Yutaro Sasaki and Junya Furukawa : Editorial Comment Regarding ''Initial Experience of Robot-Assisted Nephrectomy and Nephroureterectomy Using the Novel Saroa Surgical System'', International Journal of Urology, 2025.
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, Mikio Sugimoto, Keiji Inoue, Shinkuro Yamamoto, Koji Shiraishi, Yoshiyuki Miyaji, Nobuyuki Hinata, Junya Furukawa, Motoo Araki, Tatsushi Kawada, Atsushi Takenaka, Takashi Saika, Koichiro Wada, Yoichiro Tohi, Takuma Kato, Hirohito Naito, Hideo Fukuhara, Keita Kobayashi, Shin Ohira, Kei Daizumoto, Yutaro Sasaki, Ryotaro Tomida, Satoshi Katayama, Ryutaro Shimizu, Kenichi Nishimura, Ryuta Watanabe, Taichi Nagami, Atsushi Takamoto, Heima Niigawa, Yohei Sekino, Kohei Kobatake 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.
(キーワード)
apalutamide / nonmetastatic castration-resistant prostate cancer / prostate cancer / prostate-specific antigen response / PSA-doubling time
Kyotaro Fukuta, Kei Daizumoto, Yutaro Sasaki, Kazuyoshi Izumi, Fumiya Kadoriku, Seiya Utsunomiya, Keito Shiozaki, Takeshi Nakashima, Tomoya Fukawa, Ryoichi Nakanishi, Hirofumi Izaki, Masayuki Takahashi and Junya Furukawa : Geriatric Nutritional Risk Index Predicts Postoperative Complications in Elderly Patients Undergoing Robot-Assisted Radical Cystectomy, International Journal of Urology, 2025.
(要約)
Malnutrition is a common condition among elderly cancer patients. The Geriatric Nutritional Risk Index (GNRI) is a simple screening tool used to predict the risk of postoperative complications in patients undergoing radical cystectomy. This study aimed to evaluate the effectiveness of preoperative GNRI as a marker for predicting 90-day postoperative complications in elderly patients undergoing robot-assisted radical cystectomy (RARC). We retrospectively evaluated 385 patients who underwent RARC at four affiliated institutes of Tokushima University between 2014 and 2023. Patient background characteristics, pathological findings, and 90-day postoperative complications were analyzed. Preoperative GNRI was calculated using serum albumin and body mass index, with an abnormal nutritional status defined as GNRI < 92. A total of 166 patients aged ≥ 75 years who underwent RARC were included in the study. Among these, 26 patients (15.7%) had an abnormal GNRI. Eighty-four patients (50.6%) experienced complications within 90 days postoperatively, including 29 patients (17.5%) with major complications (Clavien-Dindo classification ≥ 3). The 90-day postoperative mortality rate was 3.0% (five patients). Patients with an abnormal GNRI had a significantly higher rate of 90-day postoperative complications (p < 0.001). Multivariable logistic regression analysis identified abnormal GNRI as a significant predictor of 90-day postoperative complications (odds ratio: 9.963; 95% confidence interval: 2.125-46.718; p = 0.004). Poor nutritional status is associated with a higher rate of 90-day postoperative complications in elderly patients undergoing RARC. Preoperative GNRI may be a useful tool for assessing the risk of complications in this patient population.
(キーワード)
bladder cancer / complication / geriatric nutritional risk index / malnutrition / robot-assisted radical cystectomy
Leandro Blas, Masaki Shiota, Takuma Kato, Ryuji Matsumoto, Yoichiro Tohi, Shinichi Sakamoto, Akira Yokomizo, Takahiro Kimura, Junya Furukawa, Sunao Shoji, Haruki Kume, Takayuki Goto, Yoshitaka Sekine, Yasuyuki Sakai, Yoh Matsuoka, Nobuyuki Hinata, Toshiyuki Kamoto, Naoki Terada, Shusuke Akamatsu, Mikio Sugimoto and Masatoshi Eto : Active Surveillance in Prostate Cancer With Intermediate-Risk Features: The PRIAS-JAPAN Study, International Journal of Urology, 32, 7, 823-827, 2025.
(要約)
To report outcomes of active surveillance (AS) for prostate cancer in men with intermediate-risk features of International Society of Urological Pathology (ISUP) grade group 2 and/or clinical stage T2 compared with ISUP grade group 1 and clinical stage T1 in the PRIAS-JAPAN study. Patients with prostate cancer diagnosed between January 2010 and February 2024 were included in this study. PSA test, rectal examination, and re-biopsy were performed regularly. We calculated the pathological reclassification rate, program persistence rate, and subsequent treatment. Data from 1302 participants were collected. After excluding patients who did not fit inclusion criteria (n = 28) or follow-up of less than 1 year (n = 208), 1066 patients were included in this analysis. The median follow-up was 42.4 months (interquartile range 17.0-72.1). There were no statistical differences in the pathological reclassification, persistence rates, and subsequent therapy between low- and intermediate-risk features. This preliminary study demonstrated medium-term outcomes of AS in prostate cancer with intermediate-risk features in Japan, suggesting no significant difference in the pathological reclassification, persistence rate, and subsequent therapy between low- and intermediate-risk features.
