Satoshi Yazawa

Role of Pelvic Lymph Node Dissection in Lymph Node-Negative Patients with Invasive Bladder Cancer

OBJECTIVES The role of pelvic lymphadenectomy in patients with lymph node-negative bladder cancer at radical cystectomy (RC) has not yet been examined in detail. We retrospectively reviewed patients who underwent RC with pelvic lymphadenectomy for bladder cancer from January 1987 to March 2008. METHODS We identified consecutive data on 169 patients who underwent RC for bladder cancer. The mean follow-up was 64 months (range: 1-253 months). Node-positive status (pN(+)) was seen in 16 patients and 91 were diagnosed as node-negative (pN(-)). The lymph node status of the remaining 62 patients was unclear (pN(x)). We analysed the association between lymph node status and cancer-specific survival (CSS), and examined the role of the number of retrieved lymph nodes, particularly in pN(-). RESULTS The median number of retrieved nodes was 12.9 and 10.2 for stage pN(+) and stage pN(-), respectively. In 91 patients with pN(-), multivariate analysis revealed that pathological T3-4 (P = 0.0276) and less than nine retrieved lymph nodes (P = 0.0108) were independent risk factors for CSS. In a subgroup of 83 patients with pT3-4, Kaplan-Meier curves showed that the 5-year CSS rate in pN(-) patients with less than nine retrieved lymph nodes was 38.8%, which was extremely similar to the 40.8% in pN(+) and 45.1% in pN(x). CONCLUSIONS Our results demonstrate that at least nine lymph nodes should be removed to improve the survival of pN(-) patients at RC and lymphadenectomy, and would provide information not only on prognosis but also on the therapeutic impact on pT3-4 invasive bladder cancer.

Visceral obesity is associated with better recurrence-free survival after curative surgery for Japanese patients with localized clear cell renal cell carcinoma

OBJECTIVE To investigate the prognostic significance of visceral obesity to predict recurrence after curative surgery for Japanese patients with localized renal cell carcinoma. METHODS The data of 285 patients who underwent curative surgery for localized renal cell carcinoma were retrospectively reviewed. Median follow-up was 36.7 months. The association between visceral obesity and recurrence-free survival rate was evaluated using the Kaplan-Meier method and Cox regression models. Visceral fat area at the level of the umbilicus measured using pre-operative computed tomography was used as an index of visceral obesity. RESULTS Twenty-nine patients (10.2%) experienced recurrence. Five-year recurrence-free survival rates were 91.3% in high visceral fat area group (≥ 120 cm(2)) and 76.9% in low visceral fat area group (<120 cm(2)) (P = 0.037); however, visceral fat area was not an independent predictor of recurrence-free survival in multivariate analysis. In the patients with clear cell renal cell carcinoma, 28 patients (11.6%) experienced recurrence. Five-year recurrence-free survival rates were 88.7% in high visceral fat area group and 71.0% in low visceral fat area group (P = 0.043), and visceral fat area was an independent predictor of recurrence-free survival (hazard ratio: 1.974, P = 0.042) as well as C-reactive protein, Fuhrman nuclear grade, tumor size and microvascular invasion. In patients with organ confined clear cell renal cell carcinoma in particular, visceral fat area was also a useful and independent predictor of recurrence-free survival (hazard ratio: 2.807, P = 0.038). Body mass index was not useful in either cohort. CONCLUSIONS High visceral fat area was a positive predictive biomarker for better recurrence-free survival after curative surgeries for localized clear cell renal cell carcinomas; however, body mass index was not a predictor.

