Annual Report 2020
Department of Gynecology
Tomoyasu Kato, Mitsuya Ishikawa, Masaya Uno, Yasuhito Tanase, Mayumi Kato
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 of and surgery for rare cancers in gynecology.
The Team and What We Do
In June 2019, we began performing full-scale laparoscopic surgery, and we are now in our second year. The number of cases has been steadily increasing and we have ensured patient safety and have been certified as a gynecological endoscopy facility. In addition, the da Vinci procedure, which we started performing in March 2020, has been used for both benign and uterine cancer surgeries and it qualified for insurance coverage by the end of the fiscal year.
The number of surgeries performed this fiscal year was 276, a decrease of 13 from last year. The number of surgeries decreased in early spring during the COVID-19 pandemic, but has since recovered.
The primary surgical sites are shown in Table 1. The increase in vulvar cancer and uterine sarcoma can be attributed to the large number of patients referred from the Rare Cancer Center. The breakdown of surgical procedures was 19 cases of wide hysterectomy and 19 cases of paravalvular lymph node dissection, a decrease from last year, but an increase in MIS (minimally invasive surgery) cases (Table 2).
Research activities
Although many institutions nationwide provide adjuvant treatment for intermediate recurrence risk of cervical cancer, we do not. We reported the results of our treatment and the reduced need for adjuvant treatment for squamous cell carcinoma (Yoneoka Y, et al. Obstet Gynecol Sci. 64:226,2021). We are planning to compare the results with those of institutions that provide the adjuvant treatment.
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 been completed and is in the follow-up period.
2) A non-randomized verification study regarding selection of fertility-sparing surgery for patients with epithelial ovarian cancer (JCOG1203) is ongoing as planned.
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 and is in the follow-up period.
4) A non-randomized confirmatory trial of postoperative concurrent chemotherapy (CCRT) using IMRT for patients with curatively resected high-risk uterine cervical cancer (JCOG1402) is ongoing as planned.
5) A randomized phase III trial to confirm the survival effect of para-aortic lymphadenectomy for patients with endometrial cancer (JCOG1412) is ongoing as planned.
GOTIC
6) GOTIC-VTE trial/GOTIC-015: A multicenter seamless prospective cohort study and single-arm confirmatory clinical trial for the venous thromboembolism in gynecological cancer patients has been completed and is under analysis.
7) GOTIC-019: Retrospective study about the application of neoadjuvant chemotherapy followed by interval debulking surgery for patients with advanced epithelial ovarian cancer has been completed and is submitted.
Education
Dr. Yoneoka, who completed his chief residency in March, passed the gynecologic oncologist exam. Dr. Natsume and Dr. Kitamura joined us for the first year of the three-year course, with Dr. Fujii being in the second year.
Future Prospects
We will educate and pass on to future generations the fact that our department's surgical results are better than those of other institutions and that this outcome is due to our surgical skills.
List of papers published in 2020
Journal
1. Wada S, Sadahiro R, Matsuoka YJ, Uchitomi Y, Yamaguchi T, Sato T, Shimada K, Yoshimoto S, Daiko H, Kanemitsu Y, Kawai A, Kato T, Fujimoto H, Shimizu K. Yokukansan for Treatment of Preoperative Anxiety and Prevention of Postoperative Delirium in Cancer Patients Undergoing Highly Invasive Surgery. J-SUPPORT 1605 (ProD Study): A Randomized, Double-Blind, Placebo-Controlled Trial. J Pain Symptom Manage, 61:71-80, 2021
2. Glasbey JC, Nepogodiev D, Simoes JFF, Omar O, Li E, Venn ML, Pgdme, Abou Chaar MK, Capizzi V, Chaudhry D, Desai A, Edwards JG, Evans JP, Fiore M, Videria JF, Ford SJ, Ganly I, Griffiths EA, Gujjuri RR, Kolias AG, Kaafarani HMA, Minaya-Bravo A, McKay SC, Mohan HM, Roberts KJ, San Miguel-Méndez C, Pockney P, Shaw R, Smart NJ, Stewart GD, Sundar Mrcog S, Vidya R, Bhangu AA. Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study. J Clin Oncol, 39:66-78, 2021
3. 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 J Oncol, 12:34-38, 2021
4. Yoneoka Y, Kato MK, Tanase Y, Uno M, Ishikawa M, Murakami T, Kato T. The baseline recurrence risk of patients with intermediate-risk cervical cancer. Obstet Gynecol Sci, 64:226-233, 2021
5. Kato MK, Yoshida H, Uehara T, Uno M, Ishikawa M, Miyasaka N, Kato T. Unique prognostic features of grade 3 endometrioid endometrial carcinoma: Findings from 101 consecutive cases at a Japanese tertiary cancer center. Taiwan J Obstet Gynecol, 60:238-244, 2021