(キーワード)
active surveillance / PRIAS / prostate cancer / prostate-specific antigen
Effectiveness and safety of second-line tyrosine kinase inhibitors (TKIs) in patients with metastatic renal cell carcinoma (mRCC) for whom first-line immuno-oncology (I-O) combination therapy was discontinued because of adverse events (AEs) remain to be determined. Clinicopathological data were retrospectively collected from 34 institutions between August 2018 and January 2022 for 243 patients with mRCC who received second-line TKIs after first-line I-O combination therapy. Two patients who requested discontinuation of first-line I-O combination therapy were excluded. Oncological outcomes and safety were compared between patients who discontinued first-line I-O combination therapy because of progressive disease (Group PD) and AEs (Group AE). First- and second-line overall survival (OS) were defined as the time from the start of first- and second-line therapy to death, respectively. Propensity score matching was applied to adjust prognostic factors between the 2 groups. There were 179 patients in Group PD and 62 patients in Group AE. Objective response rate and disease control rate were similar between the 2 groups. Progression-free survival (PFS), second-line OS, and first-line OS were significantly longer in Group AE than in Group PD (median 13.6 months vs. 8.5 months, P = 0.005; median not reached [NR] vs. 19.5 months, P = .005; median NR vs. 30.8 months, P = .012, respectively). After propensity score matching, PFS and second-line OS were still significantly longer and first-line OS tended to be longer in Group AE than in Group PD. There were no significant differences in the occurrence of AEs of any grade, including severe grades of 3 or greater, between the 2 groups. Second-line TKIs are safe and at least as effective in patients with mRCC who discontinued first-line I-O combination therapy because of AEs as they are in patients who discontinued because of PD.
Junya Furukawa, Taigo Kato, Toshinari Yamasaki, Keisuke Monji, Toshiaki Tanaka, Norihiko Tsuchiya, Tomoaki Miyagawa, Hiroshi Yaegashi, Tomoyasu Sano, Takashi Karashima, Kazutoshi Fujita, Ichi Jun Hori, Takayuki Ito, Masahiro Kajita, Yoshihiko Tomita, Nobuo Shinohara, Masatoshi Eto, Mototsugu Oya and Hirotsugu Uemura : Real-world outcomes with avelumab + axitinib in patients with advanced renal cell carcinoma in Japan: subgroup analyses from the J-DART2 study by International Metastatic Renal Cell Carcinoma Database Consortium risk classification, International Journal of Clinical Oncology, 30, 4, 749-760, 2025.
(要約)
Avelumab + axitinib was approved for the treatment of advanced renal cell carcinoma (aRCC) in Japan in December 2019. We report long-term real-world subgroup analyses with first-line avelumab + axitinib in patients with aRCC by International Metastatic RCC Database Consortium (IMDC) risk classification from the J-DART2 study in Japan. J-DART2 was a multicenter, noninterventional, retrospective study examining characteristics, treatment patterns, and outcomes in patients with aRCC who started first-line avelumab + axitinib in Japan between December 2019 and October 2022. Data from 150 patients across 19 sites were analyzed. IMDC risk was favorable in 39 patients (26.0%), intermediate (1 risk factor) in 46 (30.7%), intermediate (2 risk factors) in 36 (24.0%), and poor in 29 (19.3%). Baseline characteristics were generally consistent across IMDC risk subgroups. In subgroups with favorable, intermediate (1 risk factor), intermediate (2 risk factors), and poor risk, median progression-free survival was 31.0, 15.3, 16.4, and 8.1 months; median overall survival (OS) was not reached, but 24-month OS rates were 95.2%, 91.3%, 85.3%, and 57.6%, respectively. Objective response rates were 54.5%, 56.8%, 47.1%, and 54.2%, respectively. High-dose corticosteroid treatment for immune-related adverse events was administered in 5.1%, 8.7%, 8.3%, and 6.9% of patients, respectively. Subgroup analyses from J-DART2 confirm the long-term real-world effectiveness of first-line avelumab + axitinib across IMDC risk groups in patients with aRCC in Japan. Our findings were consistent with previous analyses by IMDC risk and support the favorable benefit-risk profile of avelumab + axitinib in clinical practice in Japan.
