surgery remains challenging because of limitations in instrument articulation, joint length, and the lack of tactile feedback. To address this critical issue, we developed the Vas Guide, a novel device, for safe blood vessel handling. This study aims to establish the efficacy, safety, and durability of the Vas Guide.The Vas Guide is a flat, curved stainless-steel strip with blunt, rounded ends and a hole near the distal end. After sufficient dissection of the posterior surface of the target blood vessel, the Vas Guide with a vessel loop tied to the distal end was passed around the blood vessel in a single step using a suturing-like motion, thereby enabling secure vessel management. It is reusable and has a unit price of approximately $600. We analyzed 83 patients undergoing robot-assisted partial nephrectomy or nephroureterectomy at Tokushima University Hospital: 39 in the Vas Guide group and 44 in the conventional group. Outcomes including looping time, looping-related complication rates, such as collisions between instruments and bleeding, and additional instrument usage were recorded. The National Aeronautics and Space Administration task load index (NASA-TLX) scores were assessed.The patients' characteristics were comparable between the two groups. The Vas Guide group demonstrated significantly better outcomes, including faster looping times (31 vs. 90 s, p < 0.001), fewer looping-related complications (0% vs. 30%, p < 0.001), no additional instrument usage (0% vs. 50%, p < 0.001), and better NASA-TLX scores (26.5 vs. 75.7, p < 0.001). The Vas Guide showed no usability issues, with only minor surface scratches and a slight radius change (8.60 mm to 8.69 mm).This reusable device combines high efficacy, safety, and durability and can be implemented at a relatively low cost.
Yoichiro Tohi, Keita Kobayashi, Kei Daizumoto, Yohei Sekino, Hideo Fukuhara, Heima Niigawa, Satoshi Katayama, Ryutaro Shimizu, Atsushi Takamoto, Kenichi Nishimura, Taichi Nagami, Yushi Hayashida, Hiromi Hirama, Koji Shiraishi, Ryotaro Tomida, Kohei Kobatake, Keiji Inoue, Yoshiyuki Miyaji, Kensuke Bekku, Shuichi Morizane, Noriyoshi Miura, Koichiro Wada and Mikio Sugimoto : Real-world clinical usage and efficacy of apalutamide in men with nonmetastatic castration-resistant prostate cancer: a multi-institutional study in the CsJUC., Japanese Journal of Clinical Oncology, 55, 6, 643-649, 2025.
(要約)
To evaluate the real-world clinical usage and effectiveness of apalutamide in men with nonmetastatic castration-resistant prostate cancer (nmCRPC).We retrospectively reviewed the data of 186 men who received apalutamide across 17 institutions. The primary outcomes were the clinical usage of apalutamide for nmCRPC: prior usage of other androgen receptor signaling inhibitors (ARSIs), prior radical treatment, and the distribution of the prostate-specific antigen (PSA) doubling time (PSA-DT) at the initial administration of apalutamide. The secondary outcomes were the efficacy of apalutamide: PSA response (50% or 90% decline), progression-free survival, and skin-adverse events (AEs).We identified 75 patients with nmCRPC. A total of 31 (41.3%) patients received prior treatment with other ARSIs. A total of 42 men (56%) did not receive any prior radical treatment. The PSA-DT was <3.0, 3.0-5.9, 6.0-10, and > 10 months in 34.7%, 40%, 14.7%, and 10.6% of the patients, respectively. Patients receiving prior treatment with other ARSIs showed a significantly lower PSA response (PSA 50% decline, 88.4% vs. 18.8%; PSA 90% decline, 60.5% vs. 6.2%, P < .001, respectively) and significantly shorter progression-free survival (median: 37 months vs. 4 months; log-rank P < .001) than those without prior ARSI treatment, although cancer status did not differ between the groups. Skin-AEs were observed in 42.7%.This real-world study revealed that apalutamide was used for the treatment after other ARSIs in >40% of patients with nmCRPC and showed limited efficacy in this context, although the effectiveness of apalutamide without prior other ARSI treatment was comparable with that reported in clinical trial results.
Yutaro Sasaki, Yasuyo Yamamoto, Kyotaro Fukuta, Kazuyoshi Izumi, Fumiya Kadoriku, Kei Daizumoto, Keito Shiozaki, Ryotaro Tomida, Yoshito Kusuhara, Tomoya Fukawa, Yutaka Yanagihara, Kunihisa Yamaguchi, Hirofumi Izaki, Masayuki Takahashi, Kenjiro Okamoto, Masahito Yamanaka and Junya Furukawa : Cutaneous ureterostomy following robot-assisted radical cystectomy: a multicenter comparative study of transperitoneal versus retroperitoneal techniques., World Journal of Urology, 42, 1, 2024.
(要約)
Compared with the r-CUS group, the t-CUS group had significantly shorter operative times (p < 0.001); significantly less estimated blood loss (p < 0.001); and significantly lower incidence of complications (Clavien-Dindo classification grade ≤ 2) within 30 days (p = 0.005). Unexpectedly, the incidence of ileus within 30 days was lower, though the difference was not statistically significant (p = 0.064). During the median follow-up period of 24.3 months, no ileus was observed in either group after 30 days postoperatively. There was no significant difference in the stent-free rate between the groups (p = 0.449). There were also no significant differences in the rates of change in estimated glomerular filtration rate from preoperatively at 3, 6, 12, and 24 months postoperatively between the groups (p = 0.590, p = 0.627, p = 0.741, and p = 0.778, respectively).
Yutaro Sasaki, Narushi Yokota, Shuhei Nozaki, Satoshi Harada, Tetsuhiro Yano, Mitsuki Nishiyama, Saki Kobayashi, Ryoei Minato, Kei Daizumoto, Ryotaro Tomida, Yoshito Kusuhara, Tomoya Fukawa, Kunihisa Yamaguchi, Yasuyo Yamamoto, Masayuki Takahashi, Kazuya Kanda, Hiroomi Kanayama and Junya Furukawa : Robot-assisted nephroureterectomy using the GelPoint Platform with a focus on optimizing the port position and specimen retrieval., Asian Journal of Endoscopic Surgery, 17, 4, e13386, 2024.
(要約)
One of the factors that makes robot-assisted nephroureterectomy difficult is that the optimal port position differs between nephrectomy and bladder cuff excision. In addition, how best to retrieve the specimen after resection while minimizing the size of the wound is a challenge in robot-assisted surgery. To solve these problems, we designed a surgical technique for robot-assisted nephroureterectomy using the GelPoint Platform with a focus on port position optimization and specimen retrieval. This study describes the surgical technique of GelPoint robot-assisted nephroureterectomy and reports our initial experience with this technique. Between January 2023 and May 2024, seven patients underwent robot-assisted nephroureterectomy using the GelPoint Platform and 11 underwent conventional robot-assisted nephroureterectomy. We compared the patients' characteristics and surgical outcomes between the two groups. Compared with the conventional robot-assisted nephroureterectomy group, the median operative time tended to be shorter in the GelPoint robot-assisted nephroureterectomy group (280 vs. 357 min, respectively; p = .135). The maximum incision length tended to be longer in the GelPoint robot-assisted nephroureterectomy group (7.0 vs. 6.0 cm, respectively; p = .078). The incidence of 30-day complications was similar between the two groups (28.5% vs. 18.2%, respectively; p = 1.000). No complications were associated with the use of the GelPoint Platform. The surgical outcomes of GelPoint robot-assisted nephroureterectomy are comparable to those of conventional robot-assisted nephroureterectomy, and it can be performed safely and effectively. GelPoint robot-assisted nephroureterectomy can be considered a feasible alternative for selected patients with upper tract urothelial carcinoma.
Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive cancer. Recent studies indicated that cancer-associated adipocytes (CAAs) play crucial roles in tumor progression; however, the precise mechanism remains unknown. Here, we analyzed specific exosomal microRNAs (miRNA) signatures derived from pancreatic CAAs to investigate their role in cancer progression. CAAs were generated by co-culturing human adipocytes with human pancreatic cancer cells, and exosomes were isolated from the CAA-conditioned medium (CAA-CM). Small RNA-seq analysis was used to identify differentially expressed miRNAs in these exosomes. The effects of miRNAs on cell proliferation, migration/invasion, and drug sensitivity were examined. Luciferase reporter assays, real-time polymerase chain reaction, and western blotting were performed to investigate the molecular mechanisms of the miRNAs. The clinical relevance of the miRNAs was investigated using publicly available data and our cohort of patients with PDAC. miR-199a-3p expression was significantly increased in CAA-CM-derived exosomes. CAA-derived exosomes transferred miR-199a-3p to pancreatic cancer cells. Transfection with miR-199a-3p increased the proliferation, invasion, migration, and drug resistance of pancreatic cancer cells by downregulating SOCS7, increasing STAT3 phosphorylation, and upregulating SAA1 expression. High tissue miR-199a-3p expression is correlated with poor prognosis in patients with PDAC. Liquid biopsies revealed that exosomal miR-199a-3p could accurately differentiate patients with PDAC from healthy controls. Multivariate survival analysis indicated that miR-199a is an independent prognostic factor for PDAC. miR-199a-3p in CAA-derived exosomes contributes to the malignant transformation of pancreatic cancer via the SOCS7/STAT3/SAA1 pathway, suggesting its potential as a biomarker and therapeutic target for PDAC.
Yutaro Sasaki, Kyotaro Fukuta, Fumiya Kadoriku, Kei Daizumoto, Keito Shiozaki, Ryotaro Tomida, Yoshito Kusuhara, Tomoya Fukawa, Yutaka Yanagihara, Ryoichi Nakanishi, Kunihisa Yamaguchi, Yasuyo Yamamoto, Hirofumi Izaki, Masayuki Takahashi, Kenjiro Okamoto and Junya Furukawa : Retroperitoneal cutaneous ureterostomy following radical cystectomy: A multicenter comparative study of robotic versus open surgery., International Journal of Urology, 31, 12, 1408-1413, 2024.
(要約)
The aim of this study was to evaluate the differences in perioperative outcomes of cutaneous ureterostomy (CUS) between open surgery (open radical cystectomy, ORC) and robot-assisted surgery (robot-assisted radical cystectomy, RARC), including the stent-free rate, readmission rates due to urinary tract infection (UTI), and changes in renal function. Between 2005 and 2023, a total of 37 patients underwent CUS following ORC, while 24 patients underwent CUS following RARC. Perioperative outcomes were compared between these two groups. The patients in the RARC group were significantly older (p = 0.007) and had a significantly higher proportion of high-risk cases with ASA-PS 3 (p = 0.002). In addition, RARC was associated with a significantly lower estimated blood loss (p < 0.001) and a reduced transfusion rate (p = 0.003). Postoperative complication rates and the stent-free rate were comparable between the ORC and RARC groups. Throughout a median follow-up period of 2.6 years, rates of readmission due to UTI did not differ significantly between the two groups. Moreover, there were no differences in the change in estimated glomerular filtration rate before and after surgery and the 3-year survival rates were similar across both groups. CUS following RARC appears to offer a safer alternative compared with CUS following ORC, and the stent-free rates are comparable. The significantly lower estimated blood loss and transfusion rate associated with RARC are particularly favorable for elderly patients, those who are frail, and individuals with multiple comorbidities.
Yutaro Sasaki, Yoshito Kusuhara, Takuro Oyama, Mitsuki Nishiyama, Saki Kobayashi, Kei Daizumoto, Ryotaro Tomida, Yoshiteru Ueno, Tomoya Fukawa, Kunihisa Yamaguchi, Yasuyo Yamamoto, Masayuki Takahashi, Hiroomi Kanayama and Junya Furukawa : Radical prostatectomy using the Hinotori robot-assisted surgical system: Docking-free design may contribute to reduction in postoperative pain., The International Journal of Medical Robotics + Computer Assisted Surgery : MRCAS, 20, 3, e2648, 2024.
(要約)
The docking-free design of the Japanese Hinotori surgical robotic system allows the robotic arm to avoid trocar grasping, thereby minimising excessive abdominal wall stress. The aim of this study was to evaluate the safety and efficacy of robotic-assisted radical prostatectomy (RARP) using the Hinotori system and to explore the potential contribution of its docking-free design to postoperative pain reduction. This study reviewed the clinical records of 94 patients who underwent RARP: 48 patients in the Hinotori group and 46 in the da Vinci Xi group. Hinotori group had significantly longer operative and console times (p = 0.030 and p = 0.029, respectively). Perioperative complications and oncologic outcomes did not differ between the two groups. On postoperative day 4, the rate of decline from the maximum visual analogue scale score was marginally significant in the Hinotori group (p = 0.062). The docking-free design may contribute to reducing postoperative pain.
Yutaro Sasaki, Yoshito Kusuhara, Takuro Oyama, Mitsuki Nishiyama, Saki Kobayashi, Kei Daizumoto, Ryotaro Tomida, Yoshiteru Ueno, Tomoya Fukawa, Kunihisa Yamaguchi, Yasuyo Yamamoto, Masayuki Takahashi, Hiroomi Kanayama and Junya Furukawa : Radical prostatectomy using the Hinotori robot-assisted surgical system: Docking-free design may contribute to reduction in postoperative pain., The International Journal of Medical Robotics + Computer Assisted Surgery : MRCAS, 20, 3, e2648, 2024.
(要約)
The docking-free design of the Japanese Hinotori surgical robotic system allows the robotic arm to avoid trocar grasping, thereby minimising excessive abdominal wall stress. The aim of this study was to evaluate the safety and efficacy of robotic-assisted radical prostatectomy (RARP) using the Hinotori system and to explore the potential contribution of its docking-free design to postoperative pain reduction. This study reviewed the clinical records of 94 patients who underwent RARP: 48 patients in the Hinotori group and 46 in the da Vinci Xi group. Hinotori group had significantly longer operative and console times (p = 0.030 and p = 0.029, respectively). Perioperative complications and oncologic outcomes did not differ between the two groups. On postoperative day 4, the rate of decline from the maximum visual analogue scale score was marginally significant in the Hinotori group (p = 0.062). The docking-free design may contribute to reducing postoperative pain.
Fumiya Kadoriku, Yutaro Sasaki, Kyotaro Fukuta, Mitsuki Nishiyama, Seiya Utsunomiya, Saki Kobayashi, Keito Shiozaki, Kei Daizumoto, Yoshiteru Ueno, Kosuke Seto, Ryotaro Tomida, Yoshito Kusuhara, Tomoya Fukawa, Ryoichi Nakanishi, Kunihisa Yamaguchi, Yasuyo Yamamoto, Hirofumi Izaki, Masayuki Takahashi and Junya Furukawa : Robot-assisted intracorporeal ileal conduit urinary diversion: A two-center comparative study of Bricker versus Wallace ureteroileal anastomosis, Asian Journal of Endoscopic Surgery, 17, 2, e13307, 2024.
(要約)
This study was performed to evaluate the differences in the perioperative results, renal function, and incidence of hydronephrosis over time between the use of Bricker anastomosis and Wallace anastomosis for robot-assisted intracorporeal ileal conduit urinary diversion (RICIC). Fifty-five patients who underwent RICIC at two institutions were evaluated (Bricker, n = 23; Wallace, n = 32). We investigated changes in estimated glomerular filtration rate and hydronephrosis before surgery and at 3, 6, and 12 months after surgery. The patients in the Bricker group were significantly older than those in the Wallace group. The urinary diversion time was significantly longer in the Bricker group. No significant difference in postoperative renal function was observed. Additionally, no significant difference was observed in the incidence of postoperative hydronephrosis. However, the incidence of right hydronephrosis tended to be high overall, especially in the Wallace group. No patients in either group required repair surgery or ureteral stent placement. In patients undergoing RICIC, there was no difference in postoperative renal function or the incidence of hydronephrosis between Wallace and Bricker anastomosis. Symptomatic hydronephrosis was not observed in either group. The present study showed that each method was equally effective and safe.
Yutaro Sasaki, Katsuhito Hori, Kei Daizumoto, Yoshito Kusuhara, Tomoya Fukawa and Masayuki Takahashi : A new trick for scrotal surgery using Doyen intestinal forceps., International Journal of Urology, 31, 4, 446-447, 2024.
