Annual Report 2022

Department of Colorectal Surgery

Masaaki Ito, Yuichiro Tsukada, Koji Ikeda, Nobuyoshi Takeshita, Hiro Hasegawa, Daichi Kitaguchi, Yuji Nishizawa, Yuta Suzuki, Shun Yamaguchi, Tomohiro Noda

Introduction

 Our main purpose is to bring both curability and postoperative function with low rate of severe complication for colorectal cancer patients. Achieving this goal requires not only the establishment of effective operative techniques but also an oncological consensus including consensus on the quality of life (QOL) and the various functions of patients with pelvic malignancies.New surgical procedures have been established, such as the two-team operation of therapeutic procedures with a transabdominal and transanal approach, named Transanal Total Mesorectal Excision (TaTME). TaTME can be applied to nerve-sparing surgery, sphincter-saving surgery, bladder-sparing surgery, and minimally invasive surgery. We are also establishing a methodology for providing effective preoperative treatments for advanced rectal cancer (such as chemotherapy and chemo-radiation therapy) according to the patient's risk factor(s) of recurrence after curative surgery.

The Team and What We Do

 The Department of Colorectal Surgery comprises 10 colorectal surgeons and six 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, medical oncologists and radiologists. Various treatment strategies, such as local excision and other minimally invasive surgeries using laparoscopy, as well as intensive radical surgeries like total pelvic exenteration, with or without adjuvant chemotherapy or radiotherapy, have been introduced for the treatment of patients in any of the stages of colorectal cancer. Laparoscopy-assisted operations with more extensive lymphadenectomy or combined resection of adjacent organs are also increasingly being performed for patients with advanced colorectal carcinomas. Function-preserving surgery to maintain the patient’s postoperative QOL, such as intersphincteric resection, have been performed on more than 500 patients with very low rectal tumors. Moreover, a strong point of our team is having extensive experience in the two-team TaTME rectal surgery starting from the abdominal side and the perineal side at the same time, which contributes to shortening the operation time and improving curability. In recent years, the postoperative anastomotic leakage rate for lower rectal cancer has decreased to 2%-3%. The postoperative local recurrence rate for rectal cancer has also been less than 5%.

Research Activities

 We have published the results of anus-preserving surgery for low rectal cancer, especially those for TaTME in Japan and worldwide. The outcomes of our medical device development, including surgical navigation systems with artificial intelligence, have also been published. The results of a phase Ib/II multicenter trial (VOLTAGE study) evaluating the safety, efficacy, and proof of concept (POC) of single-agent nivolumab as sequential therapy after preoperative chemoradiation in patients with locally advanced resectable rectal cancer showed 60% of pCR rate in the patients with high-level microsatellite instability (MSI-H) LARC, and 30% of pCR rate in the patients with microsatellite stable (MSS) LARC. We are proceeding with several clinical trials such as the NAIR study, JCOG1612, and JCOG1801 to improve rectal cancer patients’ prognoses and quality of life.

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)

 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

 We have guided university students in their studies, assisted colorectal surgeons in obtaining medical specialist certifications, and held TaTME and lapaproscopic sigmoidectomy seminars for Japanese surgeons as training for surgical procedures.

Future Prospects

 We aim to establish less-invasive surgery for cure and function-preservation in cancer patients with colorectal malignancies.

Table 1. Number of surgical cases from Apr. 2022 to Mar. 2023

List of papers published in 2022

Journal

1. Igaki T, Takenaka S, Watanabe Y, Kojima S, Nakajima K, Takabe Y, Kitaguchi D, Takeshita N, Inomata M, Kuroyanagi H, Kinugasa Y, Ito M. Universal meta-competencies of operative performances: a literature review and qualitative synthesis. Surgical endoscopy, 37:835-845, 2023

2. Yoshioka T, Hasegawa H, Ikeda K, Teramura K, Tsukada Y, Nishizawa Y, Ito M. Efficacy of transperineal minimally invasive surgery with laparoscopic abdominoperineal excision for lower rectal cancer. Surgery today, 53:490-498, 2023

3. Komai Y, Nakajima K, Saito K, Tomioka Y, Masuda H, Ogawa A, Yonese J, Kobayashi E, Ito M. Development of a New Two-Arm Transurethral Surgical System for En Bloc Resection of Bladder Tumor: A Preclinical Study. Journal of endourology, 37:165-170, 2023

