Annual Report 2020
Department of Urology
Hitoshi Masuda, Yasukazu Nakanishi, Shugo Yajima, Kenji Tanabe, Shunya Matsumoto
Introduction
The Department of Urological Surgery has been part of the Department of Pelvic Surgery at the National Cancer Center Hospital East from 2003. This department mainly treats various 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 4 days a week in the 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. The selection of internal stenting or percutaneous nephrostomy depends on the malignancy type and the degree of obstruction. A total of 75 patients received ureteral stents and 56 underwent nephrostomy for obstructive uropathy in 2020. Moreover, 141 patients received insertion of a marker or spacer for radiation therapy for localized prostate cancer in 2020.
Inpatient activities: A daily conference is held for the diagnosis and treatment of patients with urological cancer. Surgeries, especially all-robotic surgeries, increased dramatically in 2020. In the Department of Urology, 724 surgeries were performed in this year (Table 1). We also performed 17 combination surgeries with colorectal surgeons in 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 investigated the risk factors for progression of high-risk superficial bladder cancer.
2. We investigated the usefulness of novel techniques for robotic surgeries including radical prostatectomy and radical cystectomy.
3. We investigated the role of MRI-DWI in the evaluation of the malignant potential of bladder and upper urinary tract cancers.
4. We investigated the usefulness of stem cell therapy for urinary incontinence after radical prostatectomy in a rat model.
5. Six peer-reviewed papers have been accepted.
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 Resonance, the first metallic ureteral stent in Japan, to treat ureteral stricture due to extrinsic compression.
4. A phase II clinical study: Pembrolizumab in high risk NMIBC unresponsive to BCG (MK-3475-057)
5. A phase III clinical study: Pembrolizumab in MIBC (MK-3475-866)
Education
We accepted two voluntary resident of urology in 2020 and educated them in urological surgery.
Future Prospects
1. We will develop new and effective techniques for robot-assisted surgeries of the prostate, bladder and kidney.
2. We will start a clinical trial of stem cell therapy for urinary incontinence after radical prostatectomy.
List of papers published in 2020
Journal
1. Higashino T, Sakuraba M, Fukunaga Y, Oshima A, Masuda H, Ito M. Surgical outcome for colorectal or urinary tract-related fistula: Usefulness of vascularized tissue transfer-a retrospective study(?). J Plast Reconstr Aesthet Surg, 74:1041-1049, 2021
2. Kijima T, Yamamoto H, Saito K, Kusuhara S, Yoshida S, Yokoyama M, Matsuoka Y, Numao N, Sakai Y, Matsubara N, Yuasa T, Masuda H, Yonese J, Kageyama Y, Fujii Y. Early C-reactive protein kinetics predict survival of patients with advanced urothelial cancer treated with pembrolizumab. Cancer Immunol Immunother, 70:657-665, 2021
3. Kondo A, Nishizawa Y, Tsukada Y, Sasaki T, Inoue M, Masuda H, Suzuki Y, Ito M. Potential benefit of laparoscopic surgery for rectal cancer on postoperative male sexual function. Colorectal Dis, 2021
4. Kuroe T, Watanabe R, Kojima M, Morisue R, Sugano M, Kuwata T, Masuda H, Kusuhara S, Matsubara N, Oda S, Ushiku T, Ishii G. Evaluation of the morphological features and unfavorable prognostic impact of dirty necrosis in renal cell carcinoma. J Cancer Res Clin Oncol, 147:1089-1100, 2021
5. Yajima S, Nakanishi Y, Matsumoto S, Tanabe K, Masuda H. Rare small bowel obstruction: Parastomal hernia of cutaneous ureterostomy after robot-assisted radical cystectomy. Case report. Urol Case Rep, 36:101566, 2021
6. Matsumoto S, Nakanishi Y, Tanabe K, Yajima S, Watanabe R, Masuda H. A case of solid pseudopapillary neoplasm preoperatively diagnosed as left renal tumor. Urol Case Rep, 37:101630, 2021
7. Yajima S, Nakanishi Y, Matsumoto S, Tanabe K, Sugano M, Masuda H. Improvement of urinary symptoms after bladder biopsy: A case of pathologically proven allergy-related cystitis during administration of nivolumab. IJU Case Reports, doi.org/10.1002/iju5.12286, 2021
8. Fukushima H, Kijima T, Fukuda S, Moriyama S, Uehara S, Yasuda Y, Tanaka H, Yoshida S, Yokoyama M, Matsuoka Y, Saito K, Matsubara N, Numao N, Sakai Y, Yuasa T, Masuda H, Yonese J, Kageyama Y, Fujii Y. Impact of radiotherapy to the primary tumor on the efficacy of pembrolizumab for patients with advanced urothelial cancer: A preliminary study. Cancer Med, 9:8355-8363, 2020
9. Yajima S, Ooeda T, Inoue M, Suzuki H, Matsumoto S, Masuda H. Paraneoplastic remitting seronegative symmetrical synovitis with pitting edema (RS3PE), improved following surgical resection of prostatic carcinoma: A case report. Urol Case Rep, 32:101232, 2020
10. Yajima S, Nakanishi Y, Matsumoto S, Tanabe K, Masuda H. Use of indocyanine green fluorescence imaging to determine the area of ileum with poor blood flow during robot-assisted laparoscopic radical cystectomy with complete intracorporeal urinary diversion. Journal of Clinical Urology, doi.org/10.1177/2051415820974274 , 2020
11. Yokoyama M, Masuda H, Ito M, Waseda Y, Moriyama S, Toide M, Uchida Y, Uehara S, Kijima T, Yoshida S, Ishioka J, Matsuoka Y, Saito K, Fujii Y. Longitudinal changes in patient-reported outcomes after artificial urinary sphincter implantation. Low Urin Tract Symptoms, 12:240-244, 2020
12. Kijima T, Fukushima H, Kusuhara S, Tanaka H, Yoshida S, Yokoyama M, Ishioka J, Matsuoka Y, Numao N, Sakai Y, Saito K, Matsubara N, Yuasa T, Masuda H, Yonese J, Kageyama Y, Fujii Y. Association Between the Occurrence and Spectrum of Immune-Related Adverse Events and Efficacy of Pembrolizumab in Asian Patients With Advanced Urothelial Cancer: Multicenter Retrospective Analyses and Systematic Literature Review. Clin Genitourin Cancer, 2020