Annual Report 2022

Department of Colorectal Surgery

Yukihide Kanemitsu, Shunsuke Tsukamoto, Konosuke Moritani, Yasuyuki Takamizawa

Introduction

 The Department of Colorectal Surgery deals with colorectal cancer and allied malignancies in the colon and rectum. Liver metastasis from colorectal cancer is treated in cooperation with the Department of Hepatobiliary and Pancreatic Surgery. Lung metastasis from colorectal cancer is also treated in cooperation with the Department of Thoracic Surgery. Although surgery remains the primary treatment modality for colorectal cancer, multidisciplinary treatments including radiotherapy and chemotherapy are important in advanced cancer. We conduct multidisciplinary meetings with the Department of Gastrointestinal Medical Oncology, the Department of Endoscopy, the Department of Diagnostic Radiology, and the Department of Pathology and Clinical Laboratories every week, and decide the treatment strategy with a multidisciplinary team (MDT) before performing treatment.

The Team and What We Do

 Our department performs approximately 600 surgeries per year, and offers not only a large number of surgeries but also a wide variety of surgical procedures, including laparoscopic and other minimally invasive surgeries, as well as extended surgeries for the resection of adjacent or metastatic organs, to provide optimal treatment for each individual case (Table 1). As for minimally invasive surgery, we started robot-assisted rectal cancer surgery in 2014 and robot-assisted colon cancer surgery in 2021, both of which are among the largest number of surgeries in Japan. In terms of surgical approach selection, the proportion of robot-assisted surgeries is increasing significantly. Furthermore, our department also handles many difficult-to-resect recurrent pelvic cancers, and is involved in abdominal and pelvic sarcoma surgery in cooperation with other departments.

 We hold weekly conferences with the Department of Endoscopy to discuss and decide on the diagnosis and treatment. In addition, a multidisciplinary team (MDT) meeting is held once a week, in which colorectal surgeons, liver surgeons, oncologists, diagnostic radiologists, and pathologists participate to determine the best treatment plan.

Research Activities

 Utilizing a multicenter study group such as the Japan Clinical Oncology Group (JCOG), we are leading an investigator-initiated multicenter clinical trial on colorectal cancer.

 Furthermore, with the support of the Japan Agency for Medical Research and Development (AMED) "Research Project for Utilization of 8K and Other High Definition Image Data," a national project research to develop a new remote surgery-assisted laparoscopic surgery system using 8K technology and to investigate the use of high-definition image data is being conducted jointly with NHK Engineering Systems, Inc. In a demonstration experiment in which 8K laparoscopic surgery system images were transmitted (between Narita and Kyoto) and surgical support (mentoring) was remotely provided to a pig, the time required for surgery was reduced and the quality of surgery was improved. In addition, remote support (mentoring) using a remote surgery-assisted endoscopic surgery system with 8K Super Hi-Vision technology did not reduce the quality of surgery even when one surgeon was reduced. The demonstration experiment also confirmed that the communication quality required for the system can actually be ensured. Based on these results, the project is now part of the "Advanced Telemedicine Network Practical Application Research Project" led by the Japan Surgical Society, and a "Demonstration experiment for next-generation remote surgery using 8K video transmission" is being conducted as an independent project under the support of AMED in a three-year plan.

Clinical Trials

 Our department plays a central role in conducting multi-institutional clinical trials in Japan. Y. Kanemitsu is a representative of the Colorectal Cancer Group of the Japan Clinical Oncology Group (JCOG). Our department is currently participating in eight JCOG studies as shown below.

1. JCOG1502C: A Global Study to Evaluate the Potential Benefit of Adjuvant Chemotherapy for Small Bowel Adenocarcinoma

2. JCOG1503C: Efficacy of aspirin for stage III colorectal cancer: a randomized double-blind placebo-controlled trial

3. JCOG1801: A randomized controlled trial comparing surgery plus adjuvant chemotherapy with preoperative chemoradiotherapy followed by surgery plus adjuvant chemotherapy for locally recurrent rectal cancer

4. JCOG1805: A randomized controlled trial to examine efficacy of adjuvant chemotherapy for stage II colorectal cancer patients at high risk of developing recurrence according to T-stage and three selected pathological factors.

