Colorectal (Pelvic) and Urological Surgery

Introduction

The Colorectal (Pelvic) Surgery Division mainly focuses on the oncological and functional results and QOL of patients with colorectal cancer and pelvic malignancies. As a result, many clinical studies are in progress. Some are listed below.

Research Activities and Clinical Trials

1) A prospective randomized trial for extending the indications for Lap-Op (JCOG0404 CRC Surg-LAP vs. Oper). The criteria for inclusion into this trial include (1) T3 and T4 tumors located at C, A, and S in the colon and Rs in the rectum, (2) stage N0-2, (3) stage M0, and (4) maximum tumor size 8 cm. A total of 35 patients have been registered in this Division. This study is currently in progress.

2) Intersphincteric resection study (ISR Study) (59). APR has been the standard surgery for very low rectal cancer located within 5 cm of the anal verge. However, permanent colostomy causes severe impairment of QOL. This study was designed to evaluate the feasibility and the oncological and functional outcomes of ISR for treatment of very low rectal cancer. Curability with ISR was verified histologically, and acceptable oncological and functional outcomes were obtained by performing ISR in patients with very low rectal cancer. However, patients need to be informed regarding the potential functional adverse effects after ISR preoperatively. This study is in progress, and 26 patients have been registered.

3) Bladder-sparing surgery for locally advanced rectal cancer involving the prostate and/or seminal vesicles (59) (60). Total pelvic exenteration (TPE) is the standard procedure in patients with locally advanced rectal cancer involving the prostate and seminal vesicles. This study aims to evaluate the feasibility of bladder-sparing surgery as an alternative to TPE. This procedure has been performed in 15 patients. This technique permits conservative surgery in selected patients with advanced rectal cancer involving the prostate and/or seminal vesicles without compromising local control. QOL of these patients appears to be better. This study is also in progress.

4) A prospective randomized trial for the feasibility and effect of lateral node dissection in low rectal cancer—(Total) Mesorectal Excision (ME) vs. Lateral Node Dissection with preservation of autonomic nerves (D3 with nerve-sparing) [JCOG0212 CRC Surg.] (61). This study aims to evaluate the feasibility and effects of lateral node dissection in patients with advanced low rectal cancer without lateral node metastasis. In this study, 31 patients have been registered intraoperatively. This study is currently in progress.

5) Bilateral sural nerve grafting during radical retropubic prostatectomy (RRP) for preservation of urinary continence and sexual function in patients with prostate cancer. Sural nerve grafting was performed after neurovascular bundle resection. Sural nerve interposition grafting was performed in 16 patients, and they were followed up for 1 year. Spontaneous erectile activity was restored in 2/16 patients without PSA failure in any of them.

● N. Saito, T. Suzuki ●

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