Fumiya Kadoriku, Yutaro Sasaki, Kyotaro Fukuta, Mitsuki Nishiyama, Seiya Utsunomiya, Saki Kobayashi, Keito Shiozaki, Kei Daizumoto, Yoshiteru Ueno, Kosuke Seto, Ryotaro Tomida, Yoshito Kusuhara, Tomoya Fukawa, Ryoichi Nakanishi, Kunihisa Yamaguchi, Yasuyo Yamamoto, Hirofumi Izaki, Masayuki Takahashi and Junya Furukawa : Robot-assisted intracorporeal ileal conduit urinary diversion: A two-center comparative study of Bricker versus Wallace ureteroileal anastomosis, Asian Journal of Endoscopic Surgery, 17, 2, e13307, 2024.
(要約)
This study was performed to evaluate the differences in the perioperative results, renal function, and incidence of hydronephrosis over time between the use of Bricker anastomosis and Wallace anastomosis for robot-assisted intracorporeal ileal conduit urinary diversion (RICIC). Fifty-five patients who underwent RICIC at two institutions were evaluated (Bricker, n = 23; Wallace, n = 32). We investigated changes in estimated glomerular filtration rate and hydronephrosis before surgery and at 3, 6, and 12 months after surgery. The patients in the Bricker group were significantly older than those in the Wallace group. The urinary diversion time was significantly longer in the Bricker group. No significant difference in postoperative renal function was observed. Additionally, no significant difference was observed in the incidence of postoperative hydronephrosis. However, the incidence of right hydronephrosis tended to be high overall, especially in the Wallace group. No patients in either group required repair surgery or ureteral stent placement. In patients undergoing RICIC, there was no difference in postoperative renal function or the incidence of hydronephrosis between Wallace and Bricker anastomosis. Symptomatic hydronephrosis was not observed in either group. The present study showed that each method was equally effective and safe.
Yutaro Sasaki, Kazuyoshi Izumi, Kyotaro Fukuta, Fumiya Kadoriku, Yuichiro Atagi, Kei Daizumoto, Keito Shiozaki, Ryotaro Tomida, Yoshito Kusuhara, Tomoya Fukawa, Yutaka Yanagihara, Kunihisa Yamaguchi, Yasuyo Yamamoto, Hirofumi Izaki, Masayuki Takahashi, Kenjiro Okamoto, Masahito Yamanaka and Junya Furukawa : Impact of lymph node dissection on surgical and oncological outcomes in patients undergoing robot-assisted radical cystectomy for bladder cancer: a multicenter retrospective study, Journal of Robotic Surgery, 18, 1, 141, 2024.
(要約)
This study was performed to clarify the therapeutic and diagnostic roles of lymph node dissection (LND) by examining the impact of LND and lymph node yield (LNY) on oncological outcomes in patients undergoing robot-assisted radical cystectomy (RARC). Between 2014 and 2021, 216 patients underwent LND during RARC at Tokushima University Hospital and affiliated hospitals. Among the 216 patients, we compared 115 patients with an LNY of 20 and 101 with an LNY of < 20 to investigate the impact of LNY on surgical and oncological outcomes. Furthermore, we investigated the impact of LNY and the extent of LND on oncological outcomes by dividing the extent of LND into two groups (standard and extended). The 3-year rates of overall survival (OS) (p = 0.256), cancer-specific survival (CSS) (p = 0.791), and recurrence-free survival (RFS) (p = 0.953) did not differ between the two groups divided by the LNY. A higher LNY was associated with a significantly higher lymph node positivity rate (p = 0.020). The incidence of LND-related major complications was not significantly different between the two groups (p = 0.910). The 3-year survival rates did not differ between the two groups divided by the extent of LND: OS (p = 0.366), CSS (p = 0.814), and RFS (p = 0.689). The LNY and extent of LND were not associated with oncological outcomes in patients undergoing LND during RARC, whereas a higher LNY was associated with lymph node positivity. In the era of adjuvant therapy with immune checkpoint inhibitors, LND during RARC has an important diagnostic role in the detection of pathological node positivity.
Yutaro Sasaki, Kazuyoshi Izumi, Kyotaro Fukuta, Fumiya Kadoriku, Yuichiro Atagi, Kei Daizumoto, Keito Shiozaki, Ryotaro Tomida, Yoshito Kusuhara, Tomoya Fukawa, Yutaka Yanagihara, Kunihisa Yamaguchi, Yasuyo Yamamoto, Hirofumi Izaki, Masayuki Takahashi, Kenjiro Okamoto, Masahito Yamanaka and Junya Furukawa : Impact of lymph node dissection on surgical and oncological outcomes in patients undergoing robot-assisted radical cystectomy for bladder cancer: a multicenter retrospective study, Journal of Robotic Surgery, 18, 1, 141, 2024.
(要約)
This study was performed to clarify the therapeutic and diagnostic roles of lymph node dissection (LND) by examining the impact of LND and lymph node yield (LNY) on oncological outcomes in patients undergoing robot-assisted radical cystectomy (RARC). Between 2014 and 2021, 216 patients underwent LND during RARC at Tokushima University Hospital and affiliated hospitals. Among the 216 patients, we compared 115 patients with an LNY of ≥ 20 and 101 with an LNY of < 20 to investigate the impact of LNY on surgical and oncological outcomes. Furthermore, we investigated the impact of LNY and the extent of LND on oncological outcomes by dividing the extent of LND into two groups (standard and extended). The 3-year rates of overall survival (OS) (p = 0.256), cancer-specific survival (CSS) (p = 0.791), and recurrence-free survival (RFS) (p = 0.953) did not differ between the two groups divided by the LNY. A higher LNY was associated with a significantly higher lymph node positivity rate (p = 0.020). The incidence of LND-related major complications was not significantly different between the two groups (p = 0.910). The 3-year survival rates did not differ between the two groups divided by the extent of LND: OS (p = 0.366), CSS (p = 0.814), and RFS (p = 0.689). The LNY and extent of LND were not associated with oncological outcomes in patients undergoing LND during RARC, whereas a higher LNY was associated with lymph node positivity. In the era of adjuvant therapy with immune checkpoint inhibitors, LND during RARC has an important diagnostic role in the detection of pathological node positivity.
Yutaro Sasaki, Masayuki Takahashi, Keito Shiozaki, Katsuhito Hori, Fumiya Kadoriku, Kei Daizumoto, Ryotaro Tomida, Yoshiteru Ueno, Yoshito Kusuhara, Tomoya Fukawa, Kunihisa Yamaguchi, Yasuyo Yamamoto, Koichi Tomita, Koichi Sairyo and Hiroomi Kanayama : The importance of laparoscopic surgery for young urologists remains unwavering even in the era of robot assisted surgery, Asian Journal of Endoscopic Surgery, 17, 1, e13254, 2023.
(要約)
Robot-assisted surgery (RAS) cannot be achieved without the performance of laparoscopic surgical techniques by a patient-side surgeon (PSS). In many medical institutions in Japan, young urologists often take on the role of a PSS. Participating in RAS as a PSS provides a good opportunity to acquire not only the knowledge necessary for surgery, but also skills in laparoscopic surgical techniques. Learning laparoscopic surgery as a PSS may contribute to improving the quality of RAS. Furthermore, it will lead to skill improvement as an operator in laparoscopic surgery. However, notably, opportunities for young urologists to perform laparoscopic surgery are decreasing in the current era of RAS. Under these circumstances, we believe that cadaver surgical training will become increasingly important in the future. We believe that performance of cadaver surgical training will contribute to increased motivation, enhance the understanding of surgical procedures, and facilitate the acquisition of surgical techniques.
Yoichiro Tohi, Takuma Kato, Keita Kobayashi, Kei Daizumoto, Hideo Fukuhara, Shin Ohira, Satoshi Katayama, Ryutaro Shimizu, Atsushi Takamoto, Kenichi Nishimura, Kenichiro Ikeda, Taichi Nagami, Yushi Hayashida, Hiromi Hirama, Hirohito Naito, Ryotaro Tomida, Yutaro Sasaki, Shinkuro Yamamoto, Shinjiro Shimizu and Mikio Sugimoto : Real-world prostate-specific antigen response and progression to castration-resistant prostate cancer among men with metastatic castration-sensitive prostate cancer treated with apalutamide: a multi-institutional study in the Chu-shikoku Japan Urological Consortium., Japanese Journal of Clinical Oncology, 54, 2, 167-174, 2023.
