Study objective:In order to reduce the risk of vaginal recurrence, we have chosen total laparoscopic modified radical hysterectomy instead of extrafascial hysterectomy in the treatment of endometrial cancer. The aim of this study was to assess the safety of this method.Design:Retrospective study of gynecological patients.Setting:Yokohama City University Medical Center, Yokohama, Japan.Patients:Forty-nine patients who underwent total laparoscopic modified radical hysterectomy for the treatment of endometrial cancer at our hospital between December 2011 and September 2015.Interventions:Total laparoscopic modified radical hysterectomy + bilateral salpingo-oophorectomy (n = 20), total laparoscopic modified radical hysterectomy + bilateral salpingo-oophorectomy + pelvic lymphadenectomy (n = 18), or total laparoscopic modified radical hysterectomy + bilateral salpingo-oophorectomy + pelvic and para-aortic lymphadenectomy (n = 11).Measurements and Main Results:The surgical outcomes were analyzed and compared to previous reports. The median operative time was 204 minutes (range, 99–504 minutes) and the median intraoperative blood loss was 150 mL (range, 0–680 mL). No patients needed a blood transfusion, conversion to laparotomy, or reoperation. Intra- and postoperative complications were observed in three patients and nine patients, respectively. The amount of blood loss and the incidence of complications in our study were almost identical to previous reports of laparoscopic hysterectomy. The operative time in our study was equivalent to previous reports of total laparoscopic modified radical hysterectomy.Conclusion:Total laparoscopic modified radical hysterectomy is safe and feasible for the treatment of early stage endometrial cancer. This procedure can be an alternative to total laparoscopic hysterectomy, especially when the uterus must be removed completely.

Objective To examine the necessity and sufficiency of different types of hysterectomy for the surgical treatment of endometrial cancer. Methods This was a multicenter collaborative study conducted by 11 institutions. Among patients with stage I–III endometrial cancer who underwent surgery as the initial treatment (only chemotherapy was provided if adjuvant therapy was needed) from 2001 to 2012, we retrospectively examined the type of hysterectomy, clinicopathological factors, recurrence rate over a maximum period of 5 years, and the site of recurrence. The local recurrence rate was examined by univariate and multivariate analyses. Results Among 1335 patients, 982 (73.6%) underwent simple hysterectomy (SH) and 353 (26.4%) underwent modified radical hysterectomy (mRH) and were observed for a mean duration of 51.8 months. No significant difference was observed in the rate of local recurrence between the SH and mRH groups ( p = 0.928). In multivariate analysis, clinicopathological factors independently associated with localized recurrence included postmenopausal status [hazard ratio (HR) 5.036, 95% confidence interval (CI) 1.506–16.841, p = 0.009], with stages II (HR 3.337, 95% CI 1.701–6.547, p < 0.001) and III (HR 2.445, 95% CI 1.280–4.668, p = 0.007), vs stage I and histological type 2 (HR 1.610, 95% CI 0.938–2.762, p = 0.001). Conclusions For endometrial cancer patients requiring surgery, the selection of a more extensive type of hysterectomy did not reduce the rate of local recurrence. Therefore, there is little significance in performing mRH in such cases.

The management of acute leukemia during pregnancy is challenging. Delays in treatment for acute leukemia can adversely affect maternal prognosis, but chemotherapy during pregnancy may induce severe adverse effects on the fetus. Here, we report a case of a pregnant woman with Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph(+)ALL) who underwent remission induction therapy and successfully delivered a live infant after chemotherapy. The case is a 36-year-old woman diagnosed with Ph(+)ALL in the 27th week of pregnancy. She underwent remission induction therapy including daunorubicin, vincristine, cyclophosphamide, and prednisolone. Imatinib was not used in the induction therapy. She delivered the infant after one course of chemotherapy. The infant and the patient are both alive now, without any major complications.

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Study Objectives:The aim of this study is to evaluate the effects of vaginal estriol therapy in total laparoscopic hysterectomy (TLH) with gonadotropin-releasing hormone agonist (GnRH-a) treatment.Design:Retrospective analysis.Design Classification:Canadian Task Force classification II-2.Settings:Department of Gynecology, Yokohama City University Medical Center, Japan.Methods:We retrospectively investigated 50 fibroid cases that had TLH with preoperative GnRH-a treatment and compared the surgical outcome with or without vaginal estriol use (1mg). Estriol was used administered for two weeks before TLH.Measurements and Main Results:A total of 12 patients (27%) received vaginal estriol (1 mg) for 14 days before TLH. As a result of vaginal estriol treatment, there were no group differences in uterus size reduction with GnRH-a treatment (22% vs. 15%, P = 0.20), uterine removal time through the vagina (12.5 min vs. 18.5 min, P = 0.18), rate of vaginal dehiscence (3% vs. 0%, P = 0.76) or in the rate of perineal laceration (33% vs. 34%, P = 0.55).Conclusion:The use of vaginal estriol treatment before TLH with GnRH-a therapy did not improve surgical outcomes.