Biomedical subjects

Yasushi Yoshino

Publications and source records attributed to Yasushi Yoshino.

10 recordsLinked to original sources

PubMed2006

Laparoscopic nephroureterectomy for transitional cell carcinoma of renal pelvis and ureter: Nagoya experience.

OBJECTIVES: To evaluate the efficacy of retroperitoneoscopic nephroureterectomy for transitional cell carcinoma of the renal pelvis and ureter, we analyzed the clinical outcomes and long-term cancer control of 89 patients. METHODS: In 36 patients, the kidney was retroperitoneoscopically dissected and the ureteral end was resected with open procedure (combined laparoscopy group). In 53 patients, the ureteral end with a bladder cuff was transected using an endoscopic stapler (pure laparoscopy group). Sixty patients underwent open nephroureterectomy (open group). The median follow-up period was 35, 31, and 17 months in the open, combined, and pure laparoscopy groups, respectively. RESULTS: The average operative time and bleeding volume was 5.4 hours and 665 mL in the open group, 5.1 hours and 580 mL in the combined laparoscopy group, and 4.3 hours and 354 mL in the pure laparoscopy group, respectively. The cause-specific patient survival rate at 3 years was 81% in the open group, 86% in the combined laparoscopy group, and 80% in the pure laparoscopy group. The bladder recurrence-free rate at 3 years was 51% in the open group, 65% in the combined laparoscopy group, and 45% in the pure laparoscopy group. The extravesical recurrence-free rate at 3 years was 71% in the open surgery group, 76% in the combined laparoscopy group, and 71% in the pure laparoscopy group. No statistically significant difference was seen in patient survival, bladder recurrence, or extravesical recurrence rates among the three groups. CONCLUSIONS: Our retroperitoneal laparoscopic nephroureterectomy is less invasive than open surgery and is a safe and effective alternative.

Aged↗

PubMed2005

Laparoscopic radical nephrectomy for renal cell carcinoma: the standard of care already?

PURPOSE OF REVIEW: Laparoscopic radical nephrectomy has been developed and applied for patients with renal cell carcinoma since 1992. The number of patients undergoing laparoscopic radical nephrectomy has increased explosively worldwide in recent years, and laparoscopy is now extended to patients with advanced disease. It is very important to clarify the present status of laparoscopic radical nephrectomy among the treatment modalities for patients with renal cell carcinoma. RECENT FINDINGS: Laparoscopic radical nephrectomy has a minimally invasive nature as well as comparable long-term cancer control in patients with pT1-3a renal cell carcinoma to open surgery. It is technically applicable for N1-2 disease and T3b disease if the tumor thrombus is within the renal vein. Also, it is feasible as a cytoreductive surgery for patients with M1 disease. SUMMARY: Laparoscopic radical nephrectomy is a standard treatment modality for T1-3a renal cell carcinoma patients. It is also available for treating patients with N1-2 disease, and for patients with M1 disease as a cytoreductive surgery.

Carcinoma, Renal Cell↗

PubMed2005

Measurement of prostate specific antigen complexed to alpha1-antichymotrypsin to avoid unnecessary biopsy in patients with serum prostate specific antigen levels 4-20 ng/mL.

AIM: To investigate whether measuring prostate specific antigen complexed to alpha1-Antichymotrypsin (PSA-ACT) can increase sensitivity and specificity in detecting prostate cancer. METHODS: In this prospective study, we measured serum total PSA, PSA-ACT, free PSA, prostate volume and transition zone volume on 210 patients with total PSA level of 4-20 ng/mL. From fitted curves between positive predictive values for prostate cancer and age, prostate volume, transition zone volume, total PSA, PSA-ACT or F/T ratio, each function predicting prostate cancer was determined. Relative probabilities for prostate cancer (RPpca) which were defined by combined functions of age, F/T ratio, prostate volume or transition zone volume, and total PSA or PSA-ACT were calculated. Furthermore, using logistic regression, analysis was performed to determine the probability of prostate cancer. Receiver-operating characteristic analysis was performed to clarify the areas under the curve (AUC) for conventional single parameters, RPpca and logistic regression probability. RESULTS: F/T ratio showed the largest AUC among conventional parameters. The AUC of RPpca was larger than those of F/T ratio and logistic regression probability. RPpca using the functions of age, transition zone volume, PSA-ACT and F/T ratio showed the largest AUC and highest specificity at sensitivity 95% level, however, specificities at sensitivity 90% and 85% were identical to those of RPpca using the functions of age, prostate volume, total PSA and F/T ratio. CONCLUSIONS: RPpca using the functions of age, transition zone volume, PSA-ACT and F/T ratio was the best way to detect prostate cancer, however, the usefulness of PSA-ACT appears limited, considering the cost.