Surgical and chemotherapeutic options for urachal carcinoma: Report of ten cases and literature review

Objective: Several studies have associated urachal carcinoma with a poor prognosis, because the disease tends to be detected later as the patient is asymptomatic, there are few therapeutic options, and it has a high local recurrence rate. We review our experience with urachal carcinoma and discuss the role of surgical management and chemotherapeutic options. Patients and Methods: We reviewed the records of 10 cases with urachal carcinoma evaluated at Keio University Hospital from 1998 to 2009, and examine the surgical and chemotherapeutic options in the management of urachal carcinoma. Results: Median age was 55.0 years. Applying the TNM staging system, 1 case was in stage I, 4 cases in stage II, 4 cases in stage III, and 1 case was in stage IV. Nine cases were managed initially with surgery; 5 by partial cystectomy and 4 by total cystectomy. The median follow-up period was 3.5 years and the survival rate at 2 years was 87.5%. Six of the resected cases remain disease-free. Salvage chemotherapy was performed in 3 cases, and adjuvant chemotherapy was performed in 2 cases. Conclusions: We had 10 cases with urachal carcinoma. While there is still no standard chemotherapy combination, CPT-11 plus TS-1 produced stable disease in 1 case.

Prognostic value of preoperative multiparametric magnetic resonance imaging (MRI) for predicting biochemical recurrence after radical prostatectomy

To evaluate the suitability of preoperative multiparametric magnetic resonance imaging (MRI) positivity as a predictor of biochemical recurrence after radical prostatectomy (RP).

What is the predictor of prolonged operative time during laparoscopic radical prostatectomy

To study the impact of high body mass index and large prostate weight on operative time of laparoscopic radical prostatectomy.

Treatment of acute uncomplicated cystitis with faropenem for 3 days versus 7 days: multicentre, randomized, open-label, controlled trial

OBJECTIVES The increasing prevalence of resistant bacteria such as fluoroquinolone-resistant or extended-spectrum β-lactamase-producing strains in pathogens causing acute uncomplicated cystitis has been of concern in Japan. Faropenem sodium is a penem antimicrobial that demonstrates a wide antimicrobial spectrum against both aerobic and anaerobic bacteria. It is stable against a number of β-lactamases. METHODS We compared 3 and 7 day administration regimens of faropenem in a multicentre, randomized, open-label, controlled study. RESULTS In total, 200 female patients with cystitis were enrolled and randomized into 3 day (N = 97) or 7 day (N = 103) treatment groups. At the first visit, 161 bacterial strains were isolated from 154 participants, and Escherichia coli accounted for 73.9% (119/161) of bacterial strains. At 5-9 days after the completion of treatment, 73 and 81 patients from the 3 day and 7 day groups, respectively, were evaluated by intention-to-treat analysis; the microbiological efficacies were 58.9% eradication (43/73), 20.5% persistence (15/73) and 8.2% replaced (6/73), and 66.7% eradication (54/81), 6.2% persistence (5/81) and 7.4% replaced (6/81), respectively (P = 0.048). The clinical efficacies were 76.7% (56/73) and 80.2% (65/81), respectively (P = 0.695). Adverse events due to faropenem were reported in 9.5% of participants (19/200), and the most common adverse event was diarrhoea. CONCLUSIONS The 7 day regimen showed a superior rate of microbiological response. E. coli strains were in general susceptible to faropenem, including fluoroquinolone- and cephalosporin-resistant strains.

Risk factors for surgical site infection after transvaginal mesh placement in a nationwide Japanese cohort

We conducted a nationwide survey on perioperative management and antimicrobial prophylaxis of transvaginal mesh surgeries for pelvic organ prolapse in Japan to understand the practice and risk factors for surgical site infection (SSI).

Novel algorithm for management of acute epididymitis.

To identify predictive factors for the severity of epididymitis and to develop an algorithm guiding decisions on how to manage patients with this disease.

Editorial Comment to Management of fungus balls as a result of Candida albicans

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A Case of Bladder Cancer after Radiation Therapy for Prostate Cancer

An 86-year-old male who presented with the chief complaint of clot retention and had a history of prostate cancer treated with external beam radiation therapy 11 years previously is described. Cystoscopy revealed radiation cystitis in coexistence with bladder cancer. Since bladder cancer may be present in patients with macroscopic hematuria who have a history of radiation therapy, referral to an urologist is recommended.