4. Takeshita N, Sakamoto S, Kitaguchi D, Takeshita N, Yajima S, Koike T, Ishikawa Y, Matsuzaki H, Mori K, Masuda H, Ichikawa T, Ito M. Deep Learning-Based Seminal Vesicle and Vas Deferens Recognition in the Posterior Approach of Robot-Assisted Radical Prostatectomy. Urology, 173:98-103, 2023

5. Kitaguchi D, Ito M. Optimal anastomotic technique in rectal surgery to prevent anastomotic leakage. Annals of coloproctology, 39:97-105, 2023

6. Kitaguchi D, Hasegawa H, Teramura K, Ikeda K, Tsukada Y, Nishizawa Y, Ito M. Comparison of postoperative anorectal function between hand-sewn and stapled anastomoses in intersphincteric resection with transanal total mesorectal excision. The British journal of surgery, 110:375-376, 2023

7. Kitaguchi D, Wakabayashi M, Hasegawa H, Ando K, Ikeda K, Tsukada Y, Nishizawa Y, Ito M. Single-stapling technique versus hand-sewn anastomosis in inter-sphincteric resection with transanal total mesorectal excision (Super SST): protocol for a multicentre randomized clinical trial. BJS open, 7:zrac160, 2023

8. Kitaguchi D, Teramura K, Matsuzaki H, Hasegawa H, Takeshita N, Ito M. Automatic purse-string suture skill assessment in transanal total mesorectal excision using deep learning-based video analysis. BJS open, 7:zrac176, 2023

9. Adachi T, Kitaguchi D, Teramura K, Hasegawa H, Ikeda K, Tsukada Y, Nishizawa Y, Sasaki T, Ito M. Single-center comparative study of short-term outcomes of transanal and laparoscopic total mesorectal excisions for low and middle rectal cancers. Surgical endoscopy, 37:4698-4706, 2023

10. Tsukada Y, Rullier E, Shiraishi T, Capdepont M, Sasaki T, Celerier B, Denost Q, Ito M. Comparison between preoperative chemoradiotherapy and lateral pelvic lymph node dissection in clinical T3 low rectal cancer without enlarged lateral lymph nodes. Colorectal disease, 2023

11. Narihiro S, Kitaguchi D, Ikeda K, Hasegawa H, Teramura K, Tsukada Y, Nishizawa Y, Ito M. Two-team lateral lymph node dissection assisted by the transanal approach for locally advanced lower rectal cancer: comparison with the conventional transabdominal approach. Surgical endoscopy, 2023

12. Akagi T, Suzuki K, Kono Y, Ninomiya S, Shibata T, Ueda Y, Shiroshita H, Etoh T, Shiomi A, Ito M, Watanabe J, Murata K, Hirano Y, Shimomura M, Tsukamoto S, Kanemitsu Y, Inomata M. Success rate of acquiring informed consent and barriers to participation in a randomized controlled trial of laparoscopic versus open surgery for non-curative stage IV colon cancer in Japan (JCOG1107). Japanese journal of clinical oncology, 52:1270-1275, 2022

13. Kitaguchi D, Watanabe Y, Madani A, Hashimoto DA, Meireles OR, Takeshita N, Mori K, Ito M. Artificial Intelligence for Computer Vision in Surgery: A Call for Developing Reporting Guidelines. Annals of surgery, 275:e609-e611, 2022

14. Igaki T, Kitaguchi D, Kojima S, Hasegawa H, Takeshita N, Mori K, Kinugasa Y, Ito M. Artificial Intelligence-Based Total Mesorectal Excision Plane Navigation in Laparoscopic Colorectal Surgery. Diseases of the colon and rectum, 65:e329-e333, 2022

15. Takemasa I, Okuya K, Okita K, Ishii M, Ito M, Uehara K, Konishi T, Yamaguchi S, Inomata M, Sugita S, Hasegawa T, Ochiai A, Sakai Y, Watanabe M. Feasibility of the semi-opened method of specimen resection for a circumferential resection margin in rectal cancer surgery: a multicenter study. Surgery today, 52:1275-1283, 2022

