Tae-Joong Kim

Embryonic natural orifice transumbilical endoscopic surgery (E-NOTES) for adnexal tumors.

BackgroundEmbryonic natural orifice transumbilical endoscopic surgery (E-NOTES) has shown promise as a minimally invasive laparoscopic surgery technique.ObjectiveTo investigate the feasibility and surgical outcome of E-NOTES for adnexal tumors.MethodsWe performed E-NOTES in 12 patients with adnexal tumors through a 2-cm intraumblical incision. A single-port access system comprising a wound protractor and a surgical glove was used. A prospective data registry was used in this study.ResultsSince 1 July 2008, 12 patients have undergone E-NOTES for adnexal tumors. E-NOTES in all 12 cases was completed successfully without conversion to standard laparoscopic approach. Median operative time for creating an E-NOTES access system and the ensuing operative procedures was 6xa0min (range 5–15xa0min) and 73xa0min (range 25–110xa0min), respectively. Median blood loss was <10xa0ml. No complications requiring treatment occurred.ConclusionE-NOTES is a feasible alternative method for resection of adnexal tumors with better cosmetic outcome. More experience and instrumental improvement suitable for E-NOTES are needed.

Decreased galectin-3 expression during the progression of cervical neoplasia

Purpose: Galectin-3 is expressed widely in epithelial and immune cells and the level of expression varies in many cancer cells relative to the normal tissues from which they arise. We investigated whether the expression of galectin-3 is associated with the progression of cervical neoplasia. Methods: Galectin-3 expression was evaluated in fresh frozen tissues of cervical carcinoma using real-time quantitative RT-PCR. In addition, galectin-3 expression was evaluated at the protein level by immunohistochemistry in 90 formalin-fixed paraffin-embedded cervical tissues, 10 normal cervical specimens, 20 low-grade squamous intraepithelial lesions (LSILs), 20 high-grade squamous intraepithelial lesions (HSILs), and 40 invasive squamous cell carcinomas (ISCCs). Results: Real-time quantitative RT-PCR revealed that galectin-3 expressions in tumor cells were significantly downregulated compared with corresponding normal tissue (P=0.005). Moreover, immunohistochemistry showed that galectin-3 expression was strong in all normal cervical squamous epithelia and gradually decreased in accordance with the histopathologic grades in order LSIL > HSIL > ISCC (P<0.001). Conclusions: These data constitute the first observation that the expression of galectin-3 is downregulated in cervical cancer tissues and suggest that the decreased expression of this galactoside-binding lectin is associated with the progression of cervical neoplasia.

Meta-analysis of the effects of beta blocker on survival time in cancer patients

Purpose This study was to elucidate the potential benefit of beta blockers on cancer survival.MethodsWe comprehensively searched PubMed, Embase, and the Cochrane Library from their inception to April 2013. Two authors independently screened and reviewed the eligibility of each study and coded the participants, treatment, and outcome characteristics. The primary outcomes were overall survival (OS) and disease-free survival (DFS).ResultsTwelve studies published between 1993 and 2013 were included in the final analysis. Four papers reported results from 10 independent groups, resulting in a total of 18 comparisons based on data obtained from 20,898 subjects. Effect sizes (hazard ratios, HR) were heterogeneous, and random-effects models were used in the analyses. The meta-analysis demonstrated that beta blocker use is associated with improved OS (HR 0.79; 95xa0% CI 0.67–0.93; pxa0=xa00.004) and DFS (HR 0.69; 95xa0% CI 0.53–0.91; pxa0=xa00.009). Although statistically not significant, the effect size was greater in patients with low-stage cancer or cancer treated primarily with surgery than in patients with high-stage cancer or cancer treated primarily without surgery (HR 0.60 vs. 0.78, and 0.60 vs. 0.80, respectively). Although only two study codes were analyzed, the studies using nonselective beta blockers showed that there was no overall effect on OS (HR 0.52, 95xa0% CI 0.09–3.04).ConclusionThis meta-analysis provides evidence that beta blocker use can be associated with the prolonged survival of cancer patients, especially patients with early-stage cancer treated primarily with surgery.

Cosmesis and body image after single‐port access surgery for gynaecologic disease

Little is known about patient satisfaction with single‐port access (SPA) surgery for gynaecologic disease related to body image and cosmesis.

