Kenta Yoshida

Visceral Adipose Tissue Percentage Compared to Body Mass Index as Better Indicator of Surgical Outcomes in Women With Obesity and Endometrial Cancer

To assess the impact visceral adipose tissue percentage (VAT%) on surgical outcomes during minimally invasive surgery in obese women with endometrial cancer. Retrospective observational cohort study. Mie University Hospital, Japan. Of the 73 women (body mass index [BMI] >30 kg/m We investigated the correlation between surgical outcomes (operative time and blood loss) and obesity (BMI and visceral adipose tissue percentage [VAT%]). Abdominal fat-related parameters were measured at the level of the umbilicus using preoperative computed tomography. A weak negative correlation was found between BMI and VAT% (CC = -0.313, p = .001). Multivariate analysis showed that VAT% had a stronger correlation to total and practical operative time than BMI (β = 0.338 vs 0.267, β = 0.311 vs 0.209, respectively) and was an independent predictor of blood loss. VAT% was an independent predictive marker prolonged for operative time and increased blood loss during lymphadenectomy. VAT% could be an indicator of surgical outcomes for patients with obesity and endometrial cancer.

Safety and efficacy of levonorgestrel‐releasing intrauterine device in the treatment of atypical endometrial hyperplasia and early endometrial cancer

AbstractAimTo investigate the recurrence rate, live‐birth rate, and treatment outcomes of levonorgestrel‐releasing intrauterine device (LNG‐IUD) for the management of atypical endometrial hyperplasia (AEH) or Grade‐1 endometrial cancer (EC) in patients who desire fertility‐sparing treatment and those seeking conservative treatment without fertility preservation.MethodsWe prospectively enrolled nine patients from a single institution between April 2009 and September 2013 who were followed up for 60 months after LNG‐IUD insertion.ResultsThe median patient age was 35 (range: 29–39) years. The overall recurrence rate was 56% (5/9). The median interval between removal of the LNG‐IUD and recurrence was 20.5 (range: 2–30) months. Three of the nine patients had Grade‐1 EC, and six had AEH. The response rates to the LNG‐IUD in patients with Grade‐1 EC and AEH were 66% and 100%, respectively. Four patients (three with AEH, one with Grade‐1 EC) experienced recurrence 6 months after MPA treatment and all 4 (100%) had complete response. Eight patients desired fertility preservation, of which 37% (3/8) conceived after receiving fertility treatment and 25% (2/8) had a live birth; the remaining three had previously received MPA for 6 months and had a recurrence; of these, 1 had a live birth.ConclusionLNG‐IUD is effective for the management of AEH and EC in young patients who desire fertility‐sparing treatment, including those ineligible for MPA owing to the presence of comorbidities and those with recurrence after MPA treatment (6‐month treatment), and patients seeking conservative treatment without fertility preservation.

Laparoscopic retroperitoneal para‐aortic lymph node biopsy in advanced cervical cancer with pelvic lymph node metastases: A single‐center prospective study

Abstract Aim Extended‐field concurrent chemoradiation therapy (Ex‐CCRT) has been widely used for para‐aortic lymph node (PAN) metastases confirmed by radiographic assessment without surgical exploration. The objective of this prospective study was to evaluate the clinical value of laparoscopic retroperitoneal PAN biopsy in locally advanced cervical cancer (LACC) with pelvic lymph node (PLN) metastases. Methods From May 2017 to March 2020, stage IIB–IIIB cervical cancer patients who were diagnosed with PLN metastasis using positron emission tomography‐computed tomography (PET‐CT) with maximum standardized uptake value (SUVmax) ≥2.0 underwent laparoscopic retroperitoneal PAN biopsy. The radiation fields were extended to PAN areas with pathological metastases. Results Fourteen patients were diagnosed with cervical squamous cell carcinoma of the International Federation of Gynecology and Obstetrics (FIGO) stage IIB ( n  = 7) and IIIB ( n  = 7). The median operating time was 138 min (range, 104–184 min). The median number of harvested PANs was 19 (range, 6–36). Three patients were positive for PAN metastasis on histological analysis. In this study, the sensitivity and specificity of PET‐CT were 66.7% and 90.9%, respectively. Conclusion Our study is characterized by the use of more appropriate eligibility criteria for LACC with PLN metastases. Our results revealed that laparoscopic retroperitoneal PAN biopsy may be a useful approach to determine the radiation field for PANs during standard radiotherapy planning.

Comparison of treatment outcomes of surgery and radiotherapy, including concurrent chemoradiotherapy for stage Ib2-IIb cervical adenocarcinoma patients: a retrospective study

The study compared the treatment outcomes of surgery versus radiotherapy, including concurrent chemoradiotherapy, in stage Ib2-IIb cervical adenocarcinoma patients in Japan. Of 57,470 patients diagnosed with stage I-IV cervical cancer from January 2001-December 2011, 1,932 patients with stage Ib2-IIb cervical adenocarcinoma were initially treated by surgery or radiotherapy. The primary endpoint was 5-year overall survival (OS) in all and 614 propensity score-matched (PSM) patients (307 per group). We compared OS and prognosis factors based on age, primary stage, and treatment arm. In Japan, >80% (n=1,573) of stage Ib2-IIb cervical adenocarcinoma patients underwent surgery. The 5-year OS of surgery vs. radiotherapy groups were 82.1% (n=704) vs. 79.7% (n=59) (hazard ratio [HR]=1.494; 95% confidence interval [CI]=0.826-2.702; p=0.181) for stage Ib2, 76.6% (n=239) vs. 66.7% (n=54) (HR=1.679; 95% CI=0.986-2.858; p=0.053) for stage IIa, and 71.1% (n=630) vs. 58.9% (n=246) (HR=1.711; 95% CI=1.341-2.184; p65 years), treatment arm (radiotherapy), and stage IIb significantly affect OS in cervical adenocarcinoma patients. Surgery may be considered for <65-year-old patients with stage IIb adenocarcinoma.