Annual Report 2023

Department of Colorectal Surgery

Masaaki Ito, Yuichiro Tsukada, Koji Ikeda, Nobuyoshi Takeshita, Hiro Hasegawa, Daichi Kitaguchi, Yuji Nishizawa, Koji Ando, shun Yamaguchi, Tomohiro Noda, Jun Kataoka, Keisuke Obuchi, Shoma Sasaki, Naoe Yanagisawa, Fumiaki Tokito, Nariaki Okamoto

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)

 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. 2023 to Mar. 2024

List of papers published in 2023

Journal

1. Ouchi A, Sadachi R, Hamaguchi T, Tsukamoto S, Shimada Y, Inomata M, Takii Y, Komori K, Shiomi A, Shiozawa M, Ohue M, Watanabe J, Ito M, Kawashima Y, Kobatake T, Souda H, Saida Y, Hashimoto T, Sano Y, Kanemitsu Y. Prognostic Relevance of Primary Tumor Sidedness in Early-stage Colorectal Cancer: An Integrated Analysis of 4 Randomized Controlled Trials (JCOG2003A). Annals of surgery, 279:283-289, 2024

2. Komatsu M, Kitaguchi D, Yura M, Takeshita N, Yoshida M, Yamaguchi M, Kondo H, Kinoshita T, Ito M. Automatic surgical phase recognition-based skill assessment in laparoscopic distal gastrectomy using multicenter videos. Gastric cancer, 27:187-196, 2024

3. Kitaguchi D, Park EJ, Baik SH, Sasaki S, Tsukada Y, Ito M. Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy versus R0 resection for resectable colorectal cancer with peritoneal metastases and low peritoneal cancer index scores: a collaborative observational study from Korea and Japan. International journal of surgery (London, England), 110:45-52, 2024

4. Ryu K, Kitaguchi D, Nakajima K, Ishikawa Y, Harai Y, Yamada A, Lee Y, Hayashi K, Kosugi N, Hasegawa H, Takeshita N, Kinugasa Y, Ito M. Deep learning-based vessel automatic recognition for laparoscopic right hemicolectomy. Surgical endoscopy, 38:171-178, 2024

5. Ogasawara RA, Okubo N, Nakanishi Y, Imasato N, Hirose K, Kataoka M, Yajima S, Ikeda K, Ito M, Masuda H. Laparoscopic total pelvic exenteration combined with transanal total mesorectal excision for locally advanced prostate cancer with rectal infiltration. IJU case reports, 7:83-86, 2024

6. Une N, Kobayashi S, Kitaguchi D, Sunakawa T, Sasaki K, Ogane T, Hayashi K, Kosugi N, Kudo M, Sugimoto M, Hasegawa H, Takeshita N, Gotohda N, Ito M. Intraoperative artificial intelligence system identifying liver vessels in laparoscopic liver resection: a retrospective experimental study. Surgical endoscopy, 38:1088-1095, 2024

7. Nishikawa Y, Horimatsu T, Oka S, Yamada T, Mitsui K, Yamamoto H, Takahashi K, Shiomi A, Hotta K, Takeuchi Y, Kuwai T, Ishida F, Kudo SE, Saito S, Ueno M, Sunami E, Yamano T, Itabashi M, Ohtsuka K, Kinugasa Y, Matsumoto T, Sugai T, Uraoka T, Kurahara K, Yamaguchi S, Kato T, Okajima M, Kashida H, Fujita F, Ikematsu H, Ito M, Esaki M, Kawai M, Yao T, Hamada M, Koda K, Fukai Y, Komori K, Saitoh Y, Kanemitsu Y, Takamaru H, Yamada K, Nozawa H, Takayama T, Togashi K, Shinto E, Torisu T, Toyoshima A, Ohmiya N, Kato T, Otsuji E, Nagata S, Hashiguchi Y, Sugihara K, Ajioka Y, Tanaka S. Outcomes of Metastatic and Unresectable Small Bowel Adenocarcinoma in Japan According to the Treatment Strategy: A Nationwide Observational Study. JCO global oncology, 10:e2300392, 2024

8. Shida D, Kuchiba A, Shibata T, Hamaguchi T, Yamasaki S, Ito M, Kobatake T, Tonooka T, Masaki T, Shiozawa M, Takii Y, Uetake H, Okamura S, Ojima H, Kazama S, Takeyama H, Kanato K, Shimada Y, Murakami Y, Kanemitsu Y. Genomic landscape and its prognostic significance in stage III colorectal cancer: JCOG1506A1, an ancillary of JCOG0910. Cancer science, 114:3352-3363, 2023

9. Hashimoto T, Tsukada Y, Ito M, Kanato K, Mizusawa J, Fukuda H, Tsukamoto S, Takashima A, Kanemitsu Y. Utility of circulating tumour DNA for prognosis and prediction of therapeutic effect in locally recurrent rectal cancer: study protocol for a multi-institutional, prospective observational study (JCOG1801A1, CAP-LR study). BMJ open, 13:e073217, 2023