(キーワード)
Avelumab / Axitinib / IMDC risk classification / Real world / Renal cell carcinoma / Retrospective
Junya Furukawa, Yasumasa Kakei, Sae Murakami, Hiroshi Kita, Hideto Ueki, Takuto Hara, Jun Teishima, Nobuyuki Hinata, Hideaki Miyake, Masato Fujisawa and Toshiro Shirakawa : Safety and efficacy of oral cancer vaccine B440 in patients with PD-1/PD-L1 inhibitor-resistant advanced urothelial cancer: a study protocol for a phase 1 multicenter, open-label, single-arm clinical trial, BMC Cancer, 25, 1, 195, 2025.
(要約)
This is a multicenter, open-label, single-arm clinical trial to evaluate the safety and efficacy of oral cancer vaccine B440 in patients with PD-1/PD-L1 inhibitor-resistant advanced urothelial cancer. The trial will be performed at three university hospitals in Japan. The target number of patients will be 12. The patients will be treated orally with B440 once daily for 5 days followed by 2 days for four consecutive courses (4 weeks, 20 treatments). The low-dose group will receive 800 mg (4 capsules) per dose and the high-dose group will receive 1,600 mg (8 capsules) per dose. The primary outcome will be the number and incidence of DLT cases the start of treatment and Day 28. Secondary outcomes are the presence or absence of a response, the best overall response and PFS. If this trial shows B440 to be safe and effective, it may lead to a late phase randomized controlled trial in advanced urothelial cancer. Ultimately, we hope to provide a new treatment option for such patients. Japan Registry of Clinical Trials (jRCT) identifier: jRCT2051220143. Registered on December 27, 2022.
(キーワード)
advanced urothelial cancer / B440 / Clinical trial / ICI / Phase 1 / WT-1 protein
Yoshihiko Tasaki, Shuzo Hamamoto, Shimpei Yamashita, Junya Furukawa, Kazutoshi Fujita, Ryotaro Tomida, Makito Miyake, Noriyuki Ito, Hideto Iwamoto, Yoshihisa Mimura, Yosuke Sugiyama, Rei Unno, Atsushi Okada, Takahiro Yasui and Yoko Furukawa-Hibi : Eosinophil is a predictor of severe immune-related adverse events induced by ipilimumab plus nivolumab therapy in patients with renal cell carcinoma: a retrospective multicenter cohort study., Frontiers in Immunology, 15, 1483956, 2025.
(要約)
Immune-related adverse events (irAEs) induced by immune checkpoint inhibitors are difficult to predict and can lead to severe events. Although it is important to develop strategies for the early detection of severe irAEs, there is a lack of evidence on irAEs associated with ipilimumab plus nivolumab therapy for metastatic renal cell carcinoma (RCC). Therefore, this study aimed to investigate the association between eosinophil and severe irAEs in patients receiving ipilimumab plus nivolumab therapy for RCC. In this retrospective study, 161 patients receiving ipilimumab plus nivolumab therapy for RCC were divided into three groups based on whether they experienced <grade 2 irAEs (non-severe irAE group), grade 3 irAEs (severe irAE group), or not (non-irAE group). We examined the proportion of eosinophils before and 2 weeks after treatment (baseline and 2-week samples, respectively). Although the eosinophil in the baseline samples did not differ between the severe irAE and non-irAE groups (2.8% vs. 2.5%, P = 0.75), regarding the 2-week samples, the eosinophil was significantly higher in the severe irAE group (mean, 6.6% vs. 3.3%; P < 0.05). Multivariate analysis showed that an eosinophil of 3.0% was a risk factor for severe irAEs (odds ratio, 6.01). Median progression-free survival (mPFS), mPFS from the start of ipilimumab plus nivolumab therapy to second-line therapy (mPFS2), and median overall survival (mOS) were the shortest in the non-irAE group. Although the mPFS did not differ between the severe and non-severe irAE groups (9.2 vs 14.2 months, P = 0.45), notably, mPFS2 and mOS in the former group tended to be shorter than those in the latter group (mPFS2: 29.2 vs not reached, P = 0.10; mOS: 36.9 vs 52.3 months, P = 0.06). An increased eosinophil 2 weeks after ipilimumab plus nivolumab therapy may be a predictor of severe irAEs, which are associated with poor prognoses, compared with non-severe irAEs among patients with RCC. We provide a novel rationale for the importance of monitoring eosinophil counts for the early detection of severe irAEs.
Yutaro Sasaki, Yasuyo Yamamoto, Makoto Mizuguchi, Saki Kobayashi, Shinji Nagasaka, Takuya Tokunaga and Junya Furukawa : A case of laparoscopically assisted vulvar reconstruction using the gluteal fold flap for anterior enterocele after robot-assisted radical cystectomy in a woman., IJU Case Reports, 8, 2, 121-124, 2025.
