Annual Report 2019
Department of Colorectal Surgery
Masaaki Ito, Takeshi Sasaki, Yuji Nishizawa, Yuichiro Tsukada, Koji Ikeda, Nobuyoshi Takeshita, Hiro Hasegawa, Koji Inamori, Hiroki Kato, Yasuaki Yamamoto, Toshiyuki Adachi, Yushi Susuki, Takahiro Yoshioka, Ryoya Honda, Takahiro Shigaki, Takuya Shiraishi, Shinichiro Imai, Shinya Suzuhigashi, Hiroya Enomoto, Fumihiko Matsuzawa, Megumi Yoshino, Daichi Kitaguchi, Takehiro Ando, Hiroyuki Miyamoto, Noriko Okada, Keiko Yao, Aki Shiraishi, Mihoko Matsumoto, Akemi Kawamura
Introduction
Our main purpose is to bring together the outcomes of curability and postoperative patient’s function with low rate of severe complication. It requires not only the establishment of effective operative techniques but also to an oncological consensus including consensus on the quality of life (QOL) and the various functions of patients with pelvic malignancies. New surgical procedures, such as two-team operation, combine the therapeutic procedures of a trans-abdominal and trans-anal approach, which can be applied to nerve-sparing surgery, sphincter-saving surgery, bladder-sparing surgery, and minimally invasive surgery. We are also working to establish a methodology for providing effective preoperative treatments for advanced colorectal cancer (such as chemotherapy and chemo-radiation therapy) according to each patient's risk factor(s) of recurrence after curative surgery.
Table1. Number of surgical cases from Apr. 2019 to Mar. 2020
The Team and What We Do
The Department of Colorectal Surgery comprises seven colorectal surgeons and 14 residents. The outpatient clinic is open five days a week. More than 400 new patients with colorectal carcinomas visited this department during the last year. Treatment plans are discussed at a weekly conference of a multidisciplinary team including colorectal and hepatic surgeons, oncologists and radiologists. Many treatment modalities, such as local excision and other minimally invasive forms of surgery using laparoscopy, and intensive radical surgery like total pelvic exenteration, with or without adjuvant chemo- or radiotherapy, have been introduced for the treatment of patients in the any stages of colorectal cancer. Laparoscopy-assisted operations with wider lymphadenectomy or combined resection of adjacent organs are also increasingly being performed for patients with advanced colorectal carcinomas. Function-preserving surgery to keep postoperative patient’s quality of life such as intersphincteric resection and direct CAA have been performed in more than 500 patients with very low rectal tumors. Moreover, a strong point of our team is having a lot of experience of two-team rectal surgery starting from the perineal side and the perineal side at the same time, which contributes to shortening the operation time.
Research activities
1) Evaluation of semi-standard treatment for lower and early-stage rectal cancer (high-risk pT1, low-risk pT2) in the late elderly patients: a multicenter prospective observational study.
2) Registry study evaluating circumferential resection margin for locally advanced lower rectal cancer treated by laparoscopic surgery (CRM registry)
3) Intersphincteric resection with or without neoadjuvant mFOLFOX6 study (NAIR Study)- A prospective multi-center trial -A Phase II/III randomized multicenter trial of intersphincteric resection (ISR) with or without preoperative chemotherapy for very low-lying rectal cancer. APR has been the standard surgery for very low rectal cancer located within 5 cm of the anal verge. However, a permanent colostomy causes severe impairment of QOL. This study was designed to evaluate the feasibility and the oncological and functional outcomes of ISR for very low rectal cancer. Curability with ISR was verified histologically, and acceptable oncological and functional outcomes were obtained in many patients. However, patients need to be informed preoperatively regarding the potential functional adverse effects after ISR.
