Kyoko Yamamoto

Objectives: To characterize mid‐term oncological outcomes after nephrectomy for renal cell carcinoma (RCC) in Japan using the National Clinical Database (NCD). Methods: We retrospectively analyzed patients with RCC who underwent nephrectomy between April and December 2018 and had at least 5 years of follow‐up recorded in the NCD. Age, sex, nephrectomy type, operative approach, and pathological T category were evaluated. Disease‐free survival (DFS) and overall survival (OS) were estimated using the Kaplan–Meier method and compared with the log‐rank test. Results: Of 16 786 patients registered at 759 institutions, 9065 with available 5‐year follow‐up were analyzed. Patients aged ≥ 75 years comprised 24.7% of the cohort. Radical and partial nephrectomy were performed in 55.0% and 45.0% of patients, respectively. Median DFS and OS were not reached. Older age and male sex were associated with shorter DFS and OS. Radical nephrectomy and open surgery were also associated with shorter survival. Both DFS and OS decreased significantly with advancing pathological stage, with earlier recurrence in pT3–4 disease. Conclusions: This nationwide NCD‐based study provides descriptive mid‐term survival data for patients with RCC undergoing nephrectomy in Japan. Age, sex, nephrectomy type, operative approach, and pathological stage were associated with survival differences. These findings provide real‐world outcome data for patients with available long‐term follow‐up and a basis for future risk‐adjusted analyses.

Objectives: To evaluate real‐world biochemical recurrence‐free survival (BCRFS) after radical prostatectomy (RP) for prostate cancer in Japan using nationwide data from the National Clinical Database (NCD). Methods: This study included patients who underwent RP between April and December 2018 and were registered in the NCD from 647 participating institutions. BCRFS was estimated using the Kaplan–Meier method. Outcomes were evaluated according to surgical approach and clinicopathological factors without adjustment for baseline characteristics. Results: A total of 14 992 patients with available 5‐year postoperative follow‐up data were included in the analysis. Robot‐assisted RP accounted for the majority of procedures (73.2%), followed by open RP (16.0%) and laparoscopic RP (10.8%). The overall 5‐year BCRFS rate was 81%. BCRFS was comparable across age groups and surgical approaches. In contrast, pathological factors strongly influenced prognosis. Five‐year BCRFS decreased with increasing pathological stage (pT2, 86%; pT3, 65%; pT4, 41%) and was lower in patients with nodal metastasis (pN0, 81%; pN1, 59%). The International Society of Urological Pathology (ISUP) Grade Group demonstrated a stepwise association with prognosis, with 5‐year BCRFS declining from 92% in grade group 1 to 60% in grade group 5. Five‐year BCRFS was lowest in the extended lymph node dissection group (73%), followed by the obturator lymph node dissection group (80%) and the no‐dissection group (87%). Conclusions: Current nationwide data delineate the real‐world oncological outcomes following RP in Japan. Pathological tumor characteristics—rather than patient age or surgical approach—were the predominant determinants of postoperative prognosis. These findings may provide essential benchmarks to guide clinical decision‐making.

Background: Pancreaticoduodenectomy (PD) in dialysis patients is rare but carries a high risk of complications and mortality. This study aimed to identify preoperative factors associated with severe postoperative complications and mortality. Methods: Using the Japanese National Clinical Database, 329 dialysis patients undergoing PD between 2016 and 2020 were retrospectively analyzed. Multivariable penalized logistic regression identified preoperative risk factors for Clavien–Dindo classification (CDC) grade ≥ 4 complications, 30‐day mortality, operative mortality, postoperative sepsis, and postoperative pancreatic fistula (POPF) (grade B or C). Results: CDC grade ≥ 4 complications, 30‐day mortality, and operative mortality occurred in 10.3%, 5.5%, and 11.2%, respectively. Diet‐ or oral medication–treated diabetes (Odds ratio 5.19, 95% confidence interval 1.19–22.66) and insulin‐treated diabetes (7.50, 1.61–34.93) independently predicted 30‐day mortality. Serum albumin levels < 3.0 g/dL independently predicted operative mortality (2.72, 1.05–7.02), while cardiovascular disease showed a borderline association (2.15, 0.95–4.85). Elevated CRP was significantly associated with postoperative sepsis (2.47, 1.07–5.67), and pancreatic cancer was associated with a lower risk of POPF (grade B or C) (0.59, 0.37–0.94). Conclusions: Dialysis patients undergoing PD face perioperative risks. Early mortality is driven by acute metabolic and infectious vulnerability, whereas operative mortality reflects diminished physiologic reserve related to malnutrition and cardiovascular comorbidity.

Objective: To describe real‐world disease‐free survival (DFS) and overall survival (OS) after radical cystectomy (RC) for muscle‐invasive bladder cancer (MIBC) in Japan using nationwide data from the National Clinical Database (NCD). Methods: This nationwide descriptive study included patients with MIBC who underwent RC and were registered in the NCD in 2020. Demographic and clinical characteristics, including age, sex, surgical approach, neoadjuvant chemotherapy (NAC), and pathological stage, were summarized. DFS and OS were estimated using the Kaplan–Meier method. Survival outcomes were descriptively compared across age groups, sex, NAC status, and surgical approach without adjustment for baseline characteristics. Results: A total of 3773 patients were analyzed. The cohort showed an advanced age distribution, with 41% aged ≥ 75 years. Robotic‐assisted RC was the most frequently performed approach (44%), and NAC was administered in 52% of patients. Survival declined progressively with increasing age, with the poorest outcomes observed in patients aged ≥ 80 years. Female sex and nonreceipt of NAC were associated with modestly lower DFS and OS in unadjusted analyses. Robotic‐assisted and laparoscopic RC demonstrated comparable DFS and OS, whereas open RC was associated with less favorable survival outcomes. Conclusions: This nationwide descriptive analysis provides a comprehensive snapshot of real‐world survival after RC for MIBC in Japan. This nationwide data reveal marked heterogeneity in patient characteristics, treatment patterns, and outcomes, and provide a foundation for identifying clinically relevant hypotheses for future risk‐adjusted analyses.