Aged↗

PubMed2005

[Laparoscopic partial nephrectomy].

We retrospectively reviewed the clinical results of 24 patients who underwent laparoscopic partial nephrectomy by a diagnosis of renal cell carcinoma (RCC) between 1999 and 2004, including 16 elective cases and 8 imperative cases. Twenty-two were successfully treated laparoscopically; two cases in the imperative group required conversion to open surgery because of uncontrollable bleeding. A vascular clamp was used in 12 cases for an average of 26 minutes. The creatinine clearance changed from 98 to 93 ml/min in the elective cases and from 49 to 44 ml/min in the imperative cases. Pathological evaluation revealed RCC in 10 elective cases and 6 imperative cases. Local recurrence (renal hilum lymph node and ipsilateral kidney) was found in 2 patients in the imperative group. Although laparoscopic partial nephrectomy is useful, long-term follow-up is necessary for evaluating the tumor control.

Aged↗

PubMed2004

Laparoscopic partial nephrectomy for renal tumor: Nagoya experience.

OBJECTIVES: To clarify the indication for a vascular clamp during laparoscopic partial nephrectomy, the clinical results of 17 patients who underwent the procedure for small renal tumors were reviewed. METHODS: Seventeen patients with renal tumors were enrolled in our laparoscopic partial nephrectomy program between October 1999 and November 2003. During laparoscopy, a vascular clamp was used to remove the tumor mass and suture the incised renal parenchyma and urinary collecting system in 8 patients who had less-than-1-cm-thick renal parenchyma between the mass and the renal sinus or calices. In the remaining 9 patients, who had 1-cm-or-more-thick renal parenchyma between the mass and sinus or calices, renal bleeding was controlled using ultrasonic scissors, gauze tampon, argon beam coagulator, and fibrin glue. RESULTS: Sixteen patients were successfully treated with laparoscopy; one required conversion to open surgery because of uncontrollable bleeding. The average operative time was 4.5 hours, and average estimated bleeding volume was 301 mL. In the 8 patients requiring vascular clamping by forceps, the average ischemic time was 25 minutes. In all patients, the tumor mass was completely removed with negative surgical margins, and renal function was preserved. Three patients had prolonged urinary leakage for a mean of 21 days. CONCLUSIONS: Laparoscopic partial nephrectomy offers many advantages, including surgery that is both nephron sparing and minimally invasive. A vascular clamp was indicated for patients with less-than-1-cm-thick renal parenchyma between the tumor mass and renal sinus or calices.

Adult↗

PubMed2004

Early experience of laparoscopic radical nephrectomy for T3b renal cell carcinoma.

We report our experience with laparoscopic radical nephrectomy for a 79-year-old man who had renal cell carcinoma (RCC) with a renal vein thrombus. For the transaction of the renal vein with the thrombus, we used an endoscopic gastrointestinal anastomosis stapler. The operating time was 4 h and blood loss was 400 mL. The patient could walk and drink on the first postoperative day. He recovered normal activity 30 days postoperatively. There were no intraoperative and postoperative complications. The present report demonstrates the feasibility of laparoscopic radical nephrectomy in patients with T3b RCC who suffer from tumor thrombus in the renal vein.

Aged↗

PubMed2003

Long-term outcome of laparoscopic radical nephrectomy for pathologic T1 renal cell carcinoma.

OBJECTIVES: To evaluate the oncologic adequacy of laparoscopic radical nephrectomy in patients with pathologic Stage T1 renal cell carcinoma, we analyzed the long-term results in those treated with laparoscopy and those undergoing open surgery. METHODS: The renal tumor of 263 patients was confirmed to be Stage T1 by pathologic examination of the radical nephrectomy specimen between January 1992 and June 2002. Of the 263 patients, 195 were treated laparoscopically and the remaining 68 by open surgery. The patient follow-up lasted until July 31, 2002. RESULTS: The follow-up period of the laparoscopy group was 2 to 121 months (median 40). A total of 183 patients survived, 5 died of renal cancer, 7 died without any recurrent disease, and 7 were lost to follow-up. Seeding of the port sites did not develop in any of the patients. Ten patients had metastatic or recurrent disease within 3 to 110 months, and 5 of these patients died of cancer within 12 to 86 months. The 5-year disease-free and patient survival rate was 91%, and 94%, respectively. The 68 patients who underwent open surgery were followed up for 11 to 126 months (median 65). Of the 68 patients, 56 survived without any recurrent disease, 4 survived with metastasis, 6 died of metastatic disease within 8 to 49 months, and 6 were lost to follow-up. The 5-year disease-free and patient survival rate was 87% and 94%, respectively. CONCLUSIONS: Laparoscopic radical nephrectomy is an alternative technique with comparable oncologic results to open nephrectomy in patients with localized pathologic Stage T1 renal cell carcinoma.