4) Phase Ib/II, multicenter study to investigate the safety, efficacy, and proof-of-concept (POC) of nivolumab monotherapy as a sequential therapy following preoperative chemoradiotherapy in patients with locally advanced resectable rectal cancer. (VOLTAGE study)
Clinical trials
A phase III randomized controlled trial comparing surgery plus adjuvant chemotherapy with preoperative chemoradiotherapy followed by surgery plus adjuvant chemotherapy for locally recurrent rectal cancer: RC-SURVIVE study (JCOG1801)
Single-arm confirmatory trial of the adjuvant chemoradiation for the patients with the high-risk rectal submucosal invasive cancer after the local resection: RESCUE study (JCOG1612)
Efficacy of aspirin for stage III colorectal cancer: a randomized double-blind placebo-controlled trial: EPISODE III (JCOG1503C) Oxaliplatin and fluoropyrimidine chemotherapy first vs. upfront surgery for “very low” lying locally advanced rectal cancer without preoperative chemoradiation: The NAIR phase 3 trial
COLOR III Trial: Transanal vs. Laparoscopic TME (COLORIII)
Education
Guiding university students in their studies
Guiding colorectal surgeons for obtaining medical specialist
Holding taTME seminar for Japanese surgeon as training for taTME procedures
Future prospects
Establishment of less-invasive surgery for cure and function-preserving in cancer patients with colorectal malignancies.
List of papers published in 2019
Journal
1. Imaizumi K, Suzuki T, Kojima M, Shimomura M, Sakuyama N, Tsukada Y, Sasaki T, Nishizawa Y, Taketomi A, Ito M, Nakatsura T. Ki67 expression and localization of T cells after neoadjuvant therapies as reliable predictive markers in rectal cancer. Cancer Sci, 111:23-35, 2020
2. Hasegawa H, Tsukada Y, Wakabayashi M, Nomura S, Sasaki T, Nishizawa Y, Ikeda K, Akimoto T, Ito M. Impact of intraoperative indocyanine green fluorescence angiography on anastomotic leakage after laparoscopic sphincter-sparing surgery for malignant rectal tumors. Int J Colorectal Dis, 35:471-480, 2020
3. Takahashi H, Hamabe A, Hata T, Nishizawa Y, Nishimura A, Itoh M, Takemasa I. Prospective multicenter study of reduced port surgery combined with transvaginal specimen extraction for colorectal cancer resection. Surg Today, 50:734-742, 2020
4. Imaizumi K, Nishizawa Y, Ikeda K, Tsukada Y, Sasaki T, Ito M. Prognostic Impact of Curative Resection for Peritoneal Recurrence of Colorectal Cancer. Ann Surg Oncol, 27:2487-2497, 2020
5. Shiraishi T, Nishizawa Y, Nakajima M, Kado R, Ikeda K, Tsukada Y, Sasaki T, Ito M. Risk factors for the incidence and severity of peristomal skin disorders defined using two scoring systems. Surg Today, 50:284-291, 2020
6. Suzuki J, Kojima M, Aokage K, Sakai T, Nakamura H, Ohara Y, Tane K, Miyoshi T, Sugano M, Fujii S, Kuwata T, Ochiai A, Ito M, Suzuki K, Tsuboi M, Ishii G. Clinicopathological characteristics associated with necrosis in pulmonary metastases from colorectal cancer. Virchows Arch, 474:569-575, 2019
7. Kondo A, Nishizawa Y, Horikiri Y, Amemori H, Tsukada Y, Sasaki T, Kawai T, Daiko H, Ito M. A novel device designed to improve the operability of energy devices with foot pedals in endoscopic surgery: the Foot-Site Monitor. Surg Today, 49:965-970, 2019
8. Matsunaga R, Kojima M, Nishizawa Y, Yokota M, Hasegawa H, Saito N, Ito M, Ochiai A. The utility of longitudinal slicing method for rectal specimen: pathological analysis of circumferential resection margin of intersphincteric resection for low-lying rectal cancer. Pathol Int, 69:272-281, 2019
