1.Clinical Trial of the Use of Moxibustion in Version for Breech Presentation.
Kuniaki NIWA ; Yoichi KANAKURA ; Hidetaka MATSUBARA ; Yoshihisa NOMURA ; Fumitaka NAGATA ; Yasutaka SHINZATO ; Hiroshi KAMATSUKI ; Shigetoshi MORIKAWA ; Kunio KOMETANI ; Yasumoto TOKUNAGA
Kampo Medicine 1994;45(2):345-350
Correction of fetal malpresentation such as knee-chest positioning and external cephalic version, has long been performed in cases of breech presentation. The reliability and safety of such treatment, however, remains unclear. We performed moxibustion on three acupoints, namely, Saninko, Shiin, and Yusen to correct the condition.
We studied a total of 28 women, 22 of whom were observed until delivery, and six who had not reached full term by the end of the study. Cephalic presentation was achieved in 25 (89.3%), All but one of the fetuses that were corrected to cephalic presentation had full term vaginal delivery. The remaining one underwent premature delivery due to premature rupture of the membrane at 35 weeks 6 days. None of the babies showed any abnormalities. Correction could not be achieved in three women by the time of delivery. One of these three had dicornate uterus and underwent caesarian section due to premature rupture of the membrane. The other two had full term vaginal delivery of live babies. These results indicate that the correction of breech presentation by moxibustion is a safe method which cause no adverse effects on the mother or baby.
2.Clinical significance of systematic retroperitoneal lymphadenectomy during interval debulking surgery in advanced ovarian cancer patients.
Haruko IWASE ; Toshio TAKADA ; Chiaki IITSUKA ; Hidetaka NOMURA ; Akiko ABE ; Tomoko TANIGUCHI ; Ken TAKIZAWA
Journal of Gynecologic Oncology 2015;26(4):303-310
OBJECTIVE: To investigate the clinical significance of systematic retroperitoneal lymphadenectomy during interval debulking surgery (IDS) in advanced epithelial ovarian cancer (EOC) patients. METHODS: We retrospectively reviewed the medical records of 124 advanced EOC patients and analyzed the details of neoadjuvant chemotherapy (NACT), IDS, postoperative treatment, and prognoses. RESULTS: Following IDS, 98 patients had no gross residual disease (NGRD), 15 had residual disease sized <1 cm (optimal), and 11 had residual disease sized > or =1 cm (suboptimal). Two-year overall survival (OS) and progression-free survival (PFS) rates were 88.8% and 39.8% in the NGRD group, 40.0% and 13.3% in the optimal group (p<0.001 vs. NGRD for both), and 36.3% and 0% in the suboptimal group, respectively. Five-year OS and 2-year PFS rates were 62% and 56.1% in the lymph node-negative (LN-) group and 26.2% and 24.5% in the lymph node-positive (LN+) group (p=0.0033 and p=0.0024 vs. LN-, respectively). Furthermore, survival in the LN+ group, despite surgical removal of positive nodes, was the same as that in the unknown LN status group, in which lymphadenectomy was not performed (p=0.616 and p=0.895, respectively). Multivariate analysis identified gross residual tumor during IDS (hazard ratio, 3.68; 95% confidence interval, 1.31 to 10.33 vs. NGRD) as the only independent predictor of poor OS. CONCLUSION: NGRD after IDS improved prognosis in advanced EOC patients treated with NACT-IDS. However, while systematic retroperitoneal lymphadenectomy during IDS may predict outcome, it does not confer therapeutic benefits.