(要約)
Vaginal complications following radical cystectomy may require surgical treatment. We herein report a case of successful laparoscopically assisted vulvar reconstruction using the gluteal fold flap for anterior enterocele following robot-assisted radical cystectomy. A 71-year-old Japanese woman underwent robot-assisted radical cystectomy for bladder cancer (ypT1ypN1M0). The bladder, urethra, bilateral ovaries, and anterior vaginal wall were removed together transvaginally. The Mercedes-Benz closure technique was performed for vaginal reconstruction using the posterior vaginal wall. Seventeen months after surgery, she complained of a vulvar bulge, and physical examination confirmed a tennis ball-sized anterior enterocele. Therefore, she underwent laparoscopically assisted vulvar reconstruction using the gluteal fold flap. No recurrence had developed at 6 months postoperatively. The combination with laparoscopy allows vulvar reconstruction to be performed safely and efficiently.
Kyotaro Fukuta, Ryoichi Nakanishi, Keito Shiozaki, Tomoya Fukawa, Hirofumi Izaki and Junya Furukawa : Efficacy of Photodynamic Diagnosis-Assisted Transurethral Resection of Bladder Tumor in One Piece, International Journal of Urology, 2025.
Taigo Kato, Junya Furukawa, Nobuyuki Hinata, Kosuke Ueda, Isao Hara, Fumiya Hongo, Ryuichi Mizuno, Teppei Okamoto, Hiroshi Okuno, Takayuki Ito, Masahiro Kajita, Mototsugu Oya, Yoshihiko Tomita, Nobuo Shinohara, Masatoshi Eto and Hirotsugu Uemura : Real-world outcomes of avelumab plus axitinib in patients with advanced renal cell carcinoma in Japan: long-term follow-up from the J-DART2 retrospective study, International Journal of Clinical Oncology, 30, 1, 99-109, 2024.
(要約)
Avelumab + axitinib was approved for advanced renal cell carcinoma (aRCC) in Japan in December 2019. We report long-term real-world outcomes with first-line avelumab + axitinib from the J-DART2 study in Japan. J-DART2 was a multicenter, noninterventional, retrospective study examining clinical data from patients with curatively unresectable locally advanced or metastatic RCC who started treatment with first-line avelumab + axitinib in Japan between December 2019 and October 2022. Endpoints included patient characteristics, treatment patterns, and outcomes. Data from 150 patients across 19 sites were analyzed; median follow-up was 18.7 months (95% CI, 16.3-20.6 months). Median age was 70.5 years; 26.0% of patients were aged ≤64 years, 42.7% were aged 65-74 years, and 31.3% were aged ≥75 years. International Metastatic RCC Database Consortium risk was favorable in 26.0%, intermediate in 54.7% (1 risk factor in 30.7%; 2 risk factors in 24.0%), and poor in 19.3% of patients. Median progression-free survival (PFS) was 17.1 months, with 1- and 2-year PFS rates of 57.7% and 37.5%, respectively. Median overall survival (OS) was not reached, with 1- and 2-year OS rates of 90.6% and 84.7%, respectively. Objective response rate was 53.3%; disease control rate was 88.9%. Outcomes were similar across age groups, including patients aged ≥75 years. J-DART2 is the largest retrospective study to report long-term real-world outcomes in patients with aRCC treated with avelumab + axitinib in Japan. Findings were similar to those observed in previous studies and support the benefit of avelumab + axitinib in clinical practice in Japan.
(キーワード)
Avelumab / Axitinib / Japan / Real world / Renal cell carcinoma / Retrospective
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.
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.
Shuzo Hamamoto, Yoshihiko Tasaki, Shimpei Yamashita, Junya Furukawa, Kazutoshi Fujita, Ryotaro Tomida, Makito Miyake, Noriyuki Ito, Hideto Iwamoto, Yosuke Sugiyama, Kazumi Taguchi and Takahiro Yasui : External validation of hemoglobin and neutrophil levels as predictors of the effectiveness of ipilimumab plus nivolumab for treating renal cell carcinoma., Frontiers in Oncology, 14, 1400041, 2024.
(要約)
Pretreatment hemoglobin and neutrophil levels were previously reported to be important indicators for predicting the effectiveness of ipilimumab plus nivolumab (IPI + NIVO) therapy for renal cell carcinoma (RCC). Therefore, we aimed to validate this in a large external cohort. In total, 172 patients with RCC who underwent IPI + NIVO treatment at a multicenter setting were divided into three groups according to their pretreatment hemoglobin and neutrophil levels (group 1: non-anemia; group 2: anemia and low-neutrophil; and group 3: anemia and high-neutrophil). Group 1 showed better survival than groups 2 and 3 (overall survival: 52.3 vs. 21.4 vs. 9.4 months, respectively; progression-free survival: 12.1 vs. 7.0 vs. 3.4 months, respectively). In this large cohort, we validated our earlier observation that hemoglobin and neutrophil levels can be reliable predictors of the effectiveness of IPI + NIVO in advanced RCC. Thus, our approach may aid in selecting the optimal first-line therapy for RCC.