(要約)
Japanese men receiving apalutamide often experience skin-adverse events (AEs), possibly requiring treatment interruption or dose reduction. However, concerns have arisen regarding the impact of these adjustments on the efficacy of apalutamide. Our study evaluated the efficacy, safety, and persistence of apalutamide in men with metastatic castration-sensitive prostate cancer (mCSPC). We retrospectively reviewed the medical records of 108 men with mCSPC from 14 Japanese institutions. The primary outcomes were the efficacy of apalutamide: prostate-specific antigen (PSA) response (50%, 90% and < 0.2 decline) and progression to castration-resistant prostate cancer (CRPC). The secondary outcomes were the skin-AE and compliance of apalutamide. PSA50%, PSA90% and PSA < 0.2 declines were observed in 89.8, 84.3 and 65.7%, and the median time to CRPC progression was not reached. PSA < 0.2 decline and an initial full dose of apalutamide were significantly associated with a longer time to CRPC. The most common AE was skin-AE (50.9%), and there was no association between the occurrence of skin-AE and the time to CRPC (P = 0.72). The median apalutamide persistence was 29 months, which was longer in the initial full dose recipients than in the reduced dose recipients. The dosage is reduced in about 60% of patients within the first year of treatment in the initial full dose recipients. Our findings indicate the effectiveness of apalutamide in Japanese men with mCSPC, despite a substantial portion requiring dose reduction within a year among the initial full dose recipients.
Yutaro Sasaki, Masayuki Takahashi, Keito Shiozaki, Katsuhito Hori, Fumiya Kadoriku, Kei Daizumoto, Ryotaro Tomida, Yoshiteru Ueno, Yoshito Kusuhara, Tomoya Fukawa, Kunihisa Yamaguchi, Yasuyo Yamamoto, Koichi Tomita, Koichi Sairyo and Hiroomi Kanayama : The importance of laparoscopic surgery for young urologists remains unwavering even in the era of robot assisted surgery, Asian Journal of Endoscopic Surgery, 17, 1, e13254, 2023.
(要約)
Robot-assisted surgery (RAS) cannot be achieved without the performance of laparoscopic surgical techniques by a patient-side surgeon (PSS). In many medical institutions in Japan, young urologists often take on the role of a PSS. Participating in RAS as a PSS provides a good opportunity to acquire not only the knowledge necessary for surgery, but also skills in laparoscopic surgical techniques. Learning laparoscopic surgery as a PSS may contribute to improving the quality of RAS. Furthermore, it will lead to skill improvement as an operator in laparoscopic surgery. However, notably, opportunities for young urologists to perform laparoscopic surgery are decreasing in the current era of RAS. Under these circumstances, we believe that cadaver surgical training will become increasingly important in the future. We believe that performance of cadaver surgical training will contribute to increased motivation, enhance the understanding of surgical procedures, and facilitate the acquisition of surgical techniques.
Yoichiro Tohi, Takuma Kato, Keita Kobayashi, Kei Daizumoto, Hideo Fukuhara, Shin Ohira, Satoshi Katayama, Ryutaro Shimizu, Atsushi Takamoto, Kenichi Nishimura, Kenichiro Ikeda, Taichi Nagami, Yushi Hayashida, Hiromi Hirama, Hirohito Naito, Ryotaro Tomida, Yutaro Sasaki, Shinkuro Yamamoto, Shinjiro Shimizu and Mikio Sugimoto : Real-world prostate-specific antigen response and progression to castration-resistant prostate cancer among men with metastatic castration-sensitive prostate cancer treated with apalutamide: a multi-institutional study in the Chu-shikoku Japan Urological Consortium., Japanese Journal of Clinical Oncology, 54, 2, 167-174, 2023.
(要約)
Japanese men receiving apalutamide often experience skin-adverse events (AEs), possibly requiring treatment interruption or dose reduction. However, concerns have arisen regarding the impact of these adjustments on the efficacy of apalutamide. Our study evaluated the efficacy, safety, and persistence of apalutamide in men with metastatic castration-sensitive prostate cancer (mCSPC). We retrospectively reviewed the medical records of 108 men with mCSPC from 14 Japanese institutions. The primary outcomes were the efficacy of apalutamide: prostate-specific antigen (PSA) response (50%, 90% and < 0.2 decline) and progression to castration-resistant prostate cancer (CRPC). The secondary outcomes were the skin-AE and compliance of apalutamide. PSA50%, PSA90% and PSA < 0.2 declines were observed in 89.8, 84.3 and 65.7%, and the median time to CRPC progression was not reached. PSA < 0.2 decline and an initial full dose of apalutamide were significantly associated with a longer time to CRPC. The most common AE was skin-AE (50.9%), and there was no association between the occurrence of skin-AE and the time to CRPC (P = 0.72). The median apalutamide persistence was 29 months, which was longer in the initial full dose recipients than in the reduced dose recipients. The dosage is reduced in about 60% of patients within the first year of treatment in the initial full dose recipients. Our findings indicate the effectiveness of apalutamide in Japanese men with mCSPC, despite a substantial portion requiring dose reduction within a year among the initial full dose recipients.
Positive core ratios observed on prostate biopsy correlated with higher recurrence rates after LDR-BT. This indicates that the proportion of positive cores in the biopsy may be an important factor in predicting the likelihood of recurrence, especially for patients with GG3 PCa.
Positive core ratios observed on prostate biopsy correlated with higher recurrence rates after LDR-BT. This indicates that the proportion of positive cores in the biopsy may be an important factor in predicting the likelihood of recurrence, especially for patients with GG3 PCa.
Yutaro Sasaki, Masayuki Takahashi, Kei Daizumoto, Keito Shiozaki, Tomoya Fukawa and Hiroomi Kanayama : Assistent guide short: A new device for facilitating ureteric stenting in women., International Journal of Urology, 2023.
Yutaro Sasaki, Kei Daizumoto, Kyotaro Fukuta, Keito Shiozaki, Mitsuki Nishiyama, Seiya Utsunomiya, Saki Kobayashi, Kosuke Seto, Yoshiteru Ueno, Ryotaro Tomida, Yoshito Kusuhara, Tomoya Fukawa, Ryoichi Nakanishi, Kunihisa Yamaguchi, Yasuyo Yamamoto, Hirofumi Izaki and Masayuki Takahashi : Lymph node dissection during radical cystectomy for bladder cancer: A two-center comparative study of robotic versus open surgery., Asian Journal of Endoscopic Surgery, 2023.
(要約)
This study was performed to evaluate the safety and efficacy of lymph node dissection (LND) during robot-assisted radical cystectomy (RARC) compared with open radical cystectomy (ORC). From October 2003 to December 2021, 122 patients underwent LND during RARC and 103 patients underwent LND during ORC at Tokushima University Hospital and Tokushima Prefectural Central Hospital. We investigated the safety and efficacy of LND during RARC by comparing the surgical and oncological outcomes between the two groups. The patients were significantly older in the RARC than the ORC group. The operative time was significantly shorter and the estimated blood loss was significantly lower in the RARC than the ORC group. Although the lymph node yield was significantly higher in the RARC than the ORC group, there was no significant difference in lymph node positivity between the groups. There was no significant difference in the incidence of local recurrence or distant metastasis between the two groups. The 5-year survival rates (overall survival, cancer-specific survival, and recurrence-free survival) were not different between the RARC and ORC groups. This study suggests that the surgical and oncological safety and efficacy of LND during RARC are greater than those of LND during ORC. We believe that LND during RARC is a higher-quality procedure than LND during ORC.
Yutaro Sasaki, Kei Daizumoto, Kyotaro Fukuta, Keito Shiozaki, Mitsuki Nishiyama, Seiya Utsunomiya, Saki Kobayashi, Kosuke Seto, Yoshiteru Ueno, Ryotaro Tomida, Yoshito Kusuhara, Tomoya Fukawa, Ryoichi Nakanishi, Kunihisa Yamaguchi, Yasuyo Yamamoto, Hirofumi Izaki and Masayuki Takahashi : Lymph node dissection during radical cystectomy for bladder cancer: A two-center comparative study of robotic versus open surgery., Asian Journal of Endoscopic Surgery, 2023.
