1. Laparoscopic Surgery for Colon Cancer in Japan

2. 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)

3. 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)

4. Is Lap Surgery Safe for T4 Tumor? CO2 gas flows may increase cancer dissemination in the abdominal cavity.

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

6. 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

7. Depth of Invasion and Circumferential Occupation Prospective Study ≦ pT3pT4 ≦ 1/2 1/2 <4260102 73441 49 94 Specificity: 86% Sensitivity: 36% 17%

8. 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. 16639 open 49354

9. 0 100 200 300 400 500 600 700 800 900 1000 1057 cases (Mar. 2009 ） 1 6 6 6 05/ 1 06/ 1 07/ 1 08/ 6 09/3 RandomizationRandomization Open Colectomy Laparoscopic Colectomy T3/T4 Colon Cancer Primary endpoint: OS JCOG0404

10. Laparoscopic Surgery for Right Colon Cancer 5mm 10mm Ｄｉｓｐｌａｙ Scopist Operator Asistant 5 4 3 2 1

11. D3 Dissection for Right Colon Cancer

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

13. Thank you for your attention