Nobuyuki Hinata, Sae Murakami, Yuzo Nakano, Isao Hara, Tsunenori Kondo, Shuzo Hamamoto, Ryoichi Shiroki, Jun Nagayama, Mutsushi Kawakita, Masatoshi Eto, Osamu Ukimura, Atsushi Takenaka, Toshio Takagi, Masaki Shimbo, Haruhito Azuma, Tetsuya Yoshida, Junya Furukawa, Naoki Kawamorita and Masato Fujisawa : Efficacy of robot-assisted partial nephrectomy compared to conventional laparoscopic partial nephrectomy for completely endophytic renal tumor: a multicenter, prospective study, International Journal of Clinical Oncology, 29, 10, 1548-1556, 2024.
(要約)
This study aimed to compare the efficacy of robot-assisted partial nephrectomy for completely endophytic renal tumors with the reported outcomes of conventional laparoscopic partial nephrectomy and investigate the transition of renal function after robot-assisted partial nephrectomy. We conducted a prospective, multicenter, single-arm, open-label trial across 17 academic centers in Japan. Patients with endophytic renal tumors classified as cT1, cN0, cM0 were included and underwent robot-assisted partial nephrectomy. We defined two primary outcomes to assess functional and oncological aspects of the procedure, which were represented by the warm ischemic time and positive surgical margin, respectively. Comparisons were made using control values previously reported in laparoscopic partial nephrectomy studies. In the historical control group, the warm ischemia time was 25.2, and the positive surgical margin was 13%. Our per-protocol analysis included 98 participants. The mean warm ischemic time was 20.3 min (99% confidence interval 18.3-22.3; p < 0.0001 vs. 25.2). None of the 98 participants had a positive surgical margin (99% confidence interval 0-5.3%; p < 0.0001 vs. 13.0%). The renal function ratio of eGFR before and after protocol treatment multiplied by splits was 0.70 (95% confidence interval: 0.66-0.75). Factors such as preoperative eGFR, resected weight, and warm ischemic time influenced the functional loss of the partially nephrectomized kidney after robot-assisted partial nephrectomy. Robot-assisted partial nephrectomy for completely endophytic renal tumors offers a shorter warm ischemia time and comparable positive surgical margin rate compared with conventional laparoscopic partial nephrectomy.
Kyotaro Fukuta, Tomoya Fukawa, Saki Kobayashi, Keito Shiozaki, Yutaro Sasaki, Kosuke Seto, Ryoichi Nakanishi, Hirofumi Izaki, Masayuki Takahashi, Kazuya Kanda, Hiro-omi Kanayama and Junya Furukawa : Efficacy of educational stepwise robot-assisted radical prostatectomy procedure for urology residents., Asian Journal of Endoscopic Surgery, 17, 3, e13334, 2024.
(要約)
To evaluate the effectiveness of an educational stepwise robot-assisted radical prostatectomy (RARP) procedure for urology residents. We performed a detailed evaluation of 42 RARP procedures performed by a single urology resident from July 2019 to February 2022. The RARP procedures were divided into the following nine steps: (1) bladder dissection, (2) endopelvic fascia dissection, (3) bladder neck dissection, (4) seminal vesicle dissection, (5) Denonvilliers' fascia dissection, (6) dorsal vascular complex ligation, (7) dissection of the prostatic apex, (8) posterior anastomosis, and (9) urethro-vesical anastomosis. The procedures were further subcategorized as anatomical understanding, spatial recognition, and technical skills for evaluation of resident training. The surgeries were divided into first and second halves, and patient characteristics and operative outcomes were statistically analyzed. The operative time of each of the nine steps and the reasons for proctor intervention were compared. Among 42 patients, there were no significant differences in operative outcomes between the two groups. The median operative time was 169 min (164 vs. 179 min, p = .12), and the median console time was 128 min (127 vs. 130 min, p = .74). Although there were no significant differences in the time of the nine steps, the resident significantly overcame (7) dissection of the prostatic apex and (8) posterior anastomosis based on the evaluation of the proctored reasons for intervention. Urology residents can safely perform and efficiently learn RARP with this stepwise educational system. This educational stepwise RARP procedure can effectively help residents to develop their skills.
Kotaro Suzuki, Yusuke Shiraishi, Junya Furukawa, Yasuyoshi Okamura, Yukari Bando, Takuto Hara, Keisuke Okada, Tomoaki Terakawa, Yoji Hyodo, Koji Chiba, Jun Teishima, Yuzo Nakano and Hideaki Miyake : Clinical Outcomes and Risk Stratification in Patients With Metastatic Hormone-Sensitive Prostate Cancer Treated With New-Generation Androgen Receptor Signaling Inhibitors, Clinical Genitourinary Cancer, 22, 5, 102140, 2024.
