The Colorectal (Pelvic) Surgery Division mainly focuses on oncological and functional outcomes and the quality of life (QOL) of patients with colorectal cancer and pelvic malignancies. In this regard, many clinical studies are currently in progress, and some are described below.
1) A prospective randomized trial for extending the indications for Lap-Op (JCOG0404 CRC Surg-LAP vs. Open) (64). 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) a maximum tumor size ≤ 8 cm. A total of 75 patients have been registered in this Division. This trial is currently in progress.
2) Intersphincteric resection study (ISR Study) (65, 66). Abdominoperineal resection has been considered as the standard surgical procedure for very low rectal cancers located within 5 cm of the anal verge. However, permanent colostomy causes severe impairment of QOL. This study was designed to evaluate the feasibility as well as the oncological and functional outcomes of ISR for the treatment of very low rectal cancer. Curability with ISR was verified histologically, and acceptable oncological and functional outcomes were obtained by performing this procedure 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 presently in progress, and 43 patients have been registered.
3) Bladder-sparing surgery for locally advanced rectal cancer involving the prostate and/or seminal vesicles (65, 66). Total pelvic exenteration (TPE) is the standard procedure for 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 18 patients. This technique permits conservative surgery in selected patients with advanced rectal cancer involving the prostate and/or seminal vesicles without compromising local control. Following this surgical procedure, the QOL of these patients appears to be better. This study is currently in progress.
4) A prospective randomized trial regarding 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.] (65, 66). This study aims to evaluate the feasibility and effects of lateral node dissection in patients with advanced low rectal cancer (T3, T4) without lateral node metastasis. In this study, 61 patients have been registered intraoperatively. This study is presently ongoing.
5) Local excision with postoperative chemoradiotherapy of T1・T2 rectal cancer (65, 66). This study aims to evaluate the feasibility and oncologic outcome of local therapy for T1 and part of T2 rectal cancer without lymph node metastases preoperatively. In this investigation, 21 patients have been registered. This study is presently being performed.
6) Bilateral sural nerve grafting during radical retropubic prostatectomy for preservation of sexual function and urinary continence in patients with prostate cancer. Sural nerve interposition grafting was performed in 35 patients who were followed up for 1 year. Erectile activity (partial erection) returned in 7 men (20%).
● N. Saito, T. Suzuki
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