1. Japanese Approach to colon cancer and the Outcome Dep. of Surgical Oncology Tokyo Medical and Dental University Kenichi Sugihara

2. Overall Survival Colon Ca (n=3061) P = 0.0033 year Survival rate 012345678910 0.0 0.2 0.4 0.6 0.8 1.0 Rectal Ca (n=1393) 84.6% 80.6% 1997 〜 2000 in 18 hospitals median follow-up time: 71 months

3. OS; Stage II Colon Cancer N 5Y-OS 800, 93.5% 914, 88.8% 195, 81.7% 92, 82.1% 128, 91.3% 743, 77.4% 189, 55.5% P<0.0001 Stage I Stage IIA Stage IIB Stage IIC Stage IIIA Stage IIIB Stage IIIC year Survival rate 012345678910 0.0 0.2 0.4 0.6 0.8 1.0 TNM 7 th ed.

4. N 5Y-OS 800, 93.5% 914, 88.8% 195, 81.7% 92, 82.1% 128, 91.3% 743, 77.4% 189, 55.5% P<0.0001 Stage I Stage IIA Stage IIB Stage IIC Stage IIIA Stage IIIB Stage IIIC year Survival rate 012345678910 0.0 0.2 0.4 0.6 0.8 1.0 TNM 7 th ed. OS; Stage III Colon Cancer

5. Randomized Studies of Adjuvant Chemotherapy in Japan TrialsRegimenDuration (months) StageNo. of Pts Enrolment JCOG02055FU+l-LV vs. UFT+LV ６ Stage III Colon cancer 1101 completed in Nov. 2006 JCOG0910Capecitabine Vs. S-1 ６ Stage III Colon cancer 1550 started in March 2010 ACTS-CCUFT+LV Vs. S-1 ６ Stage III Colon cancer 1530 completed in June 2009 SACURAUFT vs. surgery alone 12Stage II Colon cancer 2024 completed in July 2010 ACTS-CC 02 UFT+LV vs. SOX ６ anyTN2 Colon cancer 1200 started in April 2010 ACTS-RCUFT vs. S-112Stage II, III Rectal cancer 961 completed in March 2009 JFMC37Capecitabine6 vs 12Stage III Colon cancer 1306 completed in Dec. 2009

6. UFT/LV vs. 5FU/LV JCOG 0205: Phase III non-inferiority study Stage III Colon Cancer (n=1,101) R UFT/LV (oral) (n=551) 5FU/LV (RPMI) (n=550) Primary endpoint ： DFS Secondary endpoint ： OS, Safety Feb. 2003 - Oct. 2006 78.3 % 75.0 % 73.8 % 90.3 % 94.2% 88.2 % Disease Free Survival Overall Survival

7. Mortality/Morbidity Surgery of Colon Cancer No. Mortality 118,426 0.7% rt. colectomy/hemicolectomy No. 39,386 Anastomotic Leakage 1.5% high anterior resection 17,4182.5% National Survey of Digestive Surgery by the Japanese Society of Gastroenterological Surgery 1,191,643 surgeries between 2006 and 2008 high/low anterior resection 55,557 0.34% APR 11908 0.7%

8. Differences of Colon Cancer Care between Japan and Western  Scope of LN dissection  Histopathological examination of resected specimens  Surveillance after surgery  Strategy for liver metastasis  Medical care system/Medical insurance system JSCCR 

9. Thank you for your attention