Adult
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Aged
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Aged, 80 and over
;
Cytoreduction Surgical Procedures/*methods/mortality
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Disease-Free Survival
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Female
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Humans
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Lymph Node Excision/*methods/mortality
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Lymphatic Metastasis
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Middle Aged
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Neoplasms, Glandular and Epithelial/mortality/*surgery
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Ovarian Neoplasms/mortality/*surgery
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Retroperitoneal Space
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Retrospective Studies
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Treatment Outcome
3.Feasibility and outcome of total laparoscopic radical hysterectomy with no-look no-touch technique for FIGO IB1 cervical cancer
Hiroyuki KANAO ; Koji MATSUO ; Yoichi AOKI ; Terumi TANIGAWA ; Hidetaka NOMURA ; Sanshiro OKAMOTO ; Nobuhiro TAKESHIMA
Journal of Gynecologic Oncology 2019;30(3):e71-
OBJECTIVES: Intraoperative tumor manipulation and dissemination may possibly compromise survival of women with early-stage cervical cancer who undergo minimally-invasive radical hysterectomy (RH). The objective of the study was to examine survival related to minimally-invasive RH with a “no-look no-touch” technique for clinical stage IB1 cervical cancer. METHODS: This retrospective study compared patients who underwent total laparoscopic radical hysterectomy (TLRH) with no-look no-touch technique (n=80) to those who underwent an abdominal radical hysterectomy (ARH; n=83) for stage IB1 (≤4 cm) cervical cancer. TLRH with no-look no-touch technique incorporates 4 specific measures to prevent tumor spillage: 1) creation of a vaginal cuff, 2) avoidance of a uterine manipulator, 3) minimal handling of the uterine cervix, and 4) bagging of the specimen. RESULTS: Surgical outcomes of TLRH were significantly superior to ARH for operative time (294 vs. 376 minutes), estimated blood loss (185 vs. 500 mL), and length of hospital stay (14 vs. 18 days) (all, p < 0.001). Oncologic outcomes were similar between the 2 groups, including disease-free survival (DFS) (p=0.591) and overall survival (p=0.188). When stratified by tumor size (<2 vs. ≥2 cm), DFS was similar between the 2 groups (p=0.897 and p=0.602, respectively). The loco-regional recurrence rate following TLRH was similar to the rate after ARH (6.3% vs. 9.6%, p=0.566). Multiple-pelvic recurrence was observed in only 1 patient in the TLRH group. CONCLUSION: Our study suggests that the no-look no-touch technique may be a useful surgical procedure to reduce recurrence risk via preventing intraoperative tumor spillage during TLRH for early-stage cervical cancer.
Cervix Uteri
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Disease-Free Survival
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Female
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Humans
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Hysterectomy
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Laparoscopy
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Length of Stay
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Minimally Invasive Surgical Procedures
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Operative Time
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Recurrence
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Retrospective Studies
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Uterine Cervical Neoplasms
4.Minimally invasive radical hysterectomy and the importance of avoiding cancer cell spillage for early-stage cervical cancer: a narrative review
Atsushi FUSEGI ; Hiroyuki KANAO ; Shiho TSUMURA ; Atsushi MURAKAMI ; Akiko ABE ; Yoichi AOKI ; Hidetaka NOMURA
Journal of Gynecologic Oncology 2023;34(1):e5-
Radical hysterectomy is a standard surgery to treat early-stage uterine cervical cancer. The Laparoscopic Approach to Cervical Cancer (LACC) trial has shown that patients receiving minimally invasive radical hysterectomy have a poorer prognosis than those receiving open radical hysterectomy; however, the reason for this remains unclear. The LACC trial had 2 concerns: the learning curve and the procedural effects. Appropriate management of the learning curve effect, including surgeons’ skills, is required to correctly interpret the result of surgical randomized controlled trials. Whether the LACC trial managed the learning curve effect remains controversial, based on the surgeons’ inclusion criteria and the distribution of institutions with recurrent cases. An appropriate surgical procedure is also needed, and avoiding intraoperative cancer cell spillage plays an important role during cancer surgery. Cancer cell spillage during minimally invasive surgery to treat cervical cancer is caused by several factors, including 1) exposure of tumor, 2) the use of a uterine manipulator, and 3) direct handling of the uterine cervix. Unfortunately, these issues were not addressed by the LACC trial. We evaluated the results of minimally invasive radical hysterectomy while avoiding cancer cell spillage for early-stage cervical cancer. Our findings show that avoiding cancer cell spillage during minimally invasive radical hysterectomy may ensure an equivalent oncologic outcome, comparable to that of open radical hysterectomy. Therefore, evaluating the importance of avoiding cancer cell spillage during minimally invasive surgery with a better control of the learning curve and procedural effects is needed.