10. Kojima M, Yokota M, Yanagisawa N, Kitamura S, Amemiya K, Kawano S, Tsukada Y, Sakuyama N, Nagayasu K, Hashimoto T, Nakashima K, Jiang K, Kanemitsu Y, Fujita F, Akiba J, Notohara K, Itakura J, Sekine S, Sakashita S, Sakamoto N, Ishikawa S, Nakanishi Y, Yao T, Liang WY, Lauwers GY, Ito M, Sakamoto K, Ishii G, Ochiai A. Assessment of Elastic Laminal Invasion Contributes to an Objective pT3 Subclassification in Colon Cancer. The American journal of surgical pathology, 47:1122-1133, 2023

11. 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, 278:e250-e255, 2023

12. 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

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

14. Benlice C, Parvaiz A, Baca B, Hohenberger W, Miskovic D, Stocchi L, Steele S, Kim SH, Holm T, Spinelli A, Gogenur I, Panis Y, Hasegawa H, Karachun A, Uriburu JCP, Ito M, Croner R, Kessler H, Kuzu MA. Standardization of the Definition and Surgical Management of Splenic Flexure Carcinoma by an International Expert Consensus Using the Delphi Technique: Room for Improvement? Diseases of the colon and rectum, 66:805-815, 2023

15. 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

16. 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, 25:1153-1162, 2023

17. 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, 37:5256-5264, 2023

18. Kojima S, Kitaguchi D, Igaki T, Nakajima K, Ishikawa Y, Harai Y, Yamada A, Lee Y, Hayashi K, Kosugi N, Hasegawa H, Ito M. Deep-learning-based semantic segmentation of autonomic nerves from laparoscopic images of colorectal surgery: an experimental pilot study. International journal of surgery (London, England), 109:813-820, 2023

19. Hasegawa H, Takeshita N, Hyon W, Hyon SH, Ito M. Novel external reinforcement device for gastrointestinal anastomosis in an experimental study. BMC surgery, 23:121, 2023

20. Kitaguchi D, Tsukada Y, Ito M, Horasawa S, Bando H, Yoshino T, Yamada K, Ajioka Y, Sugihara K. Survival outcomes following salvage abdominoperineal resection for recurrent and persistent anal squamous cell carcinoma. European journal of surgical oncology, 49:106929, 2023

21. Teramura K, Kitaguchi D, Matsuoka H, Hasegawa H, Ikeda K, Tsukada Y, Nishizawa Y, Ito M. Short-term outcomes following intracorporeal vs. extracorporeal anastomosis after laparoscopic right and left-sided colectomy: a propensity score-matched study. International journal of surgery (London, England), 109:2214-2219, 2023

22. Igaki T, Kitaguchi D, Matsuzaki H, Nakajima K, Kojima S, Hasegawa H, Takeshita N, Kinugasa Y, Ito M. Automatic Surgical Skill Assessment System Based on Concordance of Standardized Surgical Field Development Using Artificial Intelligence. JAMA surgery, 158:e231131, 2023

23. Kitaguchi D, Harai Y, Kosugi N, Hayashi K, Kojima S, Ishikawa Y, Yamada A, Hasegawa H, Takeshita N, Ito M. Artificial intelligence for the recognition of key anatomical structures in laparoscopic colorectal surgery. The British journal of surgery, 110:1355-1358, 2023

24. Piozzi GN, Khobragade K, Aliyev V, Asoglu O, Bianchi PP, Butiurca VO, Chen WT, Cheong JY, Choi GS, Coratti A, Denost Q, Fukunaga Y, Gorgun E, Guerra F, Ito M, Khan JS, Kim HJ, Kim JC, Kinugasa Y, Konishi T, Kuo LJ, Kuzu MA, Lefevre JH, Liang JT, Marks J, Molnar C, Panis Y, Rouanet P, Rullier E, Saklani A, Spinelli A, Tsarkov P, Tsukamoto S, Weiser M, Kim SH. International standardization and optimization group for intersphincteric resection (ISOG-ISR): modified Delphi consensus on anatomy, definition, indication, surgical technique, specimen description and functional outcome. Colorectal disease, 25:1896-1909, 2023

25. Kiyozumi Y, Yamaguchi T, Ichikawa N, Homma S, Ikeda K, Inada R, Otsuka K, Furutani A, Iijima H, Watanabe M, Taketomi A, Naitoh T. Endoscopic Surgical Skill Qualification System: propensity-score matched cohort analysis of accredited supervisors in laparoscopic rectal cancer surgery. The British journal of surgery, 110:1834-1839, 2023

26. Kitaguchi D, Hasegawa H, Ando K, Ikeda K, Tsukada Y, Nishizawa Y, Ito M. Can the Single-stapling Technique Following Intersphincteric Resection with Transanal Total Mesorectal Excision Become the New Standard Anastomosis? Journal of the anus, rectum and colon, 7:232-240, 2023

27. Kitaguchi D, Hasegawa H, Ando K, Ikeda K, Tsukada Y, Nishizawa Y, Ito M. Transanal Total Mesorectal Excision for Rectal Cancer: Toward Standardization of the Surgical Technique. Journal of the anus, rectum and colon, 7:225-231, 2023