Aged↗

PubMed2003

Relationship between serum prostate-specific antigen and calculated epithelial volume.

OBJECTIVES: To estimate the relationship between serum prostate-specific antigen (PSA) and prostatic epithelial volume, a new simple method for measuring epithelial volume was developed and its efficacy evaluated in patients with benign prostatic hyperplasia. METHODS: Between March 1998 and June 2001, 122 patients without prostate cancer in the transurethral resected specimen were enrolled in this study. Of the 122 patients, 55 had a serum PSA level of 4.0 ng/mL or greater and negative sextant biopsies before surgery. First, we measured the epithelium/glandular lumen ratio by computer image analysis in 20 specimens. Second, we measured the percentage of glandular lumen in all 122 patients. The prostatic epithelial volume was then calculated as follows: calculated epithelium volume (in cubic centimeters) = epithelium/glandular lumen ratio percentage of glandularlumen x total prostate volume (in cubic centimeters). RESULTS: The epithelium/glandular lumen ratio was 1.01 in the 20 specimens. In the 122 patients with benign prostatic hyperplasia, the calculated epithelial volume correlated more strongly with the serum PSA level than did the total prostate volume, transition zone volume, or percentage of epithelium (gamma = 0.672, P <0.0001). The mean PSA level per calculated epithelial volume was 1.27 ng/mL/cm(3). The calculated epithelial volumes from the biopsy specimens correlated significantly with those from transurethral resection specimens (gamma = 0.956, P <0.0001). CONCLUSIONS: Serum PSA levels correlated significantly with prostatic epithelial volumes in patients with benign prostatic hyperplasia. The method of measuring prostatic epithelial volume used in this study is very convenient for clinical practice.

Aged↗

PubMed2003

Retroperitoneoscopic nephroureterectomy for transitional cell carcinoma of the renal pelvis and ureter: Nagoya experience.

OBJECTIVES: To evaluate the efficacy of our new retroperitoneoscopic nephroureterectomy for patients with transitional cell carcinoma of the renal pelvis and ureter, we present the operative procedure and analysis of the clinical outcome of retroperitoneoscopy in 23 patients. METHODS: Twenty-three patients with transitional cell carcinoma of the upper urinary tract underwent retroperitoneal laparoscopic nephroureterectomy between February 2000 and February 2002. Patient age ranged from 44 to 83 years (mean 66.7). Each kidney was retroperitoneoscopically dissected en bloc, together with the perirenal fatty tissue, lymph nodes, and/or adrenal gland, without transecting the ureter. The lower ureter was resected with the bladder cuff transected using an ultrasonic scalpel and an endoscopic gastrointestinal automatic stapler. The dissected specimen was removed intact through a 6-cm-long original incision. RESULTS: The mean operating time was 4.8 hours, including 0.7 hours for complete removal of the ureteral end with the bladder cuff. The mean estimated blood loss was 304 mL. The mean time to recovery to normal activity was 18 days. In the mean follow-up period of 15 months, 2 patients died of cancer progression in the sixth postoperative month, 2 died of other causes, and 4 had recurrent transitional cell carcinoma of the bladder after surgery. CONCLUSIONS: Our retroperitoneal laparoscopic nephroureterectomy using an endoscopic gastrointestinal automatic stapler is a fast, low-risk, and minimally invasive procedure and might be an alternative to other laparoscopic techniques and open nephroureterectomy. However, long-term follow-up is necessary to confirm the efficacy for patients with transitional cell carcinoma of the renal pelvis and ureter.

Adult↗

PubMed2003

[Laparoscopic retroperitoneal lymphnode dissection for testicular cancer: Nagoya experience].

Three patients with stage I disease and 3 patients with stage III disease were treated with laparoscopic retroperitoneal lymphnode dissection. The patient was placed in a semilateral position and 5 trocars were introduced through the lateral abdominal wall. After incising the peritoneum along the Toldt line, the colon was reflected medially and the retroperitoneal structures such as the ureter, aorta, inferior vena cava and both renal arteries and veins were exposed. For right-side disease the paracaval and interaortocaval lymphnodes were dissected, and for left-side disease, the interaortocaval and paraaortic lymphnodes were dissected. The procedure was completed successfully on all 6 patients. The average operative time was 3.4 hours for 3 patients with stage I disease and 4.4 hours for 3 patients with stage III disease treated with prior chemotherapy. All patients started to walk and resumed oral intake from the first post-operative day and the average duration to full convalescence was 21 days. Anteriograde ejaculation and erection were preserved in all six patients. Laparoscopic retroperitoneal lymphnode dissection will be a useful technique for management of testicular cancer.

Adult↗