5.Transvaginal cervical tumor-concealing no-look no-touch technique in minimally invasive radical hysterectomy for early-stage cervical cancer: a novel operation technique
Hiroyuki KANAO ; Atsushi FUSEGI ; Makiko OMI ; Ariane C. YOUSSEFZADEH ; Hidetaka NOMURA ; Koji MATSUO
Journal of Gynecologic Oncology 2023;34(3):e27-
The Laparoscopic Approach to Cervical Cancer (LACC) trial demonstrated that minimally invasive radical hysterectomy was inferior to the open approach [1]; this unexpected result could be attributed to the spillage of cancer cells [2]. Following the LACC trial, laparoscopic radical hysterectomy without an intrauterine manipulator upon completion of a vaginal cuff closure became the new standard treatment method [3]. However, the lack of intrauterine manipulator results in poor visualization and inadequate paracervical tissue resection. This study describes the no-look no-touch technique to address this difficulty. The core procedures in our no-look, no-touch laparoscopic radical hysterectomy are: (Step 1) Creation and closure of a vaginal cuff; (Step 2) Manipulation of the uterus without an intra-uterine manipulator; and (Step 3) Exposure of the paracervical tissues by the suspension technique. The patient eligibility for our procedure is as follows: 1) previously untreated cervical cancer (those who underwent diagnostic conization could be included); 2) clinical stage IA2, IB1, IB2, and IIA1 based on the 2018 International Federation of Gynecology and Obstetrics staging system; 3) histologically confirmed cervical cancer, including squamous cell carcinoma, adenocarcinoma, and adenosquamous carcinoma. The important indication for this procedure is in cases where the tumor is less than 4 cm in diameter. We previously reported that our no-look no-touch technique enables smooth performance of laparoscopic radical hysterectomy without worsening oncologic outcomes [4]. According to a recent systematic review and meta-analysis [5], minimally invasive radical hysterectomy with vaginal cuff closure is a safe treatment option; however, it involves a steep learning curve, which has impeded its increased application. This video will hopefully make minimally invasive radical hysterectomy with protective maneuvers against cancer cell spillage more accessible. Based on our experiences, we propose that our transvaginal cervical tumor-concealing no-look no-touch technique will mitigate the risk of surgical spill of tumor cells during minimally invasive radical hysterectomy. The informed consent for use of this video was taken from the patient.
6.Clinical implications of the superficial uterine vein pattern for the dissection of the anterior layer of the vesicouterine ligament in radical hysterectomy
Atsushi FUSEGI ; Hiroyuki KANAO ; Mayumi KAMATA ; Shogo NISHINO ; Akiko ABE ; Makiko OMI ; Hidetaka NOMURA
Journal of Gynecologic Oncology 2024;35(4):e50-
Objective:
To describe anatomic patterns of the superficial uterine vein (sUV) and assess their association with aspects of the dissection procedure of the anterior layer of the vesicouterine ligament (aVUL) by retrospectively reviewing surgical videos.
Methods:
We analyzed patients who underwent laparoscopic radical hysterectomy for early-stage cervical cancer from 2014 to 2019. The primary endpoint was the time required for aVUL dissection. Multiple linear regression analyses were performed to identify factors influencing the time required for aVUL dissection.
Results:
Fifty-three Japanese patients were included. Two sUV configurations were observed:type 1 (the vein ran ventral to the ureter along the uterine artery) and type 2 (the vein did not run along the usual ventral course; it ran dorsal to the ureter or was absent). Approximately 30% of the sUVs were type 2. The total time for dissection of both sides of the aVUL was significantly shorter for type 2 sUVs than for type 1 sUVs. The number of hemostatic interventions during dissection of each side of the aVUL was significantly lower for type 2 sUVs than for type 1 sUVs. In the multivariate analysis, the sUV configuration was the factor significantly influencing the duration of aVUL dissection on each side (right side: β=−143.4;left side, β=−160.4).
Conclusion
We demonstrated that the sUV had 2 types of courses, ventral and others, and its course affected the time required for dissection and the number of hemostatic interventions.Our results provide information supportive of improved radical hysterectomy outcomes.
7.Cerebral infarction caused by Trousseau syndrome associated with cervical cancer
Motoko KANNO ; Mayu YUNOKAWA ; Atsushi FUSEGI ; Akiko ABE ; Hidetaka NOMURA ; Hiroyuki KANAO
Journal of Gynecologic Oncology 2024;35(4):e41-
Objective:
The combination of cancer and hypercoagulable states is often called Trousseau syndrome. In particular, cerebral infarction caused by Trousseau syndrome is reported to have a poor prognosis. In gynecology, there are many reports of ovarian cancer and a few of uterine cancer. Since there has been no comprehensive report of Trousseau syndrome in cervical cancer, we aimed to summarize Trousseau syndrome in cervical cancer.
