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国立がん研究センター 中央病院

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Department of Colorectal Surgery

Yukihide Kanemitsu, Dai Shida, Shunsuke Tsukamoto, Hiroki Ochiai, Masahiro Tanaka, Gouki Morizono

Introduction

The Department of Colorectal Surgery deals with colorectal cancer and allied malignancies in the colon and rectum. Liver metastasis from colorectal cancer is treated in cooperation with the Department of Hepatobiliary and Pancreatic Surgery. Lung metastasis from colorectal cancer is also treated in cooperation with the Department of Thoracic Surgery. Although surgery is still the main treatment modality for colorectal cancer, multidisciplinary treatments including radiotherapy and chemotherapy are important in advanced cancer. We have multi-disciplinary meetings with the Department of Gastrointestinal Oncology, Endoscopy, Radiology and Pathology and Clinical Laboratories every week, and decide treatment strategy by a multi-disciplinary team (MDT) before treatment is held.

Routine activities

There are four staff surgeons, one chief resident, and three or four rotating residents. Every morning (7:30-8:30), we have a morning conference and rounds in wards 15A and B. MDT meeting is held for cancer patients as a form of institutionalized communication every Tuesday morning (7:15-8:00), and a conference is held for the diagnosis of colorectal cancer: colorectal surgeons, endoscopists, and radiologists discuss the diagnosis for preoperative patients every Tuesday evening (18:30-19:30). Every Wednesday morning (7:00-7:30), a conference is held for the treatment of colorectal cancer: colorectal surgeons discuss treatments for preoperative and postoperative patients. Ten to twelve operations are performed a week in our Department. Thus, we operate upon about 500 patients with colorectal cancers and allied diseases annually.

Research activities

Patients with advanced rectal cancers are treated with conventional surgery. Adjuvant chemotherapy is being used in stage III colorectal cancer patients in a clinical setting. Although preoperative radiotherapy is not performed routinely for advanced rectal cancer, patients with T4b rectal cancers or rectal cancers with multiple lymph node metastases are treated with preoperative chemoradiotherapy and surgery. Patients with symptoms caused by unresectable tumors are treated with palliative surgery including palliative resection, bypass, and stoma before chemotherapy. To evaluate the survival benefit and safety of primary resection plus chemotherapy compared to chemotherapy alone in asymptomatic stage IV colorectal cancer with synchronous unresectable metastatic disease, a randomized controlled trial comparing resection of primary tumor plus chemotherapy with chemotherapy alone in incurable stage IV colorectal cancer is ongoing (The Japan Clinical Oncology Group (JCOG) 1007, iPACS). Another randomized controlled trial is ongoing to evaluate the non-inferiority of overall survival of laparoscopic surgery to open surgery for palliative resection of primary tumors in incurable stage IV colorectal cancer (JCOG1107, ENCORE). Symptomatic, stage IV colorectal cancer patients with non-curable metastasis are pre-operatively randomized to either open or laparoscopic colorectal resection. Patients with resectable liver metastasis are treated in cooperation with the Department of Hepatobiliary and Pancreatic Surgery and adjuvant chemotherapy regimens are being evaluated in a clinical trial (JCOG0603 study). To confirm the superiority of perioperative chemotherapy, a randomized phase II/III trial was started in May 2015 comparing perioperative versus postoperative chemotherapy with modified infusional fluorouracil and folinic acid with oxaliplatin (mFOLFOX6) for lower rectal cancer patients with suspected lateral pelvic node metastasis (JCOG1310).

We also carry out basic research in cooperation with scientists at the National Cancer Center Research Institute and the identification of a suitable treatment based on such a prediction is one of our important goals.

Clinical trials

Our division plays a central role in conducting multi-institutional clinical trials in Japan. Y. Shimada is a representative of the Colorectal Cancer Group of the Japan Clinical Oncology Group (JCOG). Our Department is participating in nine phase III JCOG studies.

