Laparoscopic Surgery for Colon Cancer in Japan

JSCCR Guidelines

Laparoscopic 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 Guidelines

Laparoscopic 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

100

T4bT4a

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

100

T4bT4a

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

RandomizationRandomization

Open Colectomy

Open Colectomy

Laparoscopic Colectomy

Laparoscopic Colectomy

T3/T4 Colon Cancer

Primary endpoint: OS

JCOG0404

Laparoscopic Surgery for Right Colon Cancer

5mm

5mm10mm

10mm

Ｄｉｓｐｌａｙ

Scopist

OperatorAsistant5

4

32

1

D3 Dissection for Right Colon Cancer

Laparoscopic Surgery for Sigmoid Colon Cancer

10mm 10mm

5mm 5mm

5

4

Ｄｉｓｐｌａｙ

Scopist

Operator Asistant

3

21

Thank you for your attention