laparoscopic surgery for colon cancer in japan
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Laparoscopic Surgery for Colon Cancer in Japan
JSCCR GuidelinesLaparoscopic surgery
Criteria: stage 0 /stage I colon/rectsigmoid cancer
Stage II/stage III: depend on experience of surgeons
(Japanese Society for Cancer of the Colon and Rectum)
JSCCR GuidelinesLaparoscopic surgery
Criteria: stage 0 /stage I colon/rectsigmoid cancer
Stage II/stage III: depend on experience of surgeons
D2 dissection
Scope of lymph node dissection is decided by clinical stage
D3 dissection
(Japanese Society for Cancer of the Colon and Rectum)
Is Lap Surgery Safe for T4 Tumor?
CO2 gas flows may increase cancer disseminationin the abdominal cavity.
Depth of Invasion and Circumferential Occupation
<1/3 1/3- 1/2 1/2 - 2/3 2/3 -0
10
20
30
40
50
60
70
80
90
100T4b
T4a
T3T2
217 colon cancers
Depth of Invasion and Circumferential Occupation
<1/3 1/3- 1/2 1/2 - 2/3 2/3 -0
10
20
30
40
50
60
70
80
90
100T4b
T4a
T3T2
217 colon cancers
Lap colectomy is indicated for the tumors with less than ½ of circumferential occupation
Depth of Invasion and Circumferential Occupation
Prospective Study≦ pT3 pT4
≦ 1/2
1/2 < 4260102
73441
4994
Specificity: 86%Sensitivity: 36%
17%
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
’90 ’91 ’92 ’93 ’94 ’95 ’96 ’97 ’98 ’99 ’00 ’01 ’02 ’03 ’04 ’05 ’06 ’07 ’08 ’09
進行大腸癌早期大腸癌
Lap. Surgery for CRChas been increasing
T0/T1
T3/T4
14,000
6,000
8,000
10,000
12,000
4,000
2,000
Surgery for CRC in 2009
lap.16639
open49354
0
100
200
300
400
500
600
700
800
900
10001057 cases (Mar. 2009 ）
1 6 6 605/ 106/ 107/ 108/ 6 09/3
Randomization
Open Colectomy
Laparoscopic Colectomy
T3/T4 Colon Cancer
Primary endpoint: OS
JCOG0404
Laparoscopic Surgery for Right Colon Cancer
5mm
5mm10mm
10mm
Ｄｉｓｐｌａ
ｙ
Scopist
OperatorAsistant 5
4
32
1
D3 Dissection for Right Colon Cancer
Laparoscopic Surgery for Sigmoid Colon Cancer
10mm 10mm
5mm 5mm
5
4
Ｄｉｓｐｌａ
ｙ
Scopist
Operator Asistant
3
21
Thank you for your attention
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