大城 久

OBJECTIVES: To compare functional and oncological outcomes among the novel anterior approach, the Retzius-sparing approach, and the conventional anterior approach for robot-assisted radical prostatectomy. METHODS: This retrospective cohort study included 585 patients who underwent robot-assisted radical prostatectomy between September 2017 and August 2022 at Jichi Medical University Saitama Medical Center. Among them, 173, 109, and 303 patients underwent the novel anterior approach, the Retzius - sparing approach, and the conventional anterior approach, respectively. Urinary continence recovery was evaluated as the primary endpoint, while postoperative inguinal hernia incidence and oncological outcomes, including surgical margins and biochemical recurrence-free survival, were assessed as secondary endpoints and compared using Kaplan-Meier methods. RESULTS: Patient characteristics did not differ across groups except for surgeon's experience and follow-up duration. Both the Retzius-sparing approach and the novel anterior approach were associated with earlier recovery of complete continence (HR = 3.10, 95% CI 2.26-4.26; HR = 1.60, 95% CI 1.25-2.04) and a lower incidence of inguinal hernia (HR = 0.34, 95% CI 0.19-0.62; HR = 0.23, 95% CI 0.13-0.42) compared with the conventional anterior approach. Biochemical recurrence-free survival did not differ significantly among the three approaches, despite the higher rate of positive surgical margins in the Retzius-sparing approach. CONCLUSIONS: The novel anterior approach and the Retzius-sparing approach may offer functional advantages over the conventional anterior approach, while oncological outcomes appear comparable across groups in this retrospective cohort. These hypothesis-generating findings suggest the need for further prospective studies with longer follow-up.

INTRODUCTION: Spontaneous tumor regression (STR) is a rare phenomenon in which cancer cells partially or completely disappear without treatment. We report a case of intrahepatic cholangiocarcinoma demonstrating STR following endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA). CASE PRESENTATION: A 77-year-old male presented with acute cholecystitis 1 day after percutaneous coronary intervention for acute myocardial infarction. Conservative treatment and endoscopic retrograde gallbladder drainage were performed due to antiplatelet therapy. Cytology of bile juice unexpectedly revealed adenocarcinoma. Further imaging, including CT and mapping biopsy, failed to detect a tumor. Laparoscopic cholecystectomy with gallbladder bed resection showed no histological evidence of malignancy. Four months later, surveillance CT revealed a 15 × 15 mm lesion in segment 3 of the liver. EUS-FNA confirmed adenocarcinoma. Laparoscopic left lateral resection was performed; however, no viable cancer cells were identified, and the lesion was replaced by epithelioid granulomas. Immunohistochemistry demonstrated dense infiltration of CD8-positive cytotoxic T cells, suggesting an immune-mediated regression of the tumor. CONCLUSIONS: This case highlights the possibility of tumor regression in intrahepatic adenocarcinoma following EUS-FNA, potentially triggered by an immune response.

Cutaneous arteritis (CA) is a rare cutaneous manifestation of Crohn's disease. A 50-year-old woman with a 15-year history of CA was admitted to our hospital with a fever, abdominal pain, and hematochezia. Based on these symptoms and increased C-reactive protein levels, systemic vasculitis was considered. However, emergency colonoscopy revealed multiple longitudinal ulcers throughout the colon, thus suggesting Crohn's disease. Prednisolone (60 mg/day) was administered intravenously. A histopathological examination of the biopsied colonic mucosa revealed epithelioid granulomas, which confirmed the diagnosis of Crohn's disease. Because the systemic evolution of CA is rare, other comorbidities should be considered when patients with CA experience systemic manifestations.

We report a case of the most severe grade TAFRO (thrombocytopenia, anasarca, fever, renal insufficiency, and organomegaly) syndrome that was successfully treated with triple combination therapy of corticosteroid, tocilizumab and cyclosporine. A 48-year-old man with a history of thrombotic thrombocytopenic purpura was referred to our department for dyspnea, pleural effusion, and ascites. Further examination revealed thrombocytopenia (platelet count 4.7×104/μL), severe renal dysfunction (creatinine 2.56 mg/dL), and systemic inflammation (C-reactive protein 18.52 mg/dL). Computed tomography revealed mild lymphadenopathy and mild hepatomegaly. Bone marrow examination showed hypocellularity and increased reticulin fibrosis, and lymph node biopsy showed proliferation of endothelial venules. Thus, the patient was diagnosed with TAFRO syndrome. After the combination of steroid pulse therapy (intravenous methylprednisolone 1 g/day for three days and subsequent oral prednisolone 60 mg/day), tocilizumab at 480 mg once weekly, and cyclosporine at 225 mg once daily, systemic inflammation and kidney function gradually improved. This case suggests that the triple combination therapy can lead to remission of the most severe grade TAFRO syndrome.