Annual Report 2019
Department of Urology
Hitoshi Masuda, Masaharu Inoue, Shugo Yajima, Hiroaki Suzuki, Shunya Matsumoto, Yudai Ishikawa
Introduction
The Department of Urological Surgery has existed as part of the Department of Pelvic Surgery at the National Cancer Center Hospital East since 2003. This Department mainly treats all urogenital malignant diseases, including kidney cancer, urothelial cancer, prostate cancer, testicular germ cell tumors and retroperitoneal sarcomas. We usually perform minimally invasive surgeries such as robotic, laparoscopic and minimum incision endoscopic surgery with preserving the sexual and/or voiding functions in prostate cancer and organ function, especially in kidney cancer.
The Team and What We Do
Outpatient activities: An outpatient clinic is open four days a week as a Urology Department. Flexible cystoscopy, abdominal ultrasonography, retrograde pyelography and prostate biopsy are performed in the outpatient clinic. Superficial bladder cancer (G3, cis, or recurrent tumor) after TUR-Bt is treated by instillation of BCG into the bladder. Advanced urogenital cancers including metastatic prostate cancer are referred to the medical oncology division for chemotherapy or hormonal therapy. Extrinsic obstructions of the upper urinary tract that directly result from invasion of an adjacent malignancy or peritoneal metastasis are also treated. Selection of internal stenting or percutaneous nephrostomy depends on malignancy type and degree of obstruction. Eighty patients newly received ureteral stents and 29 underwent nephrostomy for obstructive uropathy in 2019. Moreover, 154 patients newly received insertion of markers or spacers for radiation therapy for localized prostate cancer in 2019.
Inpatient activities: A daily conference is held for diagnosis and treatment of the patients with urological cancer. Surgeries, especially robotic prostate and bladder surgeries, increased dramatically in 2019. In the Department of Urology, 452 surgeries were performed in this year (Table 1). Also, we performed 17 combination surgeries with colorectal surgeons in 2019. We newly started robot-assisted partial nephrectomy in Feb. 2020.Other: We have a conference on urogenital cancers every other week among medical oncologists, radiation oncologists, and pathologists. Neoadjuvant chemotherapy for muscle invasive bladder cancer, combination therapy of hormone and radiation for prostate cancer, treatment strategies for metastatic renal cell carcinoma and testicular cancer, and so on, are determined in the meeting.
Research activities
1) We reported on our initial experience with a novel style of 3-dimensional printed kidney in minimally invasive off-clamp partial nephrectomy.
2) We also investigated the risk factors of progression of high-risk superficial bladder cancer.
3) We also investigated the usefulness of novel techniques of robot-assisted radical prostatectomy.
4) We also investigated the role of MRI-DWI in the evaluation of the malignant potential of bladder and upper urinary tract cancers.
Clinical trials
1) A phase III study: BCG instillation for high grade T1 bladder cancer (JCOG1019)
2) A phase III study: Pirarubicin instillation after nephroureterectomy for upper tract urothelial carcinoma (JCOG1403)
3) Examination of the usefulness of the Resonance, the first rnetallic ureteral stent in Japan, to treat ureteral stricture due to extrinsic compression.
4) A phase II clinical study: Penbrolizumab in high-risk NMIBC unresponsive to BCG (MK-3475-057)
5) A phase III clinical study: Penbrolizumab in MIBC (MK-3475-866)
Education
We accepted three voluntary residents of urology in 2019 and educated them on urological surgery.
Future prospects
We developed new and useful techniques for robot-assisted surgeries of the prostate, bladder and kidneys.
List of papers published in 2019
Journal
1. Fujiwara R, Numao N, Ishikawa Y, Inoue T, Ogawa M, Masuda H, Yuasa T, Yamamoto S, Fukui I, Yonese J. Incidence and Predictors of Deep Vein Thrombosis in Patients with Elevated Serum D-Dimer Prior to Surgery for Urologic Malignancy. Urol Int, 104:16-21, 2020
2. Fujiwara R, Inamura K, Yuasa T, Numao N, Yamamoto S, Masuda H, Kawauchi A, Takeuchi K, Yonese J. Efficacy and safety profile of nivolumab for Japanese patients with metastatic renal cell cancer. Int J Clin Oncol, 25:151-157, 2020
3. Ogawa M, Yamamoto S, Inoue T, Numao N, Yuasa T, Masuda H, Fukui I, Yonese J. Phase II Study of Second-line Chemotherapy With Paclitaxel, Gemcitabine, and Cisplatin for Advanced Urothelial Carcinoma. Anticancer Res, 40:1613-1618, 2020
4. Kijima T, Tanaka H, Koga F, Masuda H, Yoshida S, Yokoyama M, Ishioka J, Matsuoka Y, Saito K, Kihara K, Fujii Y. Selective tetramodal bladder-preservation therapy, incorporating induction chemoradiotherapy and consolidative partial cystectomy with pelvic lymph node dissection for muscle-invasive bladder cancer: oncological and functional outcomes of 107 patients. BJU Int, 124:242-250, 2019
5. Yajima S, Yoshida S, Takahara T, Arita Y, Tanaka H, Waseda Y, Yokoyama M, Ishioka J, Matsuoka Y, Saito K, Kihara K, Fujii Y. Usefulness of the inchworm sign on DWI for predicting pT1 bladder cancer progression. Eur Radiol, 29:3881-3888, 2019