(要約)
This study was performed to evaluate the safety and efficacy of lymph node dissection (LND) during robot-assisted radical cystectomy (RARC) compared with open radical cystectomy (ORC). From October 2003 to December 2021, 122 patients underwent LND during RARC and 103 patients underwent LND during ORC at Tokushima University Hospital and Tokushima Prefectural Central Hospital. We investigated the safety and efficacy of LND during RARC by comparing the surgical and oncological outcomes between the two groups. The patients were significantly older in the RARC than the ORC group. The operative time was significantly shorter and the estimated blood loss was significantly lower in the RARC than the ORC group. Although the lymph node yield was significantly higher in the RARC than the ORC group, there was no significant difference in lymph node positivity between the groups. There was no significant difference in the incidence of local recurrence or distant metastasis between the two groups. The 5-year survival rates (overall survival, cancer-specific survival, and recurrence-free survival) were not different between the RARC and ORC groups. This study suggests that the surgical and oncological safety and efficacy of LND during RARC are greater than those of LND during ORC. We believe that LND during RARC is a higher-quality procedure than LND during ORC.
Masayuki Takahashi, Kei Daizumoto, Tomoya Fukawa, Yayoi Fukuhara, Yoshimi Bando, Minoru Kowada, Tsogt-Ochir Dondoo, Yutaro Sasaki, Ryotaro Tomida, Yoshiteru Ueno, Megumi Tsuda, Yoshito Kusuhara, Kunihisa Yamaguchi, Yasuyo Yamamoto, Hisanori Uehara and Hiroomi Kanayama : Insulin receptor expression to predict resistance to axitinib and elucidation of the underlying molecular mechanism in metastatic renal cell carcinoma., British Journal of Cancer, 2023.
(要約)
Decreased INSR in RCC could be a biomarker to predict axitinib resistance. Regarding the resistant mechanism, vascular endothelial cells with decreased INSR in RCC may secrete interferon-β and induce PD-L1.
Masayuki Takahashi, Kei Daizumoto, Tomoya Fukawa, Yayoi Fukuhara, Yoshimi Bando, Minoru Kowada, Tsogt-Ochir Dondoo, Yutaro Sasaki, Ryotaro Tomida, Yoshiteru Ueno, Megumi Tsuda, Yoshito Kusuhara, Kunihisa Yamaguchi, Yasuyo Yamamoto, Hisanori Uehara and Hiroomi Kanayama : Insulin receptor expression to predict resistance to axitinib and elucidation of the underlying molecular mechanism in metastatic renal cell carcinoma., British Journal of Cancer, 2023.
(要約)
Decreased INSR in RCC could be a biomarker to predict axitinib resistance. Regarding the resistant mechanism, vascular endothelial cells with decreased INSR in RCC may secrete interferon-β and induce PD-L1.
Katsuhito Hori, Yutaro Sasaki, Keito Shiozaki, Fumiya Kadoriku, Kei Daizumoto, Ryotaro Tomida, Yoshiteru Ueno, Megumi Tsuda, Yoshito Kusuhara, Tomoya Fukawa, Kunihisa Yamaguchi, Yasuyo Yamamoto, Masayuki Takahashi, Yoshihiro Tsuruo and Hiroomi Kanayama : Efficacy of fresh-frozen cadaveric surgical training for arteriovenous fistula in vascular access., The Journal of Vascular Access, 2023.
(要約)
Twelve CST sessions were performed on nine FFCs. All training sessions allowed completion of AVF creation with a median operative time of 78.5 min. Although veins and arteries were more difficult to identify than in a living body, other surgical operations could be performed in the same way as in a living body. All the respondents stated that it was good for them to experience CST. In addition, 86% of surgeons responded that CST improved their surgical techniques, and 71% of surgeons responded that they were less anxious about AVF creation.
Katsuhito Hori, Yutaro Sasaki, Keito Shiozaki, Fumiya Kadoriku, Kei Daizumoto, Ryotaro Tomida, Yoshiteru Ueno, Megumi Tsuda, Yoshito Kusuhara, Tomoya Fukawa, Kunihisa Yamaguchi, Yasuyo Yamamoto, Masayuki Takahashi, Yoshihiro Tsuruo and Hiroomi Kanayama : Efficacy of fresh-frozen cadaveric surgical training for arteriovenous fistula in vascular access., The Journal of Vascular Access, 2023.
(要約)
Twelve CST sessions were performed on nine FFCs. All training sessions allowed completion of AVF creation with a median operative time of 78.5 min. Although veins and arteries were more difficult to identify than in a living body, other surgical operations could be performed in the same way as in a living body. All the respondents stated that it was good for them to experience CST. In addition, 86% of surgeons responded that CST improved their surgical techniques, and 71% of surgeons responded that they were less anxious about AVF creation.
Yoshiteru Ueno, Tomoharu Fukumori, Yoshito Kusuhara, Tomoya Fukawa, Megumi Tsuda, Kei Daizumoto, Yutaro Sasaki, Ryotaro Tomida, Yasuyo Yamamoto, Kunihisa Yamaguchi, Chisato Tonoiso, Akiko Kubo, Takashi Kawanaka, Shunsuke Furutani, Hitoshi Ikushima, Masayuki Takahashi and Hiro-omi Kanayama : Prostate-specific Antigen Levels Following Brachytherapy Impact Late Biochemical Recurrence in Japanese Patients With Localized Prostate Cancer., In Vivo, 37, 2, 738-746, 2023.
(要約)
PSA levels at 5 years post-treatment were associated with long-term recurrence of localized prostate cancer, which can help alleviate patient anxiety concerning prostate cancer recurrence if PSA levels remain low at 5 years after LDR-BT.
(キーワード)
Male / Humans / Prostate-Specific Antigen / Brachytherapy / Cohort Studies / East Asian People / Prostatic Neoplasms
Megumi Tsuda, Tomoya Fukawa, Yasuyo Yamamoto, Kei Daizumoto, Yutaro Sasaki, Yoshiteru Ueno, Ryotaro Tomida, Yoshito Kusuhara, Kunihisa Yamaguchi, Masayuki Takahashi and Hiro-omi Kanayama : Impact of early urinary catheter removal on successful voiding and physical function in stroke patients., The Journal of Medical Investigation : JMI, 70, 3.4, 436-442, 2023.
(要約)
The aim of the present study was to identify factors related to the success of trial without catheter (TWOC) in patients with stroke and to examine the effect of the timing of urinary catheter removal on the course of stroke. Patients who were admitted to the Stroke Care Unit of our institution between March 2018 and October 2021 were included. To identify factors related to success of TWOC, a multivariate analysis was performed on the patient's condition at admission and catheter indwelling time. The patients were divided into two groups by the timing of catheter removal, and we assessed the relationship between the timing of catheter removal successful TWOC and recovery of physical function. A total of 118 patients were included. The presence of comorbidities and scores of severity and function at admission were not predictors of successful voiding. The time to achieve voiding sussess was significantly shorter in the early catheter removal group than in the later group (p<0.005). Interestingly, the early group also showed better improvements in physical function. Early removal of catheters may lead to early recovery of bladder function, improvement of physical function, and lower risk of complications in patients with stroke. J. Med. Invest. 70 : 436-442, August, 2023.
Megumi Tsuda, Tomoya Fukawa, Yasuyo Yamamoto, Kei Daizumoto, Yutaro Sasaki, Yoshiteru Ueno, Ryotaro Tomida, Yoshito Kusuhara, Kunihisa Yamaguchi, Masayuki Takahashi and Hiro-omi Kanayama : Impact of early urinary catheter removal on successful voiding and physical function in stroke patients., The Journal of Medical Investigation : JMI, 70, 3.4, 436-442, 2023.
(要約)
The aim of the present study was to identify factors related to the success of trial without catheter (TWOC) in patients with stroke and to examine the effect of the timing of urinary catheter removal on the course of stroke. Patients who were admitted to the Stroke Care Unit of our institution between March 2018 and October 2021 were included. To identify factors related to success of TWOC, a multivariate analysis was performed on the patient's condition at admission and catheter indwelling time. The patients were divided into two groups by the timing of catheter removal, and we assessed the relationship between the timing of catheter removal successful TWOC and recovery of physical function. A total of 118 patients were included. The presence of comorbidities and scores of severity and function at admission were not predictors of successful voiding. The time to achieve voiding sussess was significantly shorter in the early catheter removal group than in the later group (p<0.005). Interestingly, the early group also showed better improvements in physical function. Early removal of catheters may lead to early recovery of bladder function, improvement of physical function, and lower risk of complications in patients with stroke. J. Med. Invest. 70 : 436-442, August, 2023.
