Colorectal (Pelvic) Surgery
Introduction
Our clinical activities during 1999 were similar to those reported in the 1998 annual report. We provide general pelvic oncology care. The number of urological oncology cases has increased gradually. Previously, cooperation between urologists and general surgeons occurred during operations rather than during preoperative consultation. In 1999, however, we prepared to institute a new system that will include such preoperative consultations. The main purpose of this trial is to challenge the wisdom of conventional treatment systems. We hope to improve patient care by dedicating ourselves fully to this new system.
Routine Activities
1.Outpatient activities:
The outpatient clinic is open
5 days a week, and about 300 new patients were accepted last year. All outpatients
who have undergone curative colorectal surgery are followed closely by their
own doctors using various diagnostic modalities to detect early recurrence.
The urological outpatient clinic is also open on Tuesdays and Thursdays, mainly
for consulting about NCCHE inpatients.
2.Treatment system:
Our pelvic oncology group consists
of five consult-ants (4 are general surgeons; 1 is a urologist) and two to
three residents, and carries out seven to eight operations a week under general
anesthesia. We have three conferences a week to discuss gastro-intestinal
malignancies, including (l) an image diagnosis conference with radiologists
and endoscopists on Mondays, (2) a case conference on Fridays, and (3) an
integral clinical conference of the gastroenterology group on Wednesdays,
where we make therapeutic decisions on all new ceases with GI malignancies
through discussion with medical oncologists, endoscopists, and surgeons. A
surgical pathology conference is held monthly with attending surgeons and
pathologists. We consult with a urologist each time an intrapelvic malignancy
is treated.
3.Treatment modalities:
Many modalities have been introduced
for treatment of early cancer cases, such as endoscopic resection or transanal
endoscopic microsurgery (TEM). In addition, the laparoscopy-assisted operation
(Lap-Op) was introduced in 1994 and has since been used as a minimally invasive
surgical technique. Patients with early cancer with submucosal invasion diagnosed
histologically after endoscopic resection or those who have unresectable metastatic
lesions were indicated for Lap-Op in our hospital through December 1997. Beginning
in January 1998, we were able to use new techniques to extend the use of Lap-Op
for dissection of wider lymph nodes up to D2, as described in the next section.
Research Activities
1.Adjuvant chemotherapy (N-SAS-CC trial):
To clarify the efficacy of
adjuvant chemotherapy using oral 5-FU derivatives (UFT: Tegafur + uracil),
a randomized controlled trial is now ongoing for patients with Dukes C colorectal
cancer.
2.The extension of indication for Lap-Op:
A prospective trial of the
extended use of Lap-Op is ongoing for patients fitting the following criteria:
(1) tumor size 5 cm in diameter or less, (2) no mass lesions over 7 mm in
diameter around the main tumor in CT image, and (3) no component of poorly
differentiated adenocarcinoma. These criteria were established after analyzing
past surgical cases, focusing on the preoperative information. The risk to
curability is less than 1% according to our analysis. About 40% of operable
colon cancer patients were resected by this method in 1998 and 1999.
3.The extension of indications for the natural anus
preservation operation for extremely lower suited rectal cancer:
The purpose of this trial is
to establish treatments other than rectal amputation for extremely lower suited
rectal cancer. Initially, we are using the technique of resecting the internal
sphincter muscle or making a local excision of the tumor combined with postoperative
radiotherapy. This trial is ongoing and is made with the informed consent
of each patient.
4.The reconstruction of the anus after Miles' operation:
This trial is planned as a
cooperative work with the Plastic Surgery Division.
5.Establishing pelvic oncology:
Patient dysfunction following
surgery for intrapelvic malignancies is an inevitable problem, and the objective
evaluation of functional damage caused by intrapelvic autonomic nerve injury
after operations is difficult. There are many methods for making such evaluations,
but stable data has not been available. To evaluate the efficacy of making
objective measurements of urinary or sexual functions, we started to accumulate
objective and subjective data prospectively.
|
Number
of Operative Cases in Colorectal Surgery Group in 1995-1999 |
||||||
|
Year |
Total |
Colorectal cases |
Stomach |
Urogenital |
||
|
colon |
rectum |
total |
||||
|
1995 |
270 |
75 |
61 |
136 |
88 |
|
|
1996 |
295 |
84 |
68 |
152 |
122 |
|
|
1997 |
318 |
120 |
75 |
195 |
115 |
|
|
1998 |
346 |
109 |
77 |
186 |
109 |
|
|
1999 |
412 |
93 |
90 |
183 |
92 |
60 |
|
Total |
1641 |
481 |
371 |
852 |
526 |
60 |
|
Survival
Rate for Each Stage (Kaplan-Meier method %) |
|||||
|
1year |
2year |
3year |
4year |
5year |
|
|
Stage
I |
99 |
99 |
97 |
97 |
97 |
|
II |
98 |
96 |
92 |
92 |
88 |
|
IIIa |
95 |
91 |
91 |
91 |
83 |
|
IIIb |
84 |
73 |
73 |
47 |
47 |
|
IV |
64 |
38 |
38 |
38 |
28 |
(M. ONO)