(要約)
Optimal drug selection for metastatic hormone-sensitive prostate cancer (mHSPC) remains unclear. We therefore assessed the clinical outcomes of mHSPC treated with new-generation androgen receptor pathway inhibitors (ARSIs) and identified risk factors associated with the prognosis of mHSPC. We retrospectively reviewed 324 patients with mHSPC who were treated with ARSIs, including abiraterone acetate, enzalutamide, and apalutamide, between January 2018 and December 2022. In addition to assessing the prostate-specific antigen (PSA) response and overall survival (OS) during ARSI treatment, we investigated several potential risk factors for a poor OS in patients with mHSPC. Patients with a ≥ 90% PSA reduction (hazard ratio [HR]: 0.24, 95% confidence interval [CI], 0.10-0.58; P = .002) and those whose PSA declined to ≤ 0.2 ng/mL (HR: 0.22, 95% CI, 0.08-0.63; P = .005) showed significantly better OS than other patients. Gleason grade group 5 (GG5), presence of liver metastasis, and an LDH ≥ 250 U/L were identified as prognostic factors significantly associated with a poor OS, with HRs of 2.31 (95% CI, 1.02-5.20; P = .044), 7.87 (95% CI, 2.61-23.8; P < .001) and 3.21 (95% CI, 1.43-7.23; P = .005). We identified GG5, the presence of liver metastasis, and elevated LDH at the diagnosis as significant factors predicting the OS of mHSPC, but the choice of ARSIs did not affect the prognosis. The potential prognostic impact of these markers requires further investigation.
Shimpei Yamashita, Shuzo Hamamoto, Junya Furukawa, Kazutoshi Fujita, Masayuki Takahashi, Makito Miyake, Noriyuki Ito, Hideto Iwamoto, Yasuo Kohjimoto and Isao Hara : Association of lung immune prognostic index with survival outcomes in patients with metastatic renal cell carcinoma treated with nivolumab plus ipilimumab, Japanese Journal of Clinical Oncology, 54, 6, 722-729, 2024.
(要約)
Lung immune prognostic index is based on derived neutrophil-to-lymphocyte ratio and lactate dehydrogenase level. Lung immune prognostic index has reported association with survival outcomes in patients with various malignancies undergoing treatment with immune checkpoint inhibitors. However, the prognostic impact of pre-treatment lung immune prognostic index in patients with metastatic renal cell carcinoma receiving nivolumab plus ipilimumab treatment remains unclear. This study examines the association between lung immune prognostic index and outcomes in this setting. We retrospectively evaluated 156 patients with metastatic renal cell carcinoma treated with nivolumab plus ipilimumab at eight institutions. We assessed the associations between pre-treatment lung immune prognostic index and survival outcomes including progression-free survival, second progression-free survival (PFS2), cancer-specific survival and overall survival. Patients were classified into good (n = 84, 54%), intermediate (n = 52, 33%) and poor (n = 20, 13%) lung immune prognostic index groups. Progression-free survival did not significantly differ between lung immune prognostic index groups, but there was significant difference in PFS2, cancer-specific survival and overall survival. In multivariable Cox proportional hazard analyses, high pre-treatment lung immune prognostic index was a significant predictor of poor PFS2 (vs. good group, intermediate group: P = 0.01 and poor group: P = 0.04) and poor overall survival (vs. good group, intermediate group: P = 0.01 and poor group: P < 0.01). Moreover, the patients with poor lung immune prognostic index had significantly poorer cancer-specific survival than those with good LIPI (P < 0.01). High pre-treatment LIPI is suggested by our results to be a significant independent predictor of poor prognosis in patients receiving nivolumab plus ipilimumab for metastatic renal cell carcinoma.
(キーワード)
biomarkers / cytotoxic T lymphocyte-associated antigen 4 inhibitor / PD-1 inhibitor / prognosis / renal cancer
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.
Shimpei Yamashita, Shuzo Hamamoto, Junya Furukawa, Kazutoshi Fujita, Masayuki Takahashi, Makito Miyake, Noriyuki Ito, Hideto Iwamoto, Yasuo Kohjimoto and Isao Hara : Prognostic impact of FAN score in patients receiving nivolumab plus ipilimumab for metastatic renal cell carcinoma, Scientific Reports, 14, 1, 12398, 2024.
