Department of Gynecology

Tomoyasu Kato, Mitsuya Ishikawa, Masaya Uno, Yasuhito Tanase, Mayumi Kato, Erisa Fujii

Introduction

The Department of Gynecology deals with tumors originating from the female genital and reproductive organs. Surgery is the main treatment modality for most gynecologic cancers, but multidisciplinary treatments consisting of radiotherapy and chemotherapy are routinely considered in close cooperation with therapeutic radiation oncologists and medical oncologists. The incidences of three common gynecologic cancers, that is, cervical, endometrial and ovarian/tubal/peritoneal cancer, are still on the rise in Japan. We are also working on the diagnosis and surgery of rare cancers in gynecology.

Table 1. Number of patients


Table 2. Type of procedure

The Team and What We Do

Minimum invasive surgery (MIS) has become more prevalent in the department with the start of laparoscopic surgery in June 2019 and da Vinci surgery in March 2020, and the number of surgeons has also increased.

The number of surgeries performed this year increased significantly from 276 in the previous year to 342. Table 1 shows the primary sites. The breakdown of surgical procedures shows that 24 (19 in the previous year) were extensive total hysterectomies and 21 (19 in the previous year) were para-aortic lymph node dissections, both of which are expansion surgeries. These are increases from last year. Laparoscopic surgery was performed in 47 cases, with 30 cases of total hysterectomy, a higher ratio than in other hospitals (Table 2). The range of surgical procedures for gynecological cancer patients has expanded and become more established, with expanded surgery for locally advanced cases being performed safely and reliably, and MIS for early-stage cases.

Research activities

The primary analysis of JCOG1311, for which Ishikawa is the principal investigator, was published, and the efficacy of the new chemotherapy dose-dense TC therapy for recurrent cervical cancer did not show the expected results (Ishikawa Gynecol. Oncol. 162(2):292, 2021).

Clinical trials

JCOG

1) A nonrandomized confirmatory trial of modified radical hysterectomy for patients with FIGO Stage Ib1 (< 2 cm) uterine cervical cancer (JCOG1101) has completed recruiting and is in the follow-up period.

2) A nonrandomized verification study regarding selection of fertility-sparing surgery for patients with epithelial ovarian cancer (JCOG1203) has completed recruiting and is in the follow-up period.

3) A randomized phase II/III trial of conventional paclitaxel and carboplatin versus dose-dense paclitaxel and carboplatin in stage IVB, recurrent, or persistent cervical carcinoma (JCOG 1311) has been completed.

4) A non-randomized confirmatory trial of postoperative concurrent chemotherapy (CCRT) using IMRT for patients with curatively resected high-risk uterine cervical cancer (JCOG1402) has completed recruiting and is in the follow-up period.

5) A randomized phase III trial to confirm the survival effect of para-aortic lymphadenectomy for patients with endometrial cancer (JCOG1412) is proceeding with recruiting as planned.

GOTIC

6) GOTIC-VTE trial/GOTIC-015: A multicenter seamless prospective cohort study and single-arm confirmatory clinical trial for venous thromboembolism in gynecological cancer patients has been completed and will be presented at the IGCS meeting at the end of September 2022.

7) GOTIC-019: A retrospective study about the application of neoadjuvant chemotherapy followed by interval debulking surgery for patients with advanced epithelial ovarian cancer has been completed and submitted.

Education

Dr. Fujii is in the third year of a three-year course and has completed the number of cases required to become a qualified gynecologic oncologist. Dr. Natsume and Dr. Kitamura are in their second year of the three-year course and are training in other departments. Dr. Ozawa and Dr. Nakahara have newly joined the department, making the resident lineup richer. In addition, Dr. Ogimoto was accepted from Chibune Hospital as a late-career trainee.

Future prospects

Our staff doctors educate future generations and pass on to them the fact that our department's surgical results are higher than those of other institutions and that this is due to our surgical skills.

