近澤 研郎

BACKGROUND/AIM: Data are limited regarding the use of pegfilgrastim in gynaecologic oncology. We evaluated its efficacy for maintaining dose intensity during chemotherapy. PATIENTS AND METHODS: We retrospectively examined the data of 65 women (26 pegfilgrastim users) who underwent primary surgical treatment for stages IB-IV endometrial cancer and had adjuvant chemotherapy containing platinum and taxane; the primary outcome was a relative dose intensity ≥85%. RESULTS: In the pegfilgrastim vs. the control group, body mass index (26.6±5.9 vs. 23.4±4.4), rate of relative dose intensity ≥85% (88.5% vs. 15.4%), plus other adverse event incidences were significantly higher; rate of neutropenia, total hospital visits during chemotherapy (11.0±2.1 vs. 18±5.6 days), unscheduled hospital visits (1.1±1.8 vs. 5.8±5.1 days), and unscheduled granulocyte colony-stimulating factor injections (0.58±1.7 vs. 6.4±5.1 days) were significantly lower. CONCLUSION: Pegfilgrastim can maintain a dose intensity of ≥85% during chemotherapy for the treatment of gynaecologic cancers and decrease hospital-visit frequency.

We present a case of laparoscopic bladder injury, a single case in a total of 127 total laparoscopic hysterectomies (TLHs). The incidence of laparoscopic bladder injury is reported to be 0.2- 2.0% of TLHs. The injury was noted following the patient's complaint of urinary incontinence 14 days after undergoing TLH. The vesicovaginal fistula was diagnosed by cystoscopy. A retrospective review of the moving images of the surgical operation revealed that we cut the bladder by monopolar diathermy in poor visibility due to smoke. Secondary surgical repair was performed via laparoscopy. Final closure of the fistula was achieved abdominally since the laparoscopic approach was unsuccessful. The American Association of Gynecologic Laparoscopists (AAGL) recommends routine cystoscopy after TLH because only 25-50% of urinary tract injuries caused during TLH are recognized during the procedure.