In vitro extreme drug resistance assay to taxanes or platinum compounds for the prediction of clinical outcomes in epithelial ovarian cancer: a prospective cohort study

PurposeWe sought to investigate the efficacy of in vitro extreme drug resistance (EDR) assay for the prediction of drug response, platinum-resistance (progression-free survival, PFS <6xa0months) and survival in patients with epithelial ovarian cancer (EOC) who received taxane- and platinum-based chemotherapy after surgery.MethodsBetween December 2005 and August 2007, 43 patients were enrolled prospectively. They underwent staging laparotomy followed by six or nine cycles of taxane- and platinum-based chemotherapy, and their tumors were submitted for in vitro EDR assay to taxanes (paclitaxel or docetaxel) and platinum compounds (carboplatin or cisplatin).ResultsThe rates of EDR to taxanes and platinum compounds were 20.9% (9/43) and 23.3% (10/43). Patients with EDR to platinum compounds showed a lower rate of overall response (60 vs. 100%), a higher rate of platinum-resistance (50 vs. 18.2%) and poor overall survival (OS) (median OS; 29.2 vs. 33.7xa0months) than those without EDR to platinum compounds (Pxa0<xa00.05), whereas patients with EDR to taxanes showed poor PFS than those without EDR to taxanes (12.5 vs. 19xa0months, Pxa0<xa00.01). Moreover, suboptimal debulking surgery and EDR to taxanes were poor prognostic factors for PFS (adjusted hazard ratio 3.215 and 3.984; 95% confidence interval 1.845–7.895 and 3.814–11.674, respectively) although there was no independent risk factor for poor OS by the multivariate Cox’s proportional hazard analysis.ConclusionsIn vitro EDR assay to taxanes and platinum compounds may be helpful for predicting drug response, platinum-resistance and survival in patients with EOC who received taxane- and platinum-based chemotherapy after staging laparotomy.

Comparison of Laparoscopic-Assisted Radical Vaginal Hysterectomy and Laparoscopic Radical Hysterectomy in the Treatment of Cervical Cancer

BackgroundThe aim of this study was to compare the surgical and oncologic outcomes of laparoscopic-assisted radical vaginal hysterectomy (LARVH) with that of laparoscopic radical hysterectomy (LRH) for early-stage cervical cancer.MethodsPatients affected by invasive cervical cancer (FIGO stage I–IIA) who had received LARVH (nxa0=xa089) in our institute between September 2004 and December 2010 were compared with patients treated by LRH (nxa0=xa0105) during the same period. All patient information, surgical and pathological data, and oncological results were prospectively collected. Patients undergoing abdominal radical hysterectomy (ARH) were included for comparison of safety, morbidity, and recurrence rate.ResultsThe mean estimated blood loss (EBL) and return of bowel activity were significantly reduced in the LRH group compared with the LARVH group (pxa0=xa0.011 and pxa0=xa0.002, respectively). Intraoperative complications occurred in 10 patients (11.2xa0%) in the LARVH group, 6 (5.7xa0%) in the LRH group, and 3 (3.0xa0%) in the ARH group. Forest plot analyses of the previous studies showed higher incidence of intraoperative complication in the LARVH group than in LRH group (pxa0=xa0.02). Despite the similar overall recurrence rate, stump recurrence seems to be high in the LRH group in the forest plot analysis of previous studies (pxa0=xa00.08).ConclusionsBoth LARVH and LRH are safe and effective therapeutic procedures for the management of early-stage cervical cancer, although LRH is characterized by less blood loss and shorter bowel recovery time. Possible higher stump recurrence in the LRH should be further evaluated.

Direct inhibition of eIF4E reduced cell growth in endometrial adenocarcinoma

PurposeEukaryotic translation initiation factor 4E (eIF4E) is overexpressed in many cancer and is emerging as a potential therapeutic target. Yet data on the expression of eIF4E in endometrial cancer are lacking.MethodsImmunohistochemistry was used to evaluate the expression of eIF4E in 62 endometrial cancer surgical specimens. We subsequently evaluated whether inhibition of eIF4E by siRNA would have an impact on cell growth in endometrial cancer cell lines, using the MTT cell proliferation assay.ResultsAccording to a chosen cutoff value, 36 (58.1%) of 62 patient specimens scored as eIF4E positive. The positivity of eIF4E was significantly more frequent in tumors extending outside the uterus (stage III/IV vs. stage I/II, Pxa0=xa00.027). Lastly, downregulation of eIF4E by siRNA reduced the growth of HEC-1A cells significantly but had a somewhat weaker effect in Ishikawa cells (Pxa0<xa00.001).ConclusionsExpressions of eIF4E correlated with prognosis of endometrial adenocarcinomas. Our results suggest that eIF4E might be a promising therapeutic target in endometrial cancer.

