Annual Report 2024
Department of Colorectal Surgery
Yukihide Kanemitsu, Shunsuke Tsukamoto, Konosuke Moritani, Yasuyuki Takamizawa, Hiroshi Nagata
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
We perform approximately 600 surgeries per year, and we provide the best treatment for each individual case, ranging from minimally invasive surgeries (MIS) such as laparoscopic and robot-assisted surgeries to extensive surgeries such as combined resection of adjacent or metastatic organs (Table 1). As for MIS, 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 has also become very large overall. In robot-assisted surgery, the da Vinci SP has been used in addition to the conventional da Vinci Xi since 2023.
On the other hand, we also handle many difficult-to-resect recurrent pelvic cancers and are involved in abdominal and pelvic sarcoma surgery in collaboration with other departments. To achieve curative resection, we also actively perform vascular resection and cytoreductive surgery for peritoneal dissemination.
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, respiratory surgeons, medical oncologists, endoscopists, diagnostic radiologists, radiation therapists, and pathologists participate to determine the best treatment plan.
Research Activities
In a multicenter research group centered on JCOG, we are leading investigator-initiated multicenter clinical trials on colorectal cancer.
In addition, clinical trials have been initiated for complete surgical reduction of peritoneal dissemination, in which all lesions are removed, for peritoneal dissemination for which anticancer drugs are ineffective, with the aim of establishing a standard treatment for colorectal cancer with peritoneal dissemination, for which no effective treatment is available.
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 nine 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
9. JCOG2304: A randomized controlled trial comparing transverse colectomy with extended right hemicolectomy for Stage II/III transverse colon 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
Over the past decades, the Department of Colorectal Surgery has played a leading role in advancing the standard of care for colorectal cancer in Japan and globally. Through numerous investigator-initiated clinical trials, many of which were conducted under the JCOG, we have established high-level evidence that has shaped national and international treatment guidelines. Our department has also contributed to the refinement of surgical anatomy, minimally invasive techniques, and multidisciplinary management, earning recognition as a global leader in precision colorectal surgery.
Building upon this foundation, we aim to further transform colorectal cancer care through three strategic directions:
1. Evidence Generation and Global Collaboration
We will continue to lead high-quality, hypothesis-driven clinical trials to define the optimal treatment strategies for each disease stage, including organ-preserving, conversion, and adjuvant settings. Strengthening international partnerships, we seek to contribute Japanese data and expertise to global evidence networks and integrated databases.
2. Innovation in Surgical Science and Education
Leveraging advanced imaging, robotics, and digital technologies, we will pioneer next-generation "anatomy-based" surgery with real-time precision and safety. In parallel, we will cultivate the next generation of surgical leaders through comprehensive training programs that combine clinical excellence, research integrity, and global communication skills.
3. Patient-Centered and Sustainable Oncology Care
As a national referral center, we aspire to deliver not only curative surgery but also lifelong, patient-centered care through seamless integration with oncology, radiology, pathology, and community medicine. We are also committed to developing telemedicine and outreach models to bridge disparities in cancer care across regions, including remote and island communities.