  1. JCOG0212: A randomized study that compares mesorectal excision (ME) to ME with pelvic lateral lymph node dissection for clinical stage II or stage III lower rectal cancer patients. A total of 701 eligible patients were enrolled and recruitment is complete. Follow-up is on-going.
  2. JCOG0603: A randomized study that compares adjuvant modified FOLFOX (5-FU + l-LV +Oxaliplatin) to surgery alone after hepatic resection for liver metastasis from colorectal cancer. A total of 170 patients have been enrolled and recruitment continues.
  3. JCOG1006: A randomized study that compares conventional techniques to the no-touch isolation technique for clinical T3 or T4 colon cancer. A total of 570 patients have been enrolled and recruitment continues.
  4. JCOG1007: A randomized controlled trial comparing resection of primary tumor plus chemotherapy with chemotherapy alone in incurable stage IV colorectal cancer is ongoing.
  5. JCOG1018: Randomized phase III study of mFOLFOX7 or CAPOX plus bevacizumab versus 5-Fluorouracil/leucovorin or capecitabine plus bevacizumab as first-line treatment in elderly patients with metastatic colorectal cancer is ongoing.
  6. JCOG1107: A randomized controlled trial comparing laparoscopic surgery with open surgery in palliative resection of primary tumors in incurable stage IV colorectal cancer is ongoing.
  7. JCOG1310: A phase II/III randomized controlled trial comparing perioperative versus postoperative chemotherapy with mFOLFOX6 for lower rectal cancer with suspected lateral pelvic node metastasis is ongoing.
  8. JCOG1410A: Japanese Observational Study to Evaluate the Accuracy of Preoperative Imaging Diagnosis for Lateral Pelvic Lymph Node Metastasis in Rectal Cancer is ongoing.
  9. JCOG1506A: Prognostic or predictive biomarker study in patients who underwent surgery with/ without postoperative chemotherapy for stage II/III colorectal cancer is ongoing.

Table 1. Number of patients

List of papers published in 2015

Journal

  1. Shinto E, Takahashi K, Yamaguchi T, Hashiguchi Y, Kotake K, Itabashi M, Yasuno M, Kanemitsu Y, Nishimura G, Akagi Y, Sato T, Kato T, Matsumoto H, Hase K, Sugihara K, Study Group for Liver Metastasis projected by the Japanese Society for Cancer of the Colon and Rectum (JSCCR). Validation and modification of the Japanese classification system for liver metastases from colorectal cancer: a multi-institutional study. Ann Surg Oncol, 22:3888-3895, 2015
  2. Iwasa S, Souda H, Yamazaki K, Takahari D, Miyamoto Y, Takii Y, Ikeda S, Hamaguchi T, Kanemitsu Y, Shimada Y. Safety and efficacy of adjuvant therapy with oxaliplatin, leucovorin and 5-fluorouracil after mesorectal excision with lateral pelvic lymph node dissection for stage iii lower rectal cancer. Anticancer Res, 35:1815-1819, 2015
  3. Kihara K, Fujita S, Ohshiro T, Yamamoto S, Sekine S. Spontaneous regression of colon cancer. Jpn J Clin Oncol, 45:111- 114, 2015
  4. Watanabe T, Itabashi M, Shimada Y, Tanaka S, Ito Y, Ajioka Y, Hamaguchi T, Hyodo I, Igarashi M, Ishida H, Ishihara S, Ishiguro M, Kanemitsu Y, Kokudo N, Muro K, Ochiai A, Oguchi M, Ohkura Y, Saito Y, Sakai Y, Ueno H, Yoshino T, Boku N, Fujimori T, Koinuma N, Morita T, Nishimura G, Sakata Y, Takahashi K, Tsuruta O, Yamaguchi T, Yoshida M, Yamaguchi N, Kotake K, Sugihara K, Japanese Society for Cancer of the Colon and Rectum. Japanese Society for Cancer of the Colon and Rectum (JSCCR) Guidelines 2014 for treatment of colorectal cancer. Int J Clin Oncol, 20:207-239, 2015