(要約)
FAN score is reportedly associated with prognostic outcomes in patients with urothelial carcinoma being treated with immune check point inhibitors. However, the prognostic impact of pre-treatment FAN score in patients with metastatic renal cell carcinoma (RCC) treated with nivolumab plus ipilimumab remains unclear. We retrospectively evaluated the association between pre-treatment FAN score and prognostic outcomes in 154 patients with metastatic RCC treated with nivolumab plus ipilimumab. The pre-treatment FAN score was '0' in 56 patients (36%), '1' in 60 patients (40%), '2' in 37 patients (24%) and '3' in one patient (1%). Progression-free survival was not significantly different between patients with different FAN scores, but second progression-free survival (PFS2), cancer-specific survival (CSS) and overall survival (OS) were significantly different. In multivariable Cox proportional hazard analyses, FAN score ≥ 2 was a significant predictor of poor PFS2 (vs. FAN score 0, HR: 2.43, 95% CI 1.21-4.87, P = 0.01), poor CSS (vs. FAN score 0, HR: 2.71, 95% CI 1.13-6.47, P = 0.02) and poor OS (vs. FAN score 0, HR: 2.42, 95% CI 1.11-5.25, P = 0.02). High pre-treatment FAN score could be a significant independent predictor of poor prognosis in patients receiving nivolumab plus ipilimumab for metastatic RCC.
Yutaro Sasaki, Masayuki Takahashi, Mitsuki Nishiyama, Saki Kobayashi, Yoshiteru Ueno, Junya Furukawa and Kenji Shimada : A novel treatment strategy for bladder hypoplasia: A case of megaureter in a functional solitary kidney., IJU Case Reports, 7, 3, 243-246, 2024.
(要約)
We report a case of megaureter in a functional solitary kidney in which surgery was performed after bladder capacity was increased by home bladder cycling. A 6-day-old girl with a left megaureter, a right multicystic dysplastic kidney, and bladder hypoplasia underwent percutaneous left nephrostomy for obstructive renal failure. At 8 months, home bladder cycling was initiated to increase bladder capacity before the planned ureterocystoneostomy. Surgery was performed after bladder capacity increased. The left ureter was compressed by the left umbilical ligament, so ureteral end-to-end anastomosis was performed at 1 year and 4 months. At 2 years and 8 months, cystometry showed age-appropriate bladder capacity and improved bladder compliance. To the best of our knowledge, this is the first report of bladder hypoplasia treated by home bladder cycling.
Ryotaro Tomida, Masayuki Takahashi, Yuto Matsushita, Takahiro Kojima, Kazutoshi Yamana, Shuya Kandori, Yukari Bando, Naotaka Nishiyama, Shimpei Yamashita, Hisanori Taniguchi, Keisuke Monji, Ryo Ishiyama, Shuichi Tatarano, Kimihiko Masui, Ayumu Matsuda, Tomoyuki Kaneko, Takanobu Motoshima, Yusuke Shiraishi, Satoru Kira, Takaya Murashima, Hiroaki Hara, Masafumi Matsumura, Hiroshi Kitamura, Hideaki Miyake and Junya Furukawa : Comparison of Cabozantinib and Axitinib as Second-line Therapy After Nivolumab Plus Ipilimumab in Patients With Metastatic Clear Cell Renal Cell Carcinoma: A Comparative Analysis of Retrospective Real-world Data, Clinical Genitourinary Cancer, 22, 3, 102094, 2024.
(要約)
To date, no studies have compared the treatment outcomes of second-line therapies in patients with metastatic clear cell renal cell carcinoma (ccRCC). This study retrospectively evaluated the efficacy of cabozantinib and axitinib as second-line treatments in patients with metastatic ccRCC who previously received immune-oncology combination therapy. Patients with metastatic ccRCC treated with cabozantinib and axitinib as second-line therapy after nivolumab-ipilimumab treatment were identified among 243 patients with RCC treated between August 1, 2018 and January 31, 2022 at 34 institutions belonging to the Japanese Urological Oncology Group. Patients were assessed for treatment outcomes, including progression-free survival (PFS), overall survival, objective response rate (ORR), and incidence rate of treatment-related adverse events (AEs). Forty-eight patients treated with cabozantinib and 60 treated with axitinib as second-line therapy after nivolumab-ipilimumab treatment for metastatic ccRCC were identified. The median PFS (95% confidence interval) was 11.0 months (9.0-16.0) with cabozantinib and 9.5 months (6.0-13.0) with axitinib. The ORRs were 37.5% (cabozantinib) and 38.3% (axitinib). The rates of any-grade AEs and grade ≥3 AEs were 79.2% (cabozantinib) versus 63.3% (axitinib; P = .091) and 35.4% (cabozantinib) versus 23.3% (axitinib; P = .202), respectively. In the poor-risk group, PFS was longer in the cabozantinib group than in the axitinib group (P = .033). The efficacy and safety of cabozantinib and axitinib were comparable. In the poor-risk group, cabozantinib was more effective than axitinib. These findings provide valuable insights into the selection of second-line treatment options after nivolumab-ipilimumab treatment in patients with metastatic ccRCC.
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.