Keisuke Ozaki, Tomoya Fukawa, Kei Daizumoto, Yutaro Sasaki, Yoshiteru Ueno, Megumi Tsuda, Takayuki Uchida, Yoshito Kusuhara, Yasuyo Yamamoto, Kunihisa Yamaguchi, Masayuki Takahashi and Hiro-omi Kanayama : The impact of nutritional status and changes of body composition on the prognosis of metastatic renal cell carcinoma patients., The Journal of Medical Investigation : JMI, 70, 1.2, 80-87, 2023.
(要約)
Nutritional status of mRCC patients may predict changes in body composition and be associated with their prognosis. J. Med. Invest. 70 : 80-87, February, 2023.
(キーワード)
Humans / Carcinoma, Renal Cell / Kidney Neoplasms / Nutritional Status / Prognosis / Body Composition / Retrospective Studies / Protein Kinase Inhibitors
Yoshiteru Ueno, Tomoharu Fukumori, Yoshito Kusuhara, Tomoya Fukawa, Megumi Tsuda, Kei Daizumoto, Yutaro Sasaki, Ryotaro Tomida, Yasuyo Yamamoto, Kunihisa Yamaguchi, Chisato Tonoiso, Akiko Kubo, Takashi Kawanaka, Shunsuke Furutani, Hitoshi Ikushima, Masayuki Takahashi and Hiro-omi Kanayama : Prostate-specific Antigen Levels Following Brachytherapy Impact Late Biochemical Recurrence in Japanese Patients With Localized Prostate Cancer., In Vivo, 37, 2, 738-746, 2023.
(要約)
PSA levels at 5 years post-treatment were associated with long-term recurrence of localized prostate cancer, which can help alleviate patient anxiety concerning prostate cancer recurrence if PSA levels remain low at 5 years after LDR-BT.
(キーワード)
Male / Humans / Prostate-Specific Antigen / Brachytherapy / Cohort Studies / East Asian People / Prostatic Neoplasms
Fumiya Kadoriku, Yutaro Sasaki, Kyotaro Fukuta, Yuichiro Atagi, Keito Shiozaki, Kei Daizumoto, Ryotaro Tomida, Yoshiteru Ueno, Megumi Tsuda, Yoshito Kusuhara, Tomoya Fukawa, Yutaka Yanagihara, Kunihisa Yamaguchi, Yasuyo Yamamoto, Hirofumi Izaki, Masayuki Takahashi, Sadamu Yamashi, Masaharu Kan and Hiroomi Kanayama : A propensity score matching study on robot-assisted radical cystectomy for older patients: comparison of intracorporeal ileal conduit and cutaneous ureterostomy., BMC Urology, 22, 1, 2022.
(要約)
The median age was lower in the ICIC group compared with the CUS group, and the proportion of high-risk cases (ECOG-PS ≥ 2 or ASA-PS ≥ 3) did not differ. The median operation time was longer in the ICIC group, and estimated blood loss was higher, compared with the CUS group. There were no significant differences in the incidence of complications within the first 30 postoperative days, incidence of complications 30-90 days after surgery, 2-year overall survival, 2-year cancer-specific survival, and 2-year recurrence-free survival. The stent-free rate was significantly lower in the CUS group than that in the ICIC group.
Fumiya Kadoriku, Yutaro Sasaki, Kyotaro Fukuta, Yuichiro Atagi, Keito Shiozaki, Kei Daizumoto, Ryotaro Tomida, Yoshiteru Ueno, Megumi Tsuda, Yoshito Kusuhara, Tomoya Fukawa, Yutaka Yanagihara, Kunihisa Yamaguchi, Yasuyo Yamamoto, Hirofumi Izaki, Masayuki Takahashi, Sadamu Yamashi, Masaharu Kan and Hiroomi Kanayama : A propensity score matching study on robot-assisted radical cystectomy for older patients: comparison of intracorporeal ileal conduit and cutaneous ureterostomy., BMC Urology, 22, 1, 2022.
(要約)
The median age was lower in the ICIC group compared with the CUS group, and the proportion of high-risk cases (ECOG-PS ≥ 2 or ASA-PS ≥ 3) did not differ. The median operation time was longer in the ICIC group, and estimated blood loss was higher, compared with the CUS group. There were no significant differences in the incidence of complications within the first 30 postoperative days, incidence of complications 30-90 days after surgery, 2-year overall survival, 2-year cancer-specific survival, and 2-year recurrence-free survival. The stent-free rate was significantly lower in the CUS group than that in the ICIC group.
Kouki Tada, Kei Daizumoto, Masayuki Takahashi, Hisanori Uehara, Megumi Tsuda, Yoshito Kusuhara, Tomoya Fukawa, Yasuyo Yamamoto, Kunihisa Yamaguchi and Hiro-omi Kanayama : Recurrent multiple liver metastases of clear cell renal cell carcinoma with a significant response to sunitinib after nivolumab treatment., IJU Case Reports, 6, 1, 41-44, 2022.
(要約)
The patient was a 65-year-old man who underwent open nephrectomy for RCC. After the nephrectomy, he had recurrences several times, and metastasectomy had been performed for each recurrence. At 13 years after the nephrectomy, multiple liver, and lung metastases appeared. The treatment was switched to axitinib, followed by cabozantinib, then nivolumab. The best response was PR, SD, and PD for these three drugs, and treatment duration was 14, 3, and 3 months, respectively. As the fifth line, sunitinib was administered, with significant shrinkage of the multiple liver metastases, and PR has been maintained for 34 months.
K. Ozaki, Takashi Kawanaka, Tomoya Fukawa, Kei Daizumoto, Yutaro Sasaki, Megumi Tsuda, Yoshito Kusuhara, Yasuyo Yamamoto, Kunihisa Yamaguchi, Masayuki Takahashi and Hiro-omi Kanayama : Appropriate management reduces radiation exposure in daily urological practice, International Journal of Urology, 2022.
(要約)
To identify and raise awareness of the radiation exposure of urologists due to X-ray fluoroscopic procedures in daily practice. This was a single-center, cohort study of 30 consecutive patients who underwent periodic percutaneous or transurethral replacements of urinary tract catheters. A total of 55 replacements every 3 months with cases aligned were performed by a single urologist. The urologist's radiation exposure and the incident dose to patients per case were measured with thermoluminescent dosimeters. In the latter 3-month period, the pulse fluoroscopy condition was changed from 15 to 7.5 pulses per second, and collimation was added to the field of view. In the analysis of all patients, the use of a modified pulse rate and collimation did not affect the fluoroscopy time, but it did significantly reduce the air kerma and dose area product; in addition, with respect to the medical exposure dose during percutaneous catheter replacement, fluoroscopy time was longer, but air kerma and dose area product showed significant decreases. As with decreases in medical exposure of patients, the equivalent dose for eye lenses of the urologist decreased from 1.2 mSv in the first 3-month period to 0.2 mSv in the second 3-month period. Similarly, the exposure dose for the extremities also decreased significantly, from 33.9 mSv to 8.1 mSv. Urologists are exposed to non-negligible amounts of radiation due to fluoroscopy. Appropriate management such as modified pulse fluoroscopy condition and precautions are required.
Yutaro Sasaki, Kei Daizumoto, Megumi Tsuda, Yoshito Kusuhara, Tomoya Fukawa, Kunihisa Yamaguchi, Yasuyo Yamamoto and Hiro-omi Kanayama : Efficacy of the Mercedes-Benz closure technique for vaginal reconstruction in female robot-assisted radical cystectomy, Asian Journal of Endoscopic Surgery, 16, 1, 23-27, 2022.