List of papers published

Journal

1. Ebata T, Yamashita S, Takeshima H, Yoshida H, Kawata Y, Kino N, Yasugi T, Terao Y, Yonemori K, Kato T, Ushijima T. DNA methylation marker to estimate ovarian cancer cell fraction. Med Oncol, 39:78, 2022

2. Nagai T, Shimada M, Tokunaga H, Ishikawa M, Yaegashi N. Clinical issues of surgery for uterine endometrial cancer in Japan. Japanese journal of clinical oncology, 52:346-352, 2022

3. Onuki M, Yamamoto K, Yahata H, Kanao H, Yokota H, Kato H, Shimamoto K, Takehara K, Kamiura S, Tsuda N, Takei Y, Shigeta S, Matsumura N, Yoshida H, Motohara T, Watari H, Nakamura K, Ueda A, Tasaka N, Ishikawa M, Hirashima Y, Kudaka W, Taguchi A, Iwata T, Takahashi F, Kukimoto I, Yoshikawa H, Yaegashi N, Matsumoto K. Human papillomavirus vaccine effectiveness by age at first vaccination among Japanese women. Cancer science, 113:1428-1434, 2022

4. Kobayashi Kato M, Asami Y, Takayanagi D, Matsuda M, Shimada Y, Hiranuma K, Kuno I, Komatsu M, Hamamoto R, Matsumoto K, Ishikawa M, Kohno T, Kato T, Shiraishi K, Yoshida H. Clinical impact of genetic alterations of CTNNB1 in patients with grade 3 endometrial endometrioid carcinoma. Cancer science, 113:1712-1721, 2022

5. Onuki M, Yamamoto K, Yahata H, Kanao H, Horie K, Konnai K, Nio A, Takehara K, Kamiura S, Tsuda N, Takei Y, Shigeta S, Nakai H, Yoshida H, Motohara T, Kato T, Nakamura K, Hamanishi J, Tasaka N, Ishikawa M, Kado N, Taira Y, Mori M, Iwata T, Takahashi F, Kukimoto I, Yoshikawa H, Yaegashi N, Matsumoto K, For The Mint Study Group. Changes in HPV16/18 Prevalence among Unvaccinated Women with Cervical Intraepithelial Neoplasia in Japan: Assessment of Herd Effects following the HPV Vaccination Program. Vaccines, 10:2022

6. Machino H, Kaneko S, Komatsu M, Ikawa N, Asada K, Nakato R, Shozu K, Dozen A, Sone K, Yoshida H, Kato T, Oda K, Osuga Y, Fujii T, von Keudell G, Saloura V, Hamamoto R. The metabolic stress-activated checkpoint LKB1-MARK3 axis acts as a tumor suppressor in high-grade serous ovarian carcinoma. Communications biology, 5:39, 2022

7. Ishikawa M, Shibata T, Iwata T, Nishio S, Takada T, Suzuki S, Horie K, Kudaka W, Kagabu M, Tanikawa M, Kitagawa R, Takekuma M, Kobayashi H, Yaegashi N. A randomized phase II/III trial of conventional paclitaxel and carboplatin with or without bevacizumab versus dose-dense paclitaxel and carboplatin with or without bevacizumab, in stage IVB, recurrent, or persistent cervical carcinoma (JCOG1311): Primary analysis. Gynecologic oncology, 162:292-298, 2021

8. Yoshida H, Naka T, Kobayashi-Kato M, Kikkawa N, Tanase Y, Uno M, Ishikawa M, Kato T. Gastric-type cervical adenocarcinoma with squamous differentiation: buried in adenosquamous carcinomas? Virchows Archiv: an international journal of pathology, 479:407-412, 2021

9. Yoshida H, Asami Y, Kobayashi-Kato M, Tanase Y, Uno M, Ishikawa M, Shiraishi K, Kato T. Genetic features of endometrioid-type endometrial carcinoma arising in uterine adenomyosis. Virchows Archiv: an international journal of pathology, 2021