9. Muro S, Tsukada Y, Harada M, Ito M, Akita K. Anatomy of the smooth muscle structure in the female anorectal anterior wall: convergence and anterior extension of the internal anal sphincter and longitudinal muscle. Colorectal Dis, 21:472-480, 2019
10. Nishizawa Y, Akagi T, Inomata M, Katayama H, Mizusawa J, Yamamoto S, Ito M, Masaki T, Watanabe M, Shimada Y, Kitano S. Risk factors for early postoperative complications after D3 dissection for stage II or III colon cancer: Supplementary analysis of a multicenter randomized controlled trial in Japan (JCOG0404). Ann Gastroenterol Surg, 3:310-317, 2019
11. Kondo A, Nishizawa Y, Tsunemori H, Taketani H, Yamamoto N, Okazoe H, Fujita T, Sugimoto M, Suzuki Y. Use of a linear stapler for urethral and dorsal vein complex transection during laparoscopic total pelvic exenteration in rectal cancer. Tech Coloproctol, 23:487-490, 2019
12. Kondo A, Sasaki T, Kitaguchi D, Tsukada Y, Nishizawa Y, Ito M. Resection of the urinary bladder for locally advanced colorectal cancer: a retrospective comparison of partial versus total cystectomy. BMC Surg, 19:63, 2019
13. Kitaguchi D, Nishizawa Y, Sasaki T, Tsukada Y, Ikeda K, Ito M. Recurrence of rectal anastomotic leakage following stoma closure: assessment of risk factors. Colorectal Dis, 21:1304-1311, 2019
14. Nishimoto W, Kawahira H, Shimomura Y, Nishizawa Y, Ito M. A standing posture support device that reduces laparoscopic surgeons' occupational lower limb stress. Minim Invasive Ther Allied Technol, 28:151-156, 2019
15. Yokoyama S, Watanabe Y, Kurashima Y, Oshita A, Nishizawa Y, Naitoh T, Nakamura F, Kikuchi S, Noma K, Poudel S, Suzuki A, Nishihara Y, Ito M, Hirano S. Identifying the needs for teaching fundamental knowledge of laparoscopic surgery: a cross-sectional study in Japan. Surg Endosc, 33:2242-2248, 2019
16. Imaizumi K, Tsukada Y, Komai Y, Nomura S, Ikeda K, Nishizawa Y, Sasaki T, Taketomi A, Ito M. Prediction of urinary retention after surgery for rectal cancer using voiding efficiency in the 24 h following Foley catheter removal. Int J Colorectal Dis, 34:1431-1443, 2019
17. Nishizawa Y, Kondo A, Tsukada Y, Sasaki T, Inoue M, Masuda H, Ito M. Operative procedure contributes to decreased male sexual dysfunction after surgery for mid to low rectal cancer. Colorectal Disease, 21:5, 2019
18. Masatake A, Kawai T, Han S, Nishizawa Y, Ito M, Sasaki T, Tsukada Y, Ikeda K, Hasegawa H. 27th International Congress of the European Association for Endoscopic Surgery (EAES) Sevilla, Spain, 12-15 June 2019 (Effectiveness of Pivot Restraint Device for Laparoscopic Accurate Procedure). Surg Endosc, 33:485-781, 2019
19. Fukase M, Oshio H, Murai S, Kawana T, Saito Y, Kono E, Oshima Y, Yunome G, Teshima S, Ito M. Transanal total mesorectal excision of giant villous tumor of the lower rectum with McKittrick-Wheelock syndrome: a case report of a novel surgical approach. Surg Case Rep, 5:173, 2019
20. Shiraishi T, Sasaki T, Ikeda K, Tsukada Y, Nishizawa Y, Ito M. Predicting prognosis according to preoperative chemotherapy response in patients with locally advanced lower rectal cancer. BMC Cancer, 19:1222, 2019
21. Kitaguchi D, Takeshita N, Matsuzaki H, Takano H, Owada Y, Enomoto T, Oda T, Miura H, Yamanashi T, Watanabe M, Sato D, Sugomori Y, Hara S, Ito M. Real-time automatic surgical phase recognition in laparoscopic sigmoidectomy using the convolutional neural network-based deep learning approach. Surg Endosc, 2019