List of papers published in 2024
Journal
1. Hirata S, Kanemitsu Y, Moritani K, Arikawa M, Kudose Y, Takamizawa Y, Inoue M, Tsukamoto S, Daiko H, Akazawa S. A pedicled anterolateral thigh flap decreased the risk of empty pelvis syndrome following total pelvic exenteration. Colorectal disease, 27:e17239, 2025
2. 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
3. Kato T, Tsukamoto S, Miyake M, Kudose Y, Takamizawa Y, Moritani K, Daiko H, Kanemitsu Y. Prognostic impact of extramural venous invasion detected by contrast-enhanced CT colonography in colon cancer. BJS open, 8:zrad121, 2024
4. 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
5. Takayama Y, Tsukamoto S, Kudose Y, Takamizawa Y, Moritani K, Esaki M, Kanemitsu Y, Igarashi A. Cost-effectiveness of surveillance intervals after curative resection of colorectal cancer. Japanese journal of clinical oncology, 54:637-646, 2024
6. Yamashita K, 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, Akagi Y, Ikematsu H, Ito M, Esaki M, Kawai M, Yao T, Hamada M, Horimatsu T, 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. Clinicopathological features and prognosis of primary small bowel adenocarcinoma: a large multicenter analysis of the JSCCR database in Japan. Journal of gastroenterology, 59:376-388, 2024
7. Inoue M, Kanemitsu Y, Tsukamoto S, Moritani K, Takamizawa Y, Daiko H. Prognostic impact of primary tumour location after curative resection in Stage I-III colorectal cancer: a single-centre retrospective study. Japanese journal of clinical oncology, 54:753-760, 2024
8. Kataoka K, Ouchi A, Suwa Y, Hirano H, Yamaguchi T, Takamizawa Y, Hanaoka M, Iguchi K, Boku S, Nagata K, Koyama T, Shimada Y, Inomata M, Sano Y, Mizusawa J, Hamaguchi T, Takii Y, Tsukamoto S, Takashima A, Kanemitsu Y. Localized colorectal cancer database integrating 4 randomized controlled trials; (JCOG2310A). European journal of surgical oncology, 50:108354, 2024
9. Song J, Kataoka K, Inoue M, Yamada T, Shiozawa M, Beppu N, Kuriyama S, Suto T, Matsuhashi N, Sakura Y, Kanazawa A, Kagawa H, Kanemitsu Y, Ceelen W, Ikeda M. Lymphatic spread patterns in young versus elderly patients with stage III colon cancer. BJS open, 8:zrae036, 2024
10. Ito S, Tsukamoto S, Kagawa H, Kanemitsu Y, Hiro J, Kawai K, Nozawa H, Takii Y, Yamaguchi T, Akagi Y, Suto T, Hirano Y, Ozawa H, Komori K, Ohue M, Toiyama Y, Shinji S, Minami K, Shimizu T, Sakamoto K, Uehara K, Sugihara K, Kinugasa Y, Ajioka Y. Short- and long-term outcomes of surgical treatment for inguinal lymph node metastasis in rectal and anal canal adenocarcinoma. Colorectal disease, 26:1378-1387, 2024
11. Natsume T, Kobayashi-Kato M, Tanase Y, Uno M, Yoshida H, Moritani K, Kanemitsu Y, Ishikawa M. Laparoscopic Posterior Pelvic Exenteration with Radical Vulvectomy for Intestinal-type Vulvar Adenocarcinoma. Gynecology and minimally invasive therapy, 13:126-129, 2024
12. Hamabe A, Takemasa I, Kotake M, Nakano D, Hasegawa S, Shiomi A, Numata M, Sakamoto K, Kimura K, Hanai T, Naitoh T, Fukunaga Y, Kinugasa Y, Watanabe J, Kawamura J, Ozawa M, Okabayashi K, Matoba S, Takano Y, Uemura M, Kanemitsu Y, Sakai Y, Watanabe M. Feasibility of robotic-assisted surgery in advanced rectal cancer: a multicentre prospective phase II study (VITRUVIANO trial). BJS open, 8:zrae048, 2024
13. Ito S, Kinugasa Y, Yamauchi S, Sato H, Hirakawa A, Ishihara S, Shiomi A, Kanemitsu Y, Suto T, Takahashi H, Itabashi M, Shiozawa M, Hiyoshi M, Kobatake T, Komori K, Egi H, Ozawa H, Yamaguchi T, Inada R, Ito M, Hirano Y, Furutani A, Tanabe Y, Ueno H, Ohue M, Hida K, Kawai K, Sunami E, Ishida H, Uehara K, Watanabe J, Hotchi M, Ishibe A, Takii Y, Hiro J, Numata M, Takemasa I, Kato T, Kakeji Y, Hirata A, Ajioka Y. Long-term Outcome After Surgical Resection of Para-aortic Lymph Node Metastasis of Colorectal Cancer: A Multicenter Retrospective Study. Diseases of the colon and rectum, 67:1423-1436, 2024