10. Tanase Y, Yoshida H, Naka T, Kitamura S, Natsume T, Kobayashi Kato M, Uno M, Ishikawa M, Ali Mahmoud Ali A, Kato T. Clear Cell Carcinoma of the Cervix With OHVIRA Syndrome: A Rare Case Report. World journal of oncology, 12:34-38, 2021

11. Death following pulmonary complications of surgery before and during the SARS-CoV-2 pandemic. The British journal of surgery, 108:1448-1464, 2021

12. COVIDSurg Collaborative. Effect of COVID-19 pandemic lockdowns on planned cancer surgery for 15 tumour types in 61 countries: an international, prospective, cohort study. The Lancet. Oncology, 22:1507-1517, 2021

13. Yoshida H, Shiraishi K, Kato T. Molecular Pathology of Human Papilloma Virus-Negative Cervical Cancers. Cancers, 13:2021

14. Sugawara S, Sone M, Itou C, Kimura S, Kusumoto M, Kato T, Yonemori K, Yatabe Y, Arai Y. Analysis of factors affecting the diagnostic yield of image-guided percutaneous core needle biopsy for peritoneal/omental lesions. Abdominal radiology (New York), 46:4499-4508, 2021

15. Shimoi T, Hashimoto J, Sudo K, Shimomura A, Noguchi E, Shimizu C, Yunokawa M, Yonemori K, Yoshida H, Yoshida M, Kato T, Kinoshita T, Fukuda T, Fujiwara Y, Tamura K. Hotspot mutation profiles of AKT1 in Asian women with breast and endometrial cancers. BMC cancer, 21:1131, 2021

16. Murakami N, Asami Y, Yoshida H, Takayanagi D, Hirose S, Kuno I, Takahashi K, Matsuda M, Shimada Y, Yamano S, Sunami K, Honda T, Nakahara T, Watanabe T, Okuma K, Kuroda T, Kohno T, Kato T, Shiraishi K, Itami J. Distribution of genetic alterations in high-risk early-stage cervical cancer patients treated with postoperative radiation therapy. Scientific reports, 11:10567, 2021

17. Kikkawa N, Ito K, Yoshida H, Kato MK, Kubo Y, Onishi Y, Sugawara H, Kato T, Kusumoto M. Magnetic resonance imaging findings in 11 cases of dedifferentiated endometrial carcinoma of the uterus. Japanese journal of radiology, 39:477-486, 2021

18. Kaneko S, Mitsuyama T, Shiraishi K, Ikawa N, Shozu K, Dozen A, Machino H, Asada K, Komatsu M, Kukita A, Sone K, Yoshida H, Motoi N, Hayami S, Yoneoka Y, Kato T, Kohno T, Natsume T, Keudell GV, Saloura V, Yamaue H, Hamamoto R. Genome-Wide Chromatin Analysis of FFPE Tissues Using a Dual-Arm Robot with Clinical Potential. Cancers, 13:2021

19. Honda K, Hishiki T, Yamamoto S, Yamamoto T, Miura N, Kubo A, Itoh M, Chen WY, Takano M, Yoshikawa T, Kasamatsu T, Sonoda S, Yoshizawa H, Nakamura S, Itai Y, Shiota M, Koike D, Naya M, Hayakawa N, Naito Y, Matsuura T, Iwaisako K, Masui T, Uemoto S, Nagashima K, Hashimoto Y, Sakuma T, Matsubara O, Huang W, Ida T, Akaike T, Masugi Y, Sakamoto M, Kato T, Ino Y, Yoshida H, Tsuda H, Hiraoka N, Kabe Y, Suematsu M. On-tissue polysulfide visualization by surface-enhanced Raman spectroscopy benefits patients with ovarian cancer to predict post-operative chemosensitivity. Redox biology, 41:101926, 2021