Safety and efficacy of aprepitant, ramosetron, and dexamethasone for chemotherapy-induced nausea and vomiting in patients with ovarian cancer treated with paclitaxel/carboplatin

PurposeWomen with ovarian carcinoma that are treated with paclitaxel/carboplatin are particularly susceptible to chemotherapy-induced nausea and vomiting (CINV). The current study evaluated the new combination (aprepitant/ramosetron/dexamethasone, 20xa0mg) in ovarian cancer patients receiving multiple cycles of paclitaxel/carboplatin.MethodsThis is a prospective non-randomized single site study. Patients received the following regimen for the prevention of CINV—day 1, 125xa0mg aprepitant, 0.6xa0mg ramosetron, and 20xa0mg dexamethasone before chemotherapy; and days 2–3, 80xa0mg aprepitant each day. The primary end point was the proportion of patients with complete response (CR) during the 120xa0h following the first chemotherapy cycle. Toxicity assessments were conducted using the NCI-CTC investigator guide (version 3.0).ResultsOf the 89 patients enrolled, 85 patients were evaluable for efficacy and toxicity, and 68 (80xa0%) completed all 6xa0cycles. In cycle 1, the percentage of patients who achieved CR in the acute, delayed, and overall phases was 98.8xa0%, 89.4xa0%, and 89.4xa0%, respectively. Of the 460xa0cycles, adverse events, drug-related adverse events, and serious adverse events occurred in 179 (38.9xa0%), 35 (7.6xa0%), and 10xa0cycles (2.2xa0%), respectively. The most common adverse event was constipation (12.4xa0%) and headache (11.1xa0%). None of the patients discontinued the study because of adverse events.ConclusionsThe combination of aprepitant, ramosetron, and high-dose dexamethasone demonstrated efficacy for CINV prevention in ovarian cancer patients receiving paclitaxel and carboplatin.

Ploidy and S-phase fraction are correlated with lymphovascular space invasion that is predictive of outcomes in endometrial cancer

BackgroundPathological detection of lymphovascular space invasion (LVSI) is a useful prognostic marker for patients with endometrial cancer. However, LVSI is criticized for its subjectivity and poor reproducibility. To improve the outcomes of patients with endometrial cancer, we evaluated objective parameters associated with LVSI to generate more accurate LVSI assessments and to identify patients with high-risk disease.MethodsWe reviewed the medical records of 137 patients with endometrial cancer. Flow cytometry was used to determine DNA ploidy and S-phase fraction. Estrogen and progesterone receptor (ER and PR) levels and p53 and k-ras mutational status were tested.ResultsLVSI was found in 36 patients (26.3%). Patients with LVSI had significantly decreased recurrence-free survival and overall survival compared to those without LVSI. Aneuploid tumors were significantly more frequent in LVSI-positive patients compared with LVSI-negative patients (odds ratioxa0=xa05.208, Pxa0<xa00.001). With the exception of p53 mutational status, there was a statistically significant relationship between LVSI and other parameters tested. However, by multivariate analysis, DNA ploidy and S-phase fraction were significantly correlated with LVSI (Pxa0=xa00.034 and 0.001, respectively).ConclusionPloidy and S-phase fraction correlate with LVSI, which is a significant independent predictor of clinical outcome in patients with endometrial cancer.

Phase II study of ifosfamide and cisplatin for the treatment of recurrent ovarian cancer

PurposeThe aim of this phase II study was to investigate the efficacy and toxicity of combined ifosfamide and cisplatin chemotherapy in patients with recurrent epithelial ovarian cancer (EOC).Experimental designForty-seven patients with recurrent EOC were treated with ifosfamide 5xa0g/m2 and cisplatin 50xa0mg/m2 on day 1, every 3xa0weeks for 6 cycles. The primary outcomes were response rate (RR) and toxicity. Other measurements were duration of response, time to progression (TTP), and overall survival (OS).ResultsAll 47 patients with 160 cycles were assessed for response and toxicity. The overall RR was 31.9xa0%; there were 3 complete responses (6.4xa0%) and 12 partial responses (25.5xa0%). Grade 3 and 4 hematologic toxicities included neutropenia (23.6xa0%), anemia (12.8xa0%), and thrombocytopenia (10.7xa0%). Non-hematologic toxicities were mild, and no drug-related toxic deaths occurred. The median duration of response, TTP, and OS was 5.1, 4.8, and 17.0xa0months, respectively. In the initially platinum-sensitive group, RR and OS were 44.4xa0% and 20.4xa0months, while in the initially platinum-resistant group, these values were 15.0 and 8.7xa0months, respectively (Pxa0=xa00.027 and Pxa0=xa00.002, respectively).ConclusionIfosfamide combined with cisplatin is a well-tolerated regimen with modest activity in recurrent EOC. In addition, this regimen was especially effective in patients whose disease was initially platinum-sensitive.