5. JCOG2004: Randomized Phase II Study of Bevacizumab plus FOLFIRI versus Ramucirumab plus FOLFIRI versus Aflibercept plus FOLFIRI for Metastatic Colorectal Cancer after failure of First-line chemotherapy with Fluoropyrimidine and Oxaliplatin to Explore Predictive Biomarker

6. JCOG2006: A randomized phase II study comparing preoperative adjuvant chemotherapy with mFOLFOX6 versus FOLFOXIRI for resectable locally advanced colon cancer

7. JCOG2010: Single-arm confirmatory trial of the total neoadjuvant therapy and watch and wait strategy for the patients with low rectal cancer

8. JCOG2207: A phase III randomized controlled trial comparing total mesorectal excision and lateral lymph node dissection plus adjuvant chemotherapy with total neoadjuvant therapy followed by total mesorectal excision and selective lateral lymph node dissection for the patients with locoregionally advanced low rectal cancer

Education

 In our resident doctor education, under the guidance of a supervising physician, the residents are trained not only in the acquisition and improvement of skills, but also in a series of medical procedures such as judgment of the indications for surgery, selection of surgical techniques, postoperative management, working as a primary surgeon or assistant surgeon after gaining experience, and postoperative treatment. In addition, we actively instruct resident doctors in the preparation of reports and papers for various research groups and conferences. As part of these efforts, we regularly conduct video conferences to review surgical techniques and research conferences to check the progress of research and provide guidance.

Future Prospects

 The treatment of colorectal cancer has made rapid progress since the wave of new effective drugs in 1996-2003, and is expected to move toward more individualized treatment, which will require the ability to respond to individual diversity. As demands on surgeons increase with the number of surgical indications, they are required to acquire higher skills and develop new and effective treatments. On the other hand, for patients with peritoneal dissemination who have not benefited from these new effective drugs, another approach to treatment development is required, and a prospective study is planned to evaluate the safety of multidisciplinary treatment combining complete reduction surgery (cytoreductive surgery: CRS) with systemic chemotherapy.

List of papers published in 2022

Journal

1. Seki K, Sakamoto T, Makiguchi ME, Toyoshima N, Takamaru H, Sekiguchi M, Yamada M, Sekine S, Kanemitsu Y, Saito Y. Unexpected adhesive bowel obstruction after endoscopic submucosal dissection of early sigmoid colon cancer. DEN open, 3:e194, 2023

2. Watanabe J, Kanemitsu Y, Suwa H, Kakeji Y, Ishihara S, Shinto E, Ozawa H, Suto T, Kawamura J, Fujita F, Itabashi M, Ohue M, Ike H, Sugihara K. A multicenter cohort study on mapping of lymph node metastasis for splenic flexural colon cancer. Annals of gastroenterological surgery, 7:265-271, 2023

3. Ohue M, Iwasa S, Mizusawa J, Kanemitsu Y, Shiozawa M, Nishizawa Y, Ueno H, Katsumata K, Yasui M, Tsukamoto S, Katayama H, Fukuda H, Shimada Y. A randomized controlled trial comparing perioperative vs. postoperative mFOLFOX6 for lower rectal cancer with suspected lateral pelvic lymph node metastasis (JCOG1310): a phase II/III randomized controlled trial. Japanese journal of clinical oncology, 52:850-858, 2022

4. Sadahiro R, Wada S, Matsuoka YJ, Uchitomi Y, Yamaguchi T, Sato T, Esaki M, Yoshimoto S, Daiko H, Kanemitsu Y, Kawai A, Kato T, Fujimoto H, Uezono Y, Shimizu K, Matsuoka H. Prevention of delirium with agitation by yokukansan in older adults after cancer surgery. Japanese journal of clinical oncology, 52:1276-1281, 2022

5. Kudose Y, Shida D, Ahiko Y, Nakamura Y, Sakamoto R, Moritani K, Tsukamoto S, Kanemitsu Y. Evaluation of Recurrence Risk After Curative Resection for Patients With Stage I to III Colorectal Cancer Using the Hazard Function: Retrospective Analysis of a Single-institution Large Cohort. Annals of surgery, 275:727-734, 2022

6. Kataoka K, Yamada T, Taniguchi H, Ikeda M, Yamazaki K, Kanemitsu Y. A ctDNA-driven multidisciplinary treatment strategy for resectable colorectal cancer -what surgical oncologists should know. European journal of surgical oncology, 48:1-2, 2022

7. Kataoka K, Fujita S, Inomata M, Takii Y, Ohue M, Shiozawa M, Akagi T, Ikeda M, Tsukamoto S, Tsukada Y, Ito M, Ikeda S, Ueno H, Shida D, Kanemitsu Y. Challenges needed to be overcome in multi-institutional surgical trials: accumulated experience in the JCOG Colorectal Cancer Study Group (CCSG). Japanese journal of clinical oncology, 52:103-107, 2022

