黒川 真行

We assessed the efficacy of the lung immune prognostic index (LIPI) in predicting the progression of pathological T3 renal cell carcinoma (RCC). The LIPI scores of patients with pathological T3 RCC were calculated in the pre- and post-operative phases. Patients were divided into zero-point, one-point, and two-point groups according to their LIPI score and into the upstage and non-upstage groups according to the pre- and post-operative increase in LIPI score. Overall survival (OS) was evaluated using Kaplan-Meier curves stratified by group. Univariate and multivariate analyses of OS were performed via Cox proportional hazard regression analysis. LIPI scores were calculated in 80 patients wherein blood sampling data were available. The upstage and non-upstage groups comprised eight and seventy-two patients, respectively. Kaplan-Meier curves showed a significant difference in the pre- to post-operative LIPI score upstage group. LIPI score change was a poor prognostic factor using univariate analysis (OS: hazard ratio (HR) = 4.10, 95% confidence interval (CI) = 1.07-15.61, p = 0.038) and multivariate analysis (OS: HR = 4.38, 95% CI = 1.13-16.89, p = 0.031). An increase in the LIPI score in the pre-operative phase was a poor prognostic factor for pathological T3 RCC.

Objective The objective of this study is to assess how the preoperative prognostic nutritional index (PNI) affects the occurrence of postoperative complications in patients undergoing robot-assisted radical cystectomy (RARC). Methods We retrospectively analyzed data from 103 patients who underwent RARC at Jichi Medical University Hospital between June 2018 and December 2023. The PNI was calculated using the following formula: 10 × serum albumin + 0.005 × total lymphocyte count. Patients were divided into high- and low-PNI groups based on a threshold value of 45. Postoperative complications occurring within 30 days were compared between the two groups, and risk factors were identified using multivariate logistic regression analysis. Results Postoperative complications occurred in 50 patients (48.5%), with eight patients (8%) experiencing severe complications (Clavien-Dindo Grade ≥3). The most common complication was postoperative ileus, affecting 26% of patients (n = 28). The low-PNI group had significantly higher rates of overall complications (70% vs. 47%, p< 0.05) and postoperative ileus (48% vs. 18%, p < 0.05) compared to the high-PNI group. Multivariate analysis identified low PNI (ORs: 3.82 for overall complications and 3.90 for ileus) and intestinal urinary diversion (ORs: 3.33 and 5.34, respectively) as independent risk factors. Conclusions The preoperative PNI is a significant predictor of both overall complications and postoperative ileus following RARC. These findings underscore the importance of preoperative immunonutritional assessment for risk stratification and suggest that nutritional screening and immunonutritional interventions may enhance postoperative outcomes in high-risk patients.

INTRODUCTION: We describe a case in which robot-assisted radical ureterectomy was performed for residual ureteral recurrence in a postoperative patient with renal pelvis cancer. CASE PRESENTATION: A 75-year-old woman underwent laparoscopic radical nephroureterectomy for left renal pelvic cancer at another hospital. During follow-up, a papillary tumor was found in the bladder on cystoscopy, and a continuous tumor was found in the residual ureter on computed tomography. Robot-assisted radical ureterectomy was performed in combination with transurethral resection of bladder tumors. To avoid urine spillage, bladder cuff excision was performed using a mechanical suture device while monitoring the interior of the bladder. CONCLUSION: We developed a new technique for remnant ureteral resection using cystoscopy and a vascular stapler to prevent urine dissemination and cancer seeding.

BACKGROUND: Renal artery pseudoaneurysm (RAP) is one of the most stressful and life-threatening complications of partial nephrectomy, the standard treatment for small renal cell carcinoma. The use of a monopolar soft coagulation system for hemostasis during robot-assisted partial nephrectomy (RAPN) is expected to prevent post-surgical RAP development. In this study, we aimed to investigate how the use of a soft coagulation system in RAPN reduces postoperative pseudoaneurysms and changes renal function over time. METHODS: The incidence of pseudoaneurysms and postoperative renal function were compared in 208 partial nephrectomies performed between May 2016 and March 2023 at a single institution, with propensity score matching to balance patient backgrounds. Outcomes were analyzed using multivariate logistic or linear regression analyses. RESULTS: In total, 80 matched pairs were analyzed. One (1.2%) and eighteen (22.5%) pseudoaneurysms were found in the soft coagulation users and non-users, respectively (P<0.001). Compared to the non-user group, postoperative estimated glomerular filtration rates (eGFRs) in the user group were 89% vs. 96% (P<0.001), 87% vs. 93% (P=0.009), and 88% vs. 92% (P=0.15) at 1, 3, and 12 months, respectively. Subsequent multivariate analyses showed a lower incidence of pseudoaneurysms in the user group with an odds ratio of 0.05 [95% confidence interval (CI): 0.01 to 0.44; P=0.007], and no significant difference in the rate of change in renal function at 12 months postoperatively (-1.1%, 95% CI: -5.5% to 3.3%; P=0.61). CONCLUSIONS: The use of a soft coagulation system reduces pseudoaneurysm occurrence after partial nephrectomy. Although renal function decreased in the short-term for the use group, no long-term differences were observed.