Methods:
Cerebral infarction caused by cancer-related arterial thrombosis was defined as Trousseau syndrome. Patients with cervical cancer diagnosed at our hospital between January 2014 and December 2021 were retrospectively reviewed using the hospital’s medical records.
Results:
A total of 1,432 patients were included in the study. Trousseau syndrome occurred in 6 patients (0.4%). The mean age of patients with Trousseau syndrome was 63 years (range:53–78 years). Of the 6 patients who developed Trousseau’s syndrome, 4 patients had it before or during initial treatment, and 2 during recurrent/relapsed disease treatment. The 4 patients who developed the syndrome before or during initial treatment had advanced disease: 1 in stage IIIC and 3 in stage IVB. In all cases, the disease was associated with progressive distant metastasis. The median survival time from the onset of Trousseau syndrome was 1 month (range: 0–6 months).
Conclusion
Cervical cancer causes Trousseau syndrome in cases of advanced disease with a short time between the onset of the syndrome and mortality.
9.Clinical implications of the superficial uterine vein pattern for the dissection of the anterior layer of the vesicouterine ligament in radical hysterectomy
Atsushi FUSEGI ; Hiroyuki KANAO ; Mayumi KAMATA ; Shogo NISHINO ; Akiko ABE ; Makiko OMI ; Hidetaka NOMURA
Journal of Gynecologic Oncology 2024;35(4):e50-
Objective:
To describe anatomic patterns of the superficial uterine vein (sUV) and assess their association with aspects of the dissection procedure of the anterior layer of the vesicouterine ligament (aVUL) by retrospectively reviewing surgical videos.
Methods:
We analyzed patients who underwent laparoscopic radical hysterectomy for early-stage cervical cancer from 2014 to 2019. The primary endpoint was the time required for aVUL dissection. Multiple linear regression analyses were performed to identify factors influencing the time required for aVUL dissection.
Results:
Fifty-three Japanese patients were included. Two sUV configurations were observed:type 1 (the vein ran ventral to the ureter along the uterine artery) and type 2 (the vein did not run along the usual ventral course; it ran dorsal to the ureter or was absent). Approximately 30% of the sUVs were type 2. The total time for dissection of both sides of the aVUL was significantly shorter for type 2 sUVs than for type 1 sUVs. The number of hemostatic interventions during dissection of each side of the aVUL was significantly lower for type 2 sUVs than for type 1 sUVs. In the multivariate analysis, the sUV configuration was the factor significantly influencing the duration of aVUL dissection on each side (right side: β=−143.4;left side, β=−160.4).
Conclusion
We demonstrated that the sUV had 2 types of courses, ventral and others, and its course affected the time required for dissection and the number of hemostatic interventions.Our results provide information supportive of improved radical hysterectomy outcomes.
10.Cerebral infarction caused by Trousseau syndrome associated with cervical cancer
Motoko KANNO ; Mayu YUNOKAWA ; Atsushi FUSEGI ; Akiko ABE ; Hidetaka NOMURA ; Hiroyuki KANAO
Journal of Gynecologic Oncology 2024;35(4):e41-
Objective:
The combination of cancer and hypercoagulable states is often called Trousseau syndrome. In particular, cerebral infarction caused by Trousseau syndrome is reported to have a poor prognosis. In gynecology, there are many reports of ovarian cancer and a few of uterine cancer. Since there has been no comprehensive report of Trousseau syndrome in cervical cancer, we aimed to summarize Trousseau syndrome in cervical cancer.
Methods:
Cerebral infarction caused by cancer-related arterial thrombosis was defined as Trousseau syndrome. Patients with cervical cancer diagnosed at our hospital between January 2014 and December 2021 were retrospectively reviewed using the hospital’s medical records.
Results:
A total of 1,432 patients were included in the study. Trousseau syndrome occurred in 6 patients (0.4%). The mean age of patients with Trousseau syndrome was 63 years (range:53–78 years). Of the 6 patients who developed Trousseau’s syndrome, 4 patients had it before or during initial treatment, and 2 during recurrent/relapsed disease treatment. The 4 patients who developed the syndrome before or during initial treatment had advanced disease: 1 in stage IIIC and 3 in stage IVB. In all cases, the disease was associated with progressive distant metastasis. The median survival time from the onset of Trousseau syndrome was 1 month (range: 0–6 months).
Conclusion
Cervical cancer causes Trousseau syndrome in cases of advanced disease with a short time between the onset of the syndrome and mortality.