8. Ohue M, Fujita S, Mizusawa J, Kanemitsu Y, Hamaguchi T, Tsukamoto S, Noura S, Yasui M, Itoh M, Shiomi A, Komori K, Watanabe J, Akazai Y, Shiozawa M, Yamaguchi T, Bandou H, Katsumata K, Moriya Y. Preoperative and postoperative prognostic factors of patients with stage II/III lower rectal cancer without neoadjuvant therapy in the clinical trial (JCOG0212). Japanese journal of clinical oncology, 52:114-121, 2022

9. Sugishita T, Tsukamoto S, Imaizumi J, Takamizawa Y, Inoue M, Moritani K, Kinugasa Y, Kanemitsu Y. Evaluation of the learning curve for robot-assisted rectal surgery using the cumulative sum method. Surgical endoscopy, 36:5947-5955, 2022

10. Takii Y, Mizusawa J, Kanemitsu Y, Komori K, Shiozawa M, Ohue M, Ikeda S, Takiguchi N, Kobatake T, Ike H, Sato T, Tomita N, Ota M, Masaki T, Hamaguchi T, Shida D, Katayama H, Shimada Y, Fukuda H. The Conventional Technique Versus the No-touch Isolation Technique for Primary Tumor Resection in Patients With Colon Cancer (JCOG1006): A Multicenter, Open-label, Randomized, Phase III Trial. Annals of surgery, 275:849-855, 2022

11. Shinto E, Ike H, Ito M, Takahashi K, Ohue M, Kanemitsu Y, Suto T, Kinugasa T, Watanabe J, Hida JI, Itabashi M, Ozawa H, Nozawa H, Kobayashi H, Hashiguchi Y, Hase K, Sugihara K. Optimizing nodal and staging classification in low rectal cancers with lateral node metastasis: multicentre retrospective cohort study. BJS open, 6:zrac006, 2022

12. Yamada K, Saiki Y, Komori K, Shiomi A, Ueno M, Ito M, Hida K, Yamamoto S, Shiozawa M, Ishihara S, Kanemitsu Y, Ueno H, Kinjo T, Maeda K, Kawamura J, Fujita F, Takahashi K, Mizushima T, Shimada Y, Sasaki S, Sunami E, Ishida F, Hirata K, Ohnuma S, Funahashi K, Watanabe J, Kinugasa Y, Yamaguchi S, Hashiguchi Y, Ikeda M, Sudo T, Komatsu Y, Koda K, Sakamoto K, Okajima M, Ishida H, Hisamatsu Y, Masuda T, Mori S, Minami K, Hasegawa S, Endo S, Iwashita A, Hamada M, Ajioka Y, Usuku K, Ikeda T, Sugihara K. Characteristics of anal canal cancer in Japan. Cancer medicine, 11:2735-2743, 2022

13. Shiroma H, Shiba S, Erawijantari PP, Takamaru H, Yamada M, Sakamoto T, Kanemitsu Y, Mizutani S, Soga T, Saito Y, Shibata T, Fukuda S, Yachida S, Yamada T. Surgical Treatment for Colorectal Cancer Partially Restores Gut Microbiome and Metabolome Traits. mSystems, 7:e0001822, 2022

14. Inoue M, Tsukamoto S, Moritani K, Sekine H, Saito Y, Kanemitsu Y. A metastatic G2 neuroendocrine tumor smaller than 5 mm: A case report. International journal of surgery case reports, 94:107037, 2022

15. Suzuki Y, Ishida F, Ishida H, Ueno H, Kobayashi H, Yamaguchi T, Konishi T, Kanemitsu Y, Hinoi T, Inoue Y, Tomita N, Sugihara K. Morphological Analyses of Colorectal Adenocarcinomas in Japanese Familial Adenomatous Polyposis Patients. Journal of the anus, rectum and colon, 6:121-128, 2022

16. Tsukamoto S, Honma Y, Shoji H, Hirano H, Inoue M, Takamizawa Y, Moritani K, Imaizumi J, Kanemitsu Y. Clinical outcomes of surgical and imatinib treatment for rectal gastrointestinal stromal tumours: retrospective cohort study. BJS open, 6:zrac067, 2022

17. 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

18. Takayama Y, Moritani K, Ito S, Imaizumi J, Inoue M, Takamizawa Y, Tsukamoto S, Kanemitsu Y, Sekine S. Laparoscopic resection of a solitary fibrous tumor in the mesentery of the small intestine: a case report. Clinical journal of gastroenterology, 15:895-900, 2022

19. Takamizawa Y, Inoue M, Moritani K, Tsukamoto S, Esaki M, Shimada K, Kanemitsu Y. Prognostic impact of conversion hepatectomy for initially unresectable colorectal liver metastasis. Langenbeck’s archives of surgery, 407:2893-2903, 2022