(要約)
Vaginal reconstruction using the posterior vaginal wall is required following radical cystectomy in women with resection of the uterus, adnexa, and anterior vaginal wall. Roll closure and clamshell closure are two widely known techniques. Of these, clamshell closure is recommended because roll closure has a high likelihood of breakdown or a resultant canal that is too narrow for sexual intercourse. In clamshell closure, however, folding the posterior vaginal wall anteriorly can be difficult. Therefore, we devised Mercedes-Benz closure, in which the vaginal wall is sutured from three directions to form a Mercedes-Benz shape, for anastomosis without tension on the vaginal wall. The present study was performed to investigate the efficacy of this alternative surgical technique for vaginal reconstruction. Twenty-six patients who underwent vaginal reconstruction following robot-assisted radical cystectomy were divided into two groups: 15 underwent clamshell closure and 11 underwent Mercedes-Benz closure. The patients' characteristics and surgical outcomes were compared between the two groups. There were no significant differences in clinical characteristics, including age, body mass index, and prior abdominal surgery between the two groups. The median vaginal reconstruction time tended to be longer in the Mercedes-Benz closure group than in the clamshell closure group (35.0 vs. 27.0 min, p = 0.102). No complications associated with vaginal reconstruction were identified. The surgical outcomes were comparable between Mercedes-Benz closure and clamshell closure. If vaginal reconstruction with clamshell closure is difficult, Mercedes-Benz closure is a valuable alternative technique.
We report a case of papillary renal cell carcinoma that responded well to the combination of ipilimumab and nivolumab. The patient was a 68-year-old male who was being followed up for a small left renal mass without treatment. Two years later, computed tomography (CT) showed enlarged cervical and para-aortic lymph nodes, and lymph node biopsy suggested metastases of the cancer. After resection of the renal tumor, we performed pararenal aortic lymph node biopsy, and we diagnosed the case as papillary renal cell carcinoma type 1 with lymph node metastasis. The combination of ipilimumab and nivolumab each metastatic site showed regression on CT. Since immune-related adverse events occurred during the therapy nivolumab was discontinued, but partial response of the metastases was maintained.
(キーワード)
Papillary renal cell carcinoma / Ipilimumab and nivolumab / 494.9
Yutaro Sasaki, Masayuki Takahashi, Kei Daizumoto, Megumi Tsuda, Yoshito Kusuhara, Tomoya Fukawa, Yasuyo Yamamoto, Kunihisa Yamaguchi and Hiro-omi Kanayama : The patient-side surgeon plays a key role in facilitating robot-assisted intracorporeal ileal conduit urinary diversion in men, Journal of Robotic Surgery, 16, 2, 437-444, 2022.
(要約)
The influence of the console surgeon on the feasibility and outcome of various robot-assisted surgeries has been evaluated. These variables may be partially affected by the skills of the patient-side surgeon (PSS), but this has not been evaluated using objective data. This study aimed to describe the surgical techniques of the PSS in robot-assisted radical cystectomy (RARC) and intracorporeal ileal conduit (ICIC) urinary diversion and objectively examine the changes in surgical outcomes with increasing PSS experience. During a 3-year period, 28 men underwent RARC and ICIC urinary diversion. Clinical characteristics and surgical outcomes were compared between patients who underwent surgery early (first half group) or late in the study period (second half group). The pre-docking incision enabled easy specimen removal. The glove port technique widened the working space of the PSS. The stay suture allowed the PSS to control the distal portion of the conduit, facilitating the passage of the ureteral stents. During stoma creation, pneumoperitoneum pressure was lost by opening the abdominal cavity. To overcome this problem, the robotic arm was used to lift the abdominal wall to maintain the surgical field and facilitate the PSS procedure. Compared with the first half group, the second half group had significantly shorter times for urinary diversion (202 min vs 148 min, p < 0.001), ileal isolation and anastomosis (73 min vs 45 min, p < 0.001), and stenting (23.0 min vs 6.5 min, p < 0.001). As the experience of the PSS increased, the time of the PSS procedures decreased.
Keito Shiozaki, Yasuo Kawanishi, Yutaro Sasaki, Kei Daizumoto, Megumi Tsuda, Kazuyoshi Izumi, Yoshito Kusuhara, Tomoya Fukawa, Yasuyo Yamamoto, Kunihisa Yamaguchi, Masayuki Takahashi and Hiroomi Kanayama : Clinical application of virtual imaging guided Robot-assisted partial nephrectomy., The Journal of Medical Investigation : JMI, 69, 3.4, 237-243, 2022.
(要約)
Objectives : To evaluate whether virtual partial nephrectomy images could help surgeons identify vascular and collecting system around tumors during actual surgery. Materials & methods : We retrospectively analyzed 36 patients who underwent robot-assisted partial nephrectomy (RAPN) between 2016 and 2017. Virtual partial nephrectomy images were created from preoperative CT images using computer software, and then analyzed. For analysis, blood vessels and collecting system portions within a 5-mm-thick safety margin around the tumor were examined. During analysis, we predicted whether targeted vasculature around the tumor would require clipping or suturing during surgery, and also whether the collecting system would require opening during resection. Surgical outcomes for virtual partial nephrectomy analyses and actual RAPNs were compared and analyzed for sensitivity and specificity. Results : In 36 cases, 119 arteries and 100 veins were targeted on virtual partial nephrectomy images. Arterial suturing or clipping for hemostasis showed a sensitivity and specificity of 83.3% and 84.5%, respectively. For veins, the sensitivity and specificity were 39.1% and 92.2%, respectively. Collecting system opening prediction sensitivity was 85.7%, and specificity was 65.2%. Conclusion : Virtual partial nephrectomy imaging is useful for RAPN planning, particularly regarding arteries and the collecting system. It is hoped that techniques for visualizing veins will improve. J. Med. Invest. 69 : 237-243, August, 2022.
We describe two cases of locally advanced rectal cancer (LARC) treated with robot-assisted total pelvic exenteration (Ra-TPE) and intracorporeal ileal conduit (ICIC). The first case was in a 71-year-old man with LARC (RbP, T4bN2bM0, cStage IIIc). He was started on bevacizumab+S-1/oxaliplatin therapy in July 2019. In April 2020, he developed Fournier's gangrene due to subcutaneous penetration of rectal cancer. Emergency drainage and colostomy were performed simultaneously, and a percutaneous vesical fistula was created. In May 2020, Ra-TPE and ICIC were performed. Histopathological analysis revealed moderately differentiated tubular adenocarcinoma (ypT3N0, RM0). At postoperative 9 months, thoracoscopic right upper lobectomy was performed for a right metastatic lung tumor. At present, ie, at postoperative 12 months, the patient has been free of recurrence and metastasis, with a carcinoembryonic antigen (CEA) level of 1.4 ng/ml and carcinoma antigen (CA) 19-9 level of 11 U/ml. The second case was in a 61-year-old man with fistula-associated anal cancer (PRb, T4N3M1b, cStage IVb). In April 2019, he was started on FOLFOXIRI+cetuximab therapy. In August 2020, Ra-TPE, ICIC, and transperineal total mesenteric excision were performed. Histopathological analysis revealed adenocarcinoma (ypT4N0, RM0). At postoperative 11 months, thoracoscopic left lower lobectomy was performed for a left metastatic lung tumor. At present, ie, at postoperative 12 months, the patient remains free of recurrence and metastasis, with a CEA level of 7.3 ng/ml and CA19-9 level of 12 U/ml. Ra-TPE, which allows transperineal removal of a specimen, can be performed as a minimally invasive surgery in combination with ICIC.
While robot-assisted radical cystoprostatectomy (RARC) for locally advanced prostate cancer (LAPC) may sometimes prove to be excessive treatment, it can significantly reduce the risk of positive surgical margins and lower urinary tract obstruction in some cases. Here, we report a case of LAPC treated with RARC in a patient with right hydronephrosis due to bladder infiltration and left hypoplastic kidney. A 71-year-old man presented with frequent urination in August 2019. Prostate-specific antigen (PSA) level was 8.633 ng/ml, and magnetic resonance imaging led to the suspicion that the prostate cancer extended beyond the prostate capsule without distant metastasis. Prostatic biopsy revealed Gleason score 10 (5+5) adenocarcinoma in 8 out of 8 specimens. We diagnosed left hypoplastic kidney and LAPC with right hydronephrosis due to bladder infiltration. We performed percutaneous right nephrostomy and started neoadjuvant hormone therapy. RARC and intracorporeal ileal conduit were performed in March 2020. The prostate was adherent to the anterior surface of the rectum and was difficult to remove. At present, five months after the surgery, the patient remains free of recurrence and metastasis with PSA level <0.003 ng/ml. RARC for LAPC with bladder infiltration can be an effective therapeutic strategy in some cases.
