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Laparoscopic Surgery for Colon Cancer in Japan

Laparoscopic Surgery for Colon Cancer in Japan

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Laparoscopic Surgery for Colon Cancer in Japan

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  1. Laparoscopic Surgery for Colon Cancer in Japan

  2. JSCCR Guidelines (Japanese Society for Cancer of the Colon and Rectum) Laparoscopic surgery Criteria: stage 0 /stage I colon/rectsigmoid cancer Stage II/stage III: depend on experience of surgeons

  3. JSCCR Guidelines (Japanese Society for Cancer of the Colon and Rectum) Laparoscopic surgery Scope of lymph node dissection is decided by clinical stage Criteria: stage 0 /stage I colon/rectsigmoid cancer Stage II/stage III: depend on experience of surgeons D2 dissection D3 dissection

  4. Is Lap Surgery Safe for T4 Tumor? CO2 gas flows may increase cancer dissemination in the abdominal cavity.

  5. Depth of Invasion and Circumferential Occupation 217 colon cancers T4b T4a T3 T2

  6. Depth of Invasion and Circumferential Occupation 217 colon cancers T4b T4a Lap colectomy is indicated for the tumors with less than ½ of circumferential occupation T3 T2

  7. Depth of Invasion and Circumferential Occupation Prospective Study ≦ pT3 pT4 ≦ 1/2 41 34 7 1/2 < 102 60 42 49 94 Specificity: 86% 17% Sensitivity: 36%

  8. Lap. Surgery for CRChas been increasing 14,000 T0/T1 12,000 lap. 16639 10,000 T3/T4 open 49354 8,000 Surgery for CRC in 2009 6,000 4,000 2,000

  9. JCOG0404 1057 cases (Mar. 2009 ) 1000 T3/T4 Colon Cancer 900 Randomization 800 700 Open Colectomy Laparoscopic Colectomy 600 Primary endpoint: OS 500 400 300 200 100 0 05/ 06/ 07/ 08/ 6 09/3 6 6 1 1 1 6 1

  10. Laparoscopic Surgery for Right Colon Cancer 4 Display 2 3 5mm 10mm Operator Asistant 5 1 10mm 5mm Scopist

  11. D3 Dissection for Right Colon Cancer

  12. Laparoscopic Surgery for Sigmoid Colon Cancer Scopist 3 5mm 5mm 4 1 Operator Asistant 2 10mm 10mm Display 5

  13. Thank you for your attention