16. Hasegawa H, Tsukada Y, Wakabayashi M, Nomura S, Sasaki T, Nishizawa Y, Ikeda K, Takeshita N, Teramura K, Ito M. Impact of near-infrared fluorescence imaging with indocyanine green on structural sequelae of anastomotic leakage after laparoscopic intersphincteric resection of malignant rectal tumors. Techniques in coloproctology, 26:561-570, 2022

17. Narihiro S, Teramura K, Kitaguchi D, Ikeda K, Hasegawa H, Tsukada Y, Nishizawa Y, Ito M. Transanal total mesorectal excision for treating a lower rectal inflammatory myofibroblastic tumor: A case report. Asian journal of endoscopic surgery, 15:841-845, 2022

18. Kitaguchi D, Takeshita N, Matsuzaki H, Igaki T, Hasegawa H, Kojima S, Mori K, Ito M. Real-time vascular anatomical image navigation for laparoscopic surgery: experimental study. Surgical endoscopy, 36:6105-6112, 2022

19. Kitaguchi D, Fujino T, Takeshita N, Hasegawa H, Mori K, Ito M. Limited generalizability of single deep neural network for surgical instrument segmentation in different surgical environments. Scientific reports, 12:12575, 2022

20. Shigaki T, Tsukada Y, Teramura K, Hasegawa H, Ikeda K, Nishizawa Y, Sasaki T, Ito M. Trans-anal surgery with the taTME technique for rectal gastrointestinal stromal tumors: a retrospective study. International journal of colorectal disease, 37:1975-1982, 2022

21. Kitaguchi D, Lee Y, Hayashi K, Nakajima K, Kojima S, Hasegawa H, Takeshita N, Mori K, Ito M. Development and Validation of a Model for Laparoscopic Colorectal Surgical Instrument Recognition Using Convolutional Neural Network-Based Instance Segmentation and Videos of Laparoscopic Procedures. JAMA network open, 5:e2226265, 2022

22. Sasaki K, Ito M, Kobayashi S, Kitaguchi D, Matsuzaki H, Kudo M, Hasegawa H, Takeshita N, Sugimoto M, Mitsunaga S, Gotohda N. Automated surgical workflow identification by artificial intelligence in laparoscopic hepatectomy: Experimental research. International journal of surgery (London, England), 105:106856, 2022

23. Staiger RD, Rössler F, Kim MJ, Brown C, Trenti L, Sasaki T, Uluk D, Campana JP, Giacca M, Schiltz B, Bahadoer RR, Lee KY, Kupper BEC, Hu KY, Corcione F, Paredes SR, Spampati S, Ukegjini K, Jedrzejczak B, Langer D, Stakelum A, Park JW, Phang PT, Biondo S, Ito M, Aigner F, Vaccaro CA, Panis Y, Kartheuser A, Peeters KCMJ, Tan KK, Aguiar S, Ludwig K, Bracale U, Young CJ, Dziki A, Ryska M, Winter DC, Jenkins JT, Kennedy RH, Clavien PA, Puhan MA, Turina M. Benchmarks in colorectal surgery: multinational study to define quality thresholds in high and low anterior resection. The British journal of surgery, 109:1274-1281, 2022

24. Sasaki S, Kitaguchi D, Takenaka S, Nakajima K, Sasaki K, Ogane T, Takeshita N, Gotohda N, Ito M. Machine learning-based Automatic Evaluation of Tissue Handling Skills in Laparoscopic Colorectal Surgery: A Retrospective Experimental Study. Annals of surgery, 2022

25. Takemasa I, Hamabe A, Ito M, Matoba S, Watanabe J, Hasegawa S, Kotake M, Inomata M, Ueda K, Uehara K, Sakamoto K, Ikeda M, Hanai T, Konishi T, Yamaguchi S, Nakano D, Yamagishi S, Okita K, Ochiai A, Sakai Y, Watanabe M. Japanese multicenter prospective study investigating laparoscopic surgery for locally advanced rectal cancer with evaluation of CRM and TME quality (PRODUCT trial). Annals of gastroenterological surgery, 6:767-777, 2022

26. Suzuki Y, Sasaki T, Hasegawa H, Ikeda K, Teramura K, Tsukada Y, Nishizawa Y, Ito M. Morphological characteristics of lateral pelvic lymph nodes in locally advanced lower rectal cancer: A retrospective study. Annals of gastroenterological surgery, 6:795-803, 2022