Yuka Ohmachi, Masaaki Yamamoto, Yuiko Inaba, Shohei Makino, Shin Urai, Risa Matsumoto, Hironori Bando, Keitaro Kanie, Yasutaka Tsujimoto, Yuma Motomura, Yuriko Sasaki, Yuka Oi-Yo, Naoki Yamamoto, Masaki Suzuki, Michiko Takahashi, Genzo Iguchi, Maki Kanzawa, Junya Furukawa, Katsumi Shigemura, Satoshi Mizobuchi, Wataru Ogawa and Hidenori Fukuoka : The combination of doxazosin and metyrosine as a preoperative treatment for pheochromocytomas and paragangliomas, Endocrine, 84, 2, 694-703, 2024.
(要約)
Preoperative medical management is critical to prevent intraoperative cardiovascular complications in patients with pheochromocytomas and paragangliomas (PPGLs). Initial treatment involves α-adrenergic receptor blockers. However, while the routine use of metyrosine alongside these blockers is not strongly recommended due to a lack of evidence supporting its efficacy and associated safety concerns, there are previous studies on combination therapy with phenoxybenzamine and metyrosine. There are few reports on combination therapy with the selective α1-adrenergic receptor blocker doxazosin. Therefore, we investigated this combination treatment, which theoretically can affect perioperative outcomes in patients with PPGLs. To our knowledge, this is the first such study. This retrospective single-center observational study involved 51 patients who underwent surgical resection of PPGLs at Kobe University Hospital between 2014 and 2022. All patients received doxazosin at maximum doses. Fourteen patients received concomitant metyrosine, while 37 received doxazosin alone. Their perioperative outcomes were compared. No severe event, such as acute coronary syndrome, was observed in either group. Intraoperatively, the doxazosin + metyrosine group exhibited a lower median minimum systolic blood pressure (56 [54-60] vs. 68 [59-74] mmHg, P = 0.03) and required lower median remifentanil (P = 0.04) and diltiazem (P = 0.02) doses than the doxazosin-alone group. The combination of metyrosine and doxazosin as a preoperative treatment for PPGLs affects intraoperative circulatory hemodynamics, such as a reduced occurrence of blood pressure elevation during surgery. Further research is necessary to identify patients who will benefit most from this combination treatment.
Kyotaro Fukuta, Seiya Utsunomiya, Keito Shiozaki, Kosuke Seto, Ryoichi Nakanishi, Hirofumi Izaki, Takumi Kakimoto, Takeshi Oya, Eiji Kudo, Tomoya Fukawa, Masayuki Takahashi and Junya Furukawa : INITIAL RESULTS OF TRANSURETHRAL RESECTION OF BLADDER TUMOR IN ONE PIECE AT TOKUSHIMA PREFECTURAL HOSPITALS, The Nishinihon Journal of Urology, 86, 3, 91-97, 2024.
(キーワード)
depth of diagnosis / non-muscle invasive bladder cancer / Transurethral resection of bladder tumor (TURBT) / transurethral resection of bladder tumor in one piece (TURBO)
Takuto Hara, Junya Furukawa, Takahiro Tsutiya, Takayuki Kodama, Keiichiro Uehara, Tomoaki Terakawa, Kenichi Harada, Jun Teishima, Yuzo Nakano and Masato Fujisawa : Cine magnetic resonance imaging predicts thrombus adhesion in metastatic renal cell carcinoma with an inferior vena cava tumor thrombus: A case of pathological complete response with pembrolizumab plus lenvatinib, IJU Case Reports, 7, 1, 60-63, 2024.
Yutaro Sasaki, Yasuyo Yamamoto, Saki Kobayashi, Masaaki Nishi, Masayuki Takahashi and Junya Furukawa : A case of laparoscopically assisted transperineal repair of anterior enterocele dehiscence with small bowel evisceration after robot-assisted radical cystectomy, Urology Case Reports, 52, 102629, 2024.
(要約)
We herein report a case of successful laparoscopically assisted transperineal repair of anterior enterocele dehiscence with small bowel evisceration after robot-assisted radical cystectomy. A 75-year-old woman underwent robot-assisted radical cystectomy with anterior vaginectomy and urethrectomy for bladder cancer (pTisN0M0). Vaginal reconstruction was performed using the posterior vaginal wall. Four months after surgery, she presented with small bowel evisceration due to anterior enterocele dehiscence. She underwent laparoscopically assisted transperineal repair. The anterior enterocele dehiscence did not occur at the vaginal closure site but instead between the vaginal wall and posterior pubic bone. No recurrence had developed at 2 months postoperatively.
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.
Yasuyo Yamamoto, Yutaro Sasaki, Ryotaro Tomida, Kei Daizumoto, Yoshito Kusuhara, Tomoya Fukawa, Kunihisa Yamaguchi, Masayuki Takahashi and Junya Furukawa : Total cystectomy for Interstitial Cystitis, The Japanese Journal of Urology,