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Background: Although basic laparoscopic hepatectomy (LH) has become the standard procedure for hepatectomy, the safety of advanced LH remains to be clarified, especially in elderly patients. We investigated the safety of advanced LH in elderly Japanese patients. Methods: Elderly patients (≥ 65 years) who underwent advanced LH between 2016 and 2021 were analyzed using a nationwide claims database in Japan. The perioperative outcomes of patients who underwent open hepatectomy (OH group) or LH (LH group) were compared using propensity score matching (PSM). The primary outcome was in-hospital mortality. The E-value method was performed to assess the strength of the outcome point estimates against possible unmeasured confounding factors. Results: Among 5,021 patients, eligible patients were classified into the OH (n = 4,152) and LH (n = 527) groups. The median patient age was 74 years in both groups. Hepatocellular carcinoma and metastatic liver tumors were the major indications for hepatectomy (OH: 52.5% versus 30.6%; LH: 60.7% versus 26.4%). After PSM, in-hospital mortality rates for OH and LH were 1.7 and 0.76%, respectively. The risk ratio was 0.45 (95% confidence interval, 0.16–1.25; E-value = 3.87). Compared with OH, LH was associated with a longer anesthesia time (411 versus 432 min), lower rate of blood product use (red blood concentrate: 33.5% versus 20.3%; fresh frozen plasma: 29.2% versus 17.1%), and shorter hospital stay (13 versus 12 days). Conclusions: In elderly patients, the safety of advanced LH was similar to that of advanced OH, or might be better in Japan under the current policy of hospital accreditation. [ABSTRACT FROM AUTHOR]

Highlights • Besides the dramatic evolutions in advanced melanoma treatment, treatment options for advanced non-melanoma skin cancers (NMSCs) are limited. • To overcome this issue, we need to conduct clinical studies, however, there is a lack of information on how many patients with advanced NMSCs are treated annually in Japan. • Based on the data from questionnaire returned, we estimated that across all 668 certified dermatology training facilities in Japan the number of patients would be 1255.6 annually. • As most of the treatment options for advanced NMSCs are outdated, the results of this study should be used to propose clinical studies for the development of new drugs. Abstract Background There are limited treatment options for advanced non-melanoma skin cancers (NMSCs). To overcome this issue, we need to conduct clinical studies, however, there is a lack of information on how many patients with advanced NMSCs are treated annually in Japan. Objective To investigate the actual number of advanced NMSC patients in Japan. Methods A questionnaire survey was sent to 668 institutes to educe information on: 1) the numbers of patients with squamous cell carcinoma (SCC), extramammary Paget disease (EMPD), other skin origin carcinomas, and cutaneous angiosarcoma (CAS) admitted in 2016 and 2017; 2) the preferred first- and second-line chemotherapies; and 3) the anticipated for future development. Results Questionnaires were returned from 383 (57.3%) institutes. They reported a total of 1765 patients over the 2 years. The annual number patients with SCC, EMPD, other skin carcinomas, and CAS was 323.5, 192.5, 126, and 240.5, respectively. We estimated the annual number of patients for all 668 institutes to be 1255.6. Current first- and second-line treatment for NMSCs were chemotherapy regimens, but immune checkpoint inhibitors were the most anticipated new drugs for SCC and CAS, while chemotherapy was still the most anticipated treatment for EMPD. Conclusion Considering that during 2017, the number of deaths in Japan due to NMSC was reported to be 948, our estimated annual number of patients with NMSCs, 1255.6 seems to be an accurate estimation. As most of the treatment options for advanced NMSCs are outdated, the results of this study should be used to propose clinical studies. [ABSTRACT FROM AUTHOR]

Background Over the past decade, multiple randomized controlled trials have demonstrated that involvement of palliative care services concurrent with chemotherapy (Cx) can improve health outcomes including overall survival. It is widely accepted that not only inpatients, but also outpatients with advanced cancer should receive dedicated palliative care services, early in the disease course, concurrent with Cx. However, it is not established how to integrate early palliative care into standard oncology care. Since 2002, "Outpatient Chemotherapy Unit", which is the room for cancer outpatients to receive Cx, has been established in hospitals under National health insurance in Japan. Methods To build an early palliative care delivery system for outpatients with cancer, we conducted a pilot survey on the management status of the outpatient chemotherapy unit from 2007 to 2017. The data was extracted from the Database Center of National University Hospitals in Japan (http://plaza.umin.ac.jp/dbcenter/index.html). Results There were 42 outpatient chemotherapy units of national university hospitals in Japan (The median of beds in each unit was 21 (range: 8-65)). The number of outpatient Cx conducted in the units has been increasing continuously year by year since 2002, which has been 2.6 times in the last decades (the median: from 2400/yr in 2007 to 6200/yr in 2017). Focusing on the 18 small scale university hospitals as ours (the total number of beds in each hospital equals to around 600 beds), it has been tripled from 1600/yr in 2007 to 4800/yr in 2017. Conclusions This survey revealed that the rapid growing number of cancer patients have been receiving Cx in outpatient settings in the last decade in Japan. Because the routine work burden has also been increasing, proper staffing and human resource development are considered urgent issues. It is necessary to consider the new model to promote integration of oncology and early palliative care for outpatients in Japan. [ABSTRACT FROM AUTHOR]

Background: Several prognostic models predicting survival of patients with metastatic urothelial carcinoma (UC) have been developed; however, of them, the first model by Bajorin in 1999 is still the most representative and widely used, and validations of newer models are lacking. This study aimed to validate three major prognostic models for metastatic UC constructed based on clinical trials., Methods: We reviewed 200 patients with metastatic UC who received first-line chemotherapy at our five affiliate institutions between 2003 and 2011. Using this multi-institutional cohort, we validated the following models: the "Bajorin model," a model consisting of visceral metastasis and performance status; the "Apolo model," a nomogram including visceral metastasis, performance status, albumin and hemoglobin; and the "Galsky model," a nomogram including leukocyte count, number of sites of visceral metastases, site of primary tumor, performance status and lymph node metastasis. Harrell's c-index was calculated for each model. Cox proportional hazards regression model was used for multivariate analysis., Results: Among 200 patients, 171 (85.5%) died during the follow-up, with a median survival of 12.0 months. Multivariate analysis demonstrated ECOG performance status, visceral metastasis and leukocyte count to be independent predictors of overall survival. C-index results (95% confidence interval) were Bajorin: 0.86 (0.74-0.95); Apolo: 0.89 (0.78-0.98); and Galsky: 0.82 (0.69-0.93)., Conclusions: All models were demonstrated to have high external validities in real-world patients, and of them, the "Apolo model" achieved the highest c-index in the present population. Further studies with larger populations are needed for establishment of the next standard model.