Yutaro Sasaki, Masayuki Takahashi, Keisuke Ozaki, Kei Daizumoto, Yoshiteru Ueno, Megumi Tsuda, Yoshito Kusuhara, Tomoya Fukawa, Yasuyo Yamamoto, Kunihisa Yamaguchi and Hiro-omi Kanayama : Efficacy of the direct grasping technique using pean forceps under fluoroscopy to replace ureteral stents in women, The Journal of Medical Investigation : JMI, 3.4, 68, 326-329, 2021.
(要約)
Purpose : To evaluate the efficacy of the direct grasping technique using pean forceps under fluoroscopic guidance for ureteral stent replacement in women. Methods : Between April 2018 and September 2020, 28 female patients underwent ureteral stent replacements at our facility, and 184 stent replacement procedures were performed. A total of 127 stents were replaced using pean forceps under fluoroscopic guidance (pean forceps group), and 57 stents were replaced using the cystoscope (cystoscopy group). Clinical characteristics and surgical outcomes were compared between the groups. Results : All stents were successfully replaced. There was a statistically significant difference in the procedure time between the two groups (median [interquartile range], pean forceps group : 10.8 [8.2-13.9] minutes vs. cystoscopy group : 15.8 [11.1-20.9] minutes, P < 0.001). There were no intraoperative complications in either group and no difference in the incidence of postoperative complications (pean forceps group : 1.6% vs. cystoscopy group : 1.8%, P = 1.000). Fluoroscopy time was longer in the pean forceps group, although this difference was not statistically significant (pean forceps group : 38.9 [22.6-60.1] seconds vs. cystoscopy group : 33.0 [20.0-48.9] seconds, P = 0.0558). Conclusion : The direct grasping technique using pean forceps under fluoroscopy may be a beneficial alternative to cystoscopy for ureteral stent replacement in women. J. Med. Invest. 68 : 326-329, August, 2021.
We report a case of bladder diverticulum presumably caused by lower urinary tract dysfunction due to pelvic organ prolapse (POP) simultaneously treated with transurethral coagulation (TUC) of the bladder diverticulum and laparoscopic sacrocolpopexy (LSC). A literature search showed this is the first report of bladder diverticulum and POP surgically treated at the same time. A 71-year-old woman was referred to our hospital for the treatment of cystocele. She had both storage and voiding symptoms. She had a POPQ stage III cystocele and stage I uterine prolapse. Ultrasonography and computed tomographic scan showed a large volume of residual urine along with a bladder diverticulum. Since urodynamic studies revealed a low compliance bladder and obstruction, we opined that the lower urinary tract symptoms were induced by the cystocele. TUC of the bladder diverticulum and LSC were performed at the same time. After the operation, clean intermittent catheterization (CIC) was needed once a day for one month. Gradually, residual urine decreased and CIC became unnecessary. The bladder diverticulum disappeared, and there has been no recurrence of POP.
We report a case of left renal angiomyolipoma extending into the renal vein. A 67-year-old woman showed a left renal tumor which was 6 cm in diameter and had density equal to fat tissue in computed tomography. We suspected liposarcoma and performed radical nephrectomy and resection of thrombus. The pathological diagnosis was angiomyolipoma with no malignancy. To our knowledge, renal angiomyolipoma with tumor thrombus has been reported in 62 cases, and pulmonary embolism developed in 9 of these cases. We conclude that surgical treatment is effective in treating angiomyolipoma with tumor thrombus.
Junya Furukawa, Ryotaro Tomida, Kei Daizumoto, Yutaro Sasaki and Tomoya Fukawa : Advances in Adjuvant Therapy for Renal Cell Carcinoma: Perspectives on Risk Stratification and Treatment Outcomes., International Journal of Urology, Mar. 2025.
(要約)
Radical surgery is effective for localized renal cell carcinoma (RCC). However, recurrence occurs in up to 40% of patients, underscoring the need for adjuvant therapy to improve the prognosis. Historically, adjuvant treatments, including tyrosine kinase inhibitors, have shown limited success, failing to improve overall survival. The introduction of the immune checkpoint inhibitor pembrolizumab, as demonstrated in the KEYNOTE-564 trial, has revolutionized the field by showing significant overall survival benefits and prompting updates to RCC treatment guidelines. Accurate risk assessment is critical for identifying high-risk patients most likely to benefit from adjuvant therapy. Established risk models, such as the UCLA Integrated Staging System and the Leibovich score, incorporate clinical and pathological factors to stratify recurrence risk. Recent enhancements in these models have improved predictive accuracy, enabling better optimization of inclusion criteria for clinical trials targeting high-risk recurrence and the development of individualized surveillance protocols to refine patient selection for adjuvant treatment. This review examines the evolution of risk stratification models and adjuvant therapy for RCC, highlighting the potential of innovative biomarkers, such as liquid biopsies, to further enhance patient selection and optimize treatment outcomes. Ongoing clinical trials investigating new combinations of immune checkpoint inhibitors hold promise, and integrating accurate risk assessment with advanced immunotherapy will be key to improving postoperative survival rates for patients with RCC.
Kei Daizumoto, Naoka Osafune, Kohei Torii, Ryota Nishimura, Hisanori Uehara, Mitsuki Nishiyama, Saki Kobayashi, Yutaro Sasaki, Ryotaro Tomida, Yoshiteru Ueno, Yoshito Kusuhara, Tomoya Fukawa, Kunihisa Yamaguchi, Yasuyo Yamamoto, Masayuki Takahashi and Junya Furukawa : Development of pT classification prediction system in UTUC using deep-learning, 39th Annual European Association of Urology Congress, A0130, Paris, Apr. 2024.
2.
Yasuyo Yamamoto, Megumi Tsuda, Kei Daizumoto, Yoshito Kusuhara, Tomoya Fukawa, Kunihisa Yamaguchi, Masayuki Takahashi and Hiro-omi Kanayama : Examination of Mid-Urethral Sling (MUS) for elderly patients over 75 years old, Athens, Oct. 2019.
3.
Masayuki Takahashi, Kei Daizumoto, Tomoya Fukawa, Yayoi Fukuhara, Ozaki Keisuke, Megumi Tsuda, Yoshito Kusuhara, Hidehisa Mori, Yasuyo Yamamoto, Kunihisa Yamaguchi, Tomoharu Fukumori and Hiro-omi Kanayama : The significance of insulin receptor expression to predict the resistance to VEGFR-TKIs and induce PD-L1 expression in advanced clear cell renal cell carcinoma, 2019 ASCO Genitourinary Cancers Symposium, Feb. 2019.
4.
Yasuyo Yamamoto, Yoshito Kusuhara, Tomoya Fukawa, Kunihisa Yamaguchi, Tomoharu Fukumori, Masayuki Takahashi, Hiro-omi Kanayama, Yoshihiro Tsuruo, Kei Daizumoto and Hidehisa Mori : Usefulness of Fresh Frozen Cadaver and Animal Models for Surgical Training in Laparoscopic Sacrocolpopexy, The 36th World Congress of Endourology, Paris, Sep. 2018.
5.
Masayuki Takahashi, Kei Daizumoto, Yayoi Fukuhara, Ozaki Keisuke, Megumi Tsuda, Yoshito Kusuhara, Hidehisa Mori, Tomoya Fukawa, Yasuyo Yamamoto, Kunihisa Yamaguchi, Tomoharu Fukumori and Hiro-omi Kanayama : Correlation of the insulin receptor expression changes by the administration of VEGFR-TKI and the resistance to the VEGFR-TKI in clear cell renal cell carcinoma, 113th American Urological Association Annual meeting, May 2018.
Masayuki Takahashi, Kei Daizumoto, Yayoi Fukuhara, Ozaki Keisuke, Megumi Tsuda, Yoshito Kusuhara, Hidehisa Mori, Tomoya Fukawa, Yasuyo Yamamoto, Kunihisa Yamaguchi, Tomoharu Fukumori and Hiro-omi Kanayama : Correlation of the insulin receptor expression changes by the administration of VEGFR-TKI and the resistance to the VEGFR-TKI in clear cell renal cell carcinoma, 第106回日本泌尿器科学会総会, Apr. 2018.