14. Kataoka K, Yamada T, Yamazaki K, Mori K, Matsuhashi N, Shiozawa M, Iwai T, Goto M, Yasui M, Takii Y, Suto T, Takamizawa Y, Takase N, Sharma S, Ensor J, Jurdi A, Liu MC, Ikeda M, Kanemitsu Y. Trial Protocol of a Phase II Study of mFOLFOXIRI after Metastasectomy in Patients with Oligometastatic Colorectal Cancer (FANTASTIC Study). Journal of the anus, rectum and colon, 8:246-252, 2024
15. Kumamoto T, Takamizawa Y, Miyake M, Inoue M, Moritani K, Tsukamoto S, Eto K, Kanemitsu Y. Clinical utility of sarcopenia dynamics assessed by psoas muscle volume in patients with colorectal cancer. World journal of surgery, 48:2098-2108, 2024
16. Takashima A, Hamaguchi T, Mizusawa J, Nagashima F, Ando M, Ojima H, Denda T, Watanabe J, Shinozaki K, Baba H, Asayama M, Hasegawa S, Masuishi T, Nakata K, Tsukamoto S, Katayama H, Nakamura K, Fukuda H, Kanemitsu Y, Shimada Y. Oxaliplatin Added to Fluoropyrimidine/Bevacizumab as Initial Therapy for Unresectable Metastatic Colorectal Cancer in Older Patients: A Multicenter, Randomized, Open-Label Phase III Trial (JCOG1018). Journal of clinical oncology, 42:3967-3976, 2024
17. Takashima A, Ishiguro M, Sasaki K, Machida R, Nagashima F, Imaizumi J, Hamaguchi T, Yamamoto Y, Masuishi T, Asayama M, Ueno H, Shinozaki K, Kudo T, Machida N, Matsuoka H, Ishida H, Yamaguchi T, Nogami H, Yamada T, Takegawa N, Kito Y, Tonoike Y, Sawada R, Tsukamoto S, Kanemitsu Y. Real-world treatment costs of first-line treatment for metastatic colorectal cancer: a survey of the JCOG colorectal cancer study group. Japanese journal of clinical oncology, 54:1107-1114, 2024
18. Kobayashi H, Kotake K, Maeda K, Suto T, Kawasaki M, Ueno H, Komori K, Ozawa H, Koda K, Ohue M, Funahashi K, Takemasa I, Ishida H, Kazama S, Shimada Y, Morohashi H, Kinugasa Y, Kanemitsu Y, Ochiai H, Ishihara S, Itabashi M, Sugihara K, Ajioka Y. Peritoneal lavage cytology in patients with curative resection for stage II and III colorectal cancer: A multi-institutional prospective study. Annals of gastroenterological surgery, 8:807-816, 2024
19. Ito S, Takamoto T, Nara S, Ban D, Mizui T, Nagata H, Takamizawa Y, Moritani K, Tsukamoto S, Kanemitsu Y, Kinugasa Y, Esaki M. RAS mutation associated with short surgically controllable period in colorectal liver metastases: a retrospective study. World journal of surgical oncology, 22:247, 2024
20. Ito S, Takamizawa Y, Moritani K, Tsukamoto S, Kanemitsu Y. Prognostic Impact of Skip Metastasis to the Lateral Lymph Nodes in Lower Rectal Cancer. Journal of the anus, rectum and colon, 8:393-402, 2024
21. Komori K, Takii Y, Mizusawa J, Kanemitsu Y, Shiozawa M, Ohue M, Ikeda S, Kobatake T, Hamaguchi T, Katayama H, Fukuda H. Long-term follow-up of the conventional versus no-touch isolation technique for resection of primary colon cancer (JCOG1006): randomized clinical trial. BJS open, 8:zrae133, 2024
22. Takamizawa S, Hirano H, Takashima A, Shoji H, Hirose T, Okita N, Shiraishi K, Sekine S, Takamizawa Y, Kanemitsu Y, Kato K. Clinicopathological and molecular features of claudin-18 isoform 2 expression in patients with colorectal cancer: a single-center retrospective study. Therapeutic advances in medical oncology, 16:17588359241286774, 2024
23. Kanemitsu Y, Uotani T, Tsukamoto S, Ueno H, Ishiguro M, Ishihara S, Komori K, Sugihara K. Nomograms Predicting Survival, Recurrence and Beneficiary Identification of Adjuvant Chemotherapy in Treatment-naïve Patients with Rectal Cancer who Underwent Upfront Curative Resection: A multi-institutional study. Annals of surgery open : perspectives of surgical history, education, and clinical approaches, 5:e508, 2024