6. Yoshida H, Tanaka H, Tsukada T, Abeto N, Kobayashi-Kato M, Tanase Y, Uno M, Ishikawa M, Kato T. Gross mucinous multinodular appearance aids in the identification of ovarian metastases in low-grade appendiceal mucinous neoplasms during intraoperative consultation. Ann Diagn Pathol, 50:151641, 2021
7. Yoshida H, Tanaka H, Tsukada T, Abeto N, Kobayashi-Kato M, Tanase Y, Uno M, Ishikawa M, Kato T. Diagnostic Discordance in Intraoperative Frozen Section Diagnosis of Ovarian Tumors: A Literature Review and Analysis of 871 Cases Treated at a Japanese Cancer Center. Int J Surg Pathol, 29:30-38, 2021
8. Kato MK, Tanase Y, Uno M, Ishikawa M, Kato T. Brain Metastases from Uterine Cervical and Endometrial Cancer. Cancers (Basel), 13:2021
9. Uehara T, Yoshida H, Kato T. Pelvic seromucinous borderline tumor 26 years after ovarian seromucinous borderline tumor managed with post-treatment estrogen replacement therapy. Gynecol Oncol Rep, 35:100692, 2021
10. Ebata T, Yonemori K, Nishikawa T, Sudo K, Shimomura A, Noguchi E, Fujiwara Y, Kato T, Hasegawa K, Fujiwara K, Tamura K. Treatment Outcome of Second-Line Chemotherapy for Gynecologic Carcinosarcoma. Oncology, 98:699-705, 2020
11. Kato MK, Yunokawa M, Bun S, Shimoi T, Yonemori K, Miyasaka N, Kato T, Tamura K. Treatment strategies for recurrent ovarian cancer in older adult patients in Japan: a study based on real-world data. J Cancer Res Clin Oncol, 146:1335-1341, 2020
12. Mizuno T, Kojima Y, Yonemori K, Yoshida H, Sugiura Y, Ohtake Y, Okuma HS, Nishikawa T, Tanioka M, Sudo K, Shimomura A, Noguchi E, Kato T, Shimoi T, Uno M, Ishikawa M, Fujiwara Y, Ohe Y, Tamura K. HER3 protein expression as a risk factor for post-operative recurrence in patients with early-stage adenocarcinoma and adenosquamous carcinoma of the cervix. Oncol Lett, 20:38, 2020
13. Mizuno T, Kojima Y, Yonemori K, Yoshida H, Sugiura Y, Ohtake Y, Okuma HS, Nishikawa T, Tanioka M, Sudo K, Shimomura A, Noguchi E, Kato T, Shimoi T, Uno M, Ishikawa M, Fujiwara Y, Ohe Y, Tamura K. Neoadjuvant chemotherapy promotes the expression of HER3 in patients with ovarian cancer. Oncol Lett, 20:336, 2020
14. Kato MK, Shida D, Yoneoka Y, Yoshida H, Miyasaka N, Kanemitsu Y, Kato T. Novel classification of ovarian metastases originating from colorectal cancer by radiological imaging and macroscopic appearance. Int J Clin Oncol, 25:1663-1671, 2020
15. Yoshida K, Yokoi A, Kato T, Ochiya T, Yamamoto Y. The clinical impact of intra- and extracellular miRNAs in ovarian cancer. Cancer Sci, 111:3435-3444, 2020
16. Matsuoka YJ, Okubo R, Shimizu Y, Tsuji K, Narisawa T, Sasaki J, Sasai H, Akashi-Tanaka S, Hamaguchi T, Iwasa T, Iwata S, Kato T, Kurotani K, Maruyama D, Mori A, Ogawa A, Sakurai N, Shimazu T, Shimizu C, Tabuchi T, Takahashi M, Takano T, Tatematsu N, Uchitomi Y, Watanabe C, Fukui T. Developing the structure of Japan's cancer survivorship guidelines using an expert panel and modified Delphi method. J Cancer Surviv, 14:273-283, 2020
17. Kojima N, Kuno I, Ushigusa T, Kato T, Yoshida H. Chemotherapy-associated foam cell aggregates as a prognostic factor in patients with pelvic high-grade serous carcinoma receiving neo-adjuvant chemotherapy. Virchows Arch, 477:429-436, 2020
18. Kashihara T, Kobayashi K, Iijima K, Murakami N, Yoshida K, Okuma K, Nakamura S, Takahashi K, Inaba K, Igaki H, Nakayama Y, Kato T, Uno T, Itami J. A case report of a patient with bulky uterine cervical neoplasm who achieved complete response with "intentional internal high-dose policy" high-dose-rate interstitial brachytherapy. Medicine (Baltimore), 99:e20860, 2020
19. Kato MK, Muro S, Kato T, Miyasaka N, Akita K. Spatial distribution of smooth muscle tissue in the female pelvic floor and surrounding the urethra and vagina. Anat Sci Int, 95:516-522, 2020
20. Uehara T, Yoshida H, Fukuhara M, Yoshida M, Motoi N, Sugawara S, Sone M, Arai Y, Tamura K, Uno M, Ishikawa M, Kato T. Efficacy of ascitic fluid cell block for diagnosing primary ovarian, peritoneal, and tubal cancer in patients with peritoneal carcinomatosis with ascites. Gynecol Oncol, 157:398-404, 2020
21. Makiuchi S, Yoshida H, Ishikawa M, Kojima N, Kanai Y, Kato T. Primary Peritoneal Low-grade Serous Carcinoma in a Patient With Lynch Syndrome: A Case Report. Int J Gynecol Pathol, 39:327-332, 2020
22. Murakami N, Nakamura S, Kashihara T, Kato T, Shibata Y, Takahashi K, Inaba K, Okuma K, Igaki H, Nakayama Y, Galalae R, Itami J. Hyaluronic acid gel injection in rectovaginal septum reduced incidence of rectal bleeding in brachytherapy for gynecological malignancies. Brachytherapy, 19:154-161, 2020
23. Karube M, Murakami N, Okamoto H, Okuma K, Kashihara T, Takahashi K, Kaneda T, Inaba K, Igaki H, Kato T, Itami J. Transvaginal artificial ascites infusion as a spacer in gynecological brachytherapy: a novel technique. J Contemp Brachytherapy, 12:487-491, 2020
24. Delaying surgery for patients with a previous SARS-CoV-2 infection. Br J Surg, 107:e601-e602, 2020