Laparoscopic Surgery for Colon Cancer in Japan. JSCCR Guidelines Laparoscopic surgery Criteria: stage 0 /stage I colon/rectsigmoid cancer Stage II/stage.

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Presentation transcript:

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 dissemination in the abdominal cavity.

Depth of Invasion and Circumferential Occupation T4b T4a T3 T2 217 colon cancers

Depth of Invasion and Circumferential Occupation T4b T4a T3 T2 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 ≦ pT3pT4 ≦ 1/2 1/2 < Specificity: 86% Sensitivity: 36% 17%

Lap. Surgery for CRC has 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 open 49354

cases (Mar ） / 1 06/ 1 07/ 1 08/ 6 09/3 RandomizationRandomization Open Colectomy Laparoscopic Colectomy T3/T4 Colon Cancer Primary endpoint: OS JCOG0404

Laparoscopic Surgery for Right Colon Cancer 5mm 10mm Ｄｉｓｐｌａｙ Scopist Operator Asistant

D3 Dissection for Right Colon Cancer

Laparoscopic Surgery for Sigmoid Colon Cancer 10mm 5mm 5 4 Ｄｉｓｐｌａｙ Scopist OperatorAsistant 3 2 1

Thank you for your attention