Colorectal Surgery Division

Introduction
Since 1964, our division has conducted pioneering clinical research on the surgical treatment of colorectal cancer in Japan. More than 400 patients with primary or recurrent colorectal cancer are treated surgically each year. Our division has developed several new surgical techniques, including extended lympha-denectomy (1975- 1985), autonomic nerve pre-servation surgery with or without wide lympha-denectomy (1986-1999) for advanced rectal cancer, laparoscopy-assisted colectomy for early colonic cancer, and total pelvic exenteration with or without partial resection of the pelvic wall, especially the sacrum for both primary rectal cancer with adjacent organ invasion and pelvic recurrent disease.

Routine Activities
Our division consists of four staff surgeons, one or two chief residents, and three to five rotating residents. There are always some visiting training surgeons not only from Japan but also from foreign countries. The staff surgeons have outpatient clinics once or twice a week. Our original follow-up programs focused on early detection of asymptomatic recurrent disease in order to increase the number of good candidates for surgical treatment of recurrenct disease.
We perform nine to 12 major operations weekly. Three major conferences are held: (1) A colorectal conference is held every Tuesday evening from 6:00 to 7:00 p.m., which all colorectal surgeons, medical oncologists, endoscopists, and radiologists who are involved in treatment strategy decision-making for patients with colorectal cancer discuss cases attend; (2) a pre- and postoperative surgical conference is held every Friday from 5:00 to 6:30 p.m. in the 15B conference room, where we discuss the extent of primary tumor growth, type of applied surgical procedures and risks of surgical treatment in preoperative patients, as well as the postoperative complications for those who have had surgery. In addition, new and interesting papers from quality journals are presented by residents; and (3) A clinicopathological meeting focusing on cases of special interest, is held monthly using a nationwide tele-imaging network system.
Every morning at 8:00 a.m. at the 15B conference room, all staff surgeons join residents on patient rounds to suggest postoperative care for patients with problems.

Research Activities
Our research activities include: (1) the deve-lopment of new surgical techniques for treating rectal cancer based on the compatibility of lymphadenec-tomy with postoperative quality of life; (2) standardi-zation of the techniques of laparoscopy-assisted colectomy; (3) the establishment of patient selection criteria for surgical treatment of liver metastasis and pelvic recurrence; (4) the establish-ment of new prognostic factors and early detection of liver metastasis using molecular biological markers; (5) a prospective study on postoperative sexual and urinary functions by both rigiscan instruments and uro-dymamics after autonomic nerve preservation surgery; (6) the evaluation of total pelvic exenteration with combined resection of the pelvic wall for pelvic recurrence by patient selection, efficacy of pre-operative radiotherapy, and function-preserving surgical techniques; (7) preoperative staging of rectal cancer using endorectal ultrasonography; (8) the establishment of a genetic diagnosis and counseling system for persons at risk for hereditary non-polyposis colorectal cancer and familial adenomatous polyposis.

Clinical Trials
(1) Case enrollment for the N-SAS-CC trial which was designed to evaluate adjuvant oral UFT chemotherapy
for patients with Dukes C tumor compared to surgery alone was completed.
(2) A multi-institutional randomized study on chemoprevention of adenomas in familial polyposis coli using JTB522 was started.
(3) A multi-institutional randomized controlled trial both on optimal perioperative bowel preparation and prophylactic antibiotic administration is planned.
(4) Two new multi-institutional randomized study in so-called Medical Frontier Research has been started. One is designed to evaluate optimal surgery for T2 and T3 rectal cancer (total mesorectal excision vs D3 with autonomic nerve-preservation), and another one is designed to evaluate optimal adjuvant chemotherapy for Dukes C tumor (5-FU+LV vs UFT + oral LV).

Y. MORIYA

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