Hirotaka Nishi

Conception After Chemotherapy for Intraplacental Choriocarcinoma: Favorable 5-Year Follow-Up of the Mother and Child

BACKGROUND Intraplacental choriocarcinoma (IC) is a rare subtype of gestational choriocarcinoma that can be associated with placental hemorrhage and metastases to the mother and fetus. Chemotherapy can be effective in cases of placental localization and may not adversely affect fertility. This report describes a 32-year-old woman who conceived 10 months after chemotherapy for IC and achieved successful term delivery of that pregnancy. CASE REPORT A 32-year-old woman delivered her first child by vacuum extraction due to weak labor and fetal distress. The newborn presented with severe anemia, as well as elevated alpha-fetoprotein and fetal hemoglobin levels, suggesting fetomaternal hemorrhage. Placental histopathology revealed IC. Postpartum elevation of human chorionic gonadotropin levels prompted EMA-CO (etoposide, methotrexate, actinomycin D/cyclophosphamide, vincristine) chemotherapy; 7 treatment courses were completed without side effects or metastasis. Ten months after completion of chemotherapy, the patient spontaneously conceived. She subsequently delivered a healthy boy at 38+5 weeks of gestation; placental examination did not reveal malignancy. During the 5-year follow-up period, both children developed normally, and no maternal recurrence or metastasis was observed. CONCLUSIONS This report describes a case of postnatal diagnosis of IC via placental histopathology, followed by successful treatment and subsequent pregnancy within 1 year after chemotherapy completion. The findings highlight the importance of accurate diagnosis and appropriate management of IC; they support previous observations that chemotherapy does not preclude future successful pregnancies. Additionally, the report underscores the clinical challenges of IC, its implications for future pregnancies, and the need for long-term follow-up concerning both mother and child.

Current trends and challenges in minimally invasive surgical treatment for gynecologic cancers in Japan: a cancer statistics report

Minimally invasive surgery (MIS) for gynecologic cancers, which includes laparoscopic and robotic approaches, has seen significant growth in Japan over the past decade. While offering numerous benefits, including reduced postoperative pain and shorter hospital stays, its rapid adoption has also highlighted several challenges, particularly in the management of severe surgical adverse events and disparities in training and access to technology. This article explores the current trends in MIS adoption in Japan, focusing on laparoscopy and robotic surgery, their benefits and limitations, the regulatory and certification frameworks established by the Japan Society of Gynecologic and Obstetric Endoscopy and Minimally Invasive Therapy, and future directions for ensuring safety and efficacy in gynecologic oncology surgery.

Retrospective comparative study of robot‐assisted surgery, laparoscopic surgery, and laparotomy for endometrial cancer in patients with a low risk of recurrence

AbstractAimMinimally invasive surgeries for endometrial cancer are increasing worldwide. In Japan, some articles have examined surgical outcomes, but only a few have addressed oncological outcomes. This study aims to compare robot surgery, laparoscopic surgery, and laparotomy in terms of surgical and oncological outcomes within a low‐risk group for endometrial cancer recurrence.MethodsThis study included patients with endometrial cancer deemed to be at low risk of recurrence and who underwent surgery between January 2011 and December 2020. We studied 99 patients who underwent robot surgery, 85 patients who underwent laparotomy, and 77 patients who underwent laparoscopic surgery. Surgical and oncological outcomes were compared retrospectively for these groups of patients.ResultsThe median follow‐up period was 47, 61, and 60 months in the laparotomy, laparoscopy, and robotic groups, respectively. The three groups had similar perioperative and pathological data. No significant differences in overall survival and disease‐free survival were observed among the groups. Univariate and multivariate analyses conducted on the overall study population for disease‐free survival and overall survival showed that the surgical approach did not have any influence. Minimally invasive surgery groups had longer operating times compared to the laparotomy group, but they had significantly less blood loss. The number of resected pelvic lymph nodes was similar, and the complication rate was not significant.ConclusionsRobot‐assisted surgery and laparoscopic surgery were found to be less invasive and showed similar oncologic outcomes compared to laparotomy surgery for endometrial cancer in patients with a low risk of recurrence.