Surgical Treatment for Digestive Cancer

Background: Due to the westernization of the diet in Japan, the incidence of colorectal cancer has increased 4.5 times in the last 25 years. In this review, the recent results of surgical treatment for colonic cancer and the future perspectives in Japan are described. Materials and Methods: A multi-institutional registry of large bowel cancer in Japan of 10,809 patients with colonic cancer treated from 1991 to 1994 was investigated. The data have been published in the Guidelines of the Japanese Society for Cancer of the Colon and Rectum (2005). Regarding laparoscopic surgery, 1,495 patients with colon cancer were examined in a multicenter study between April 1993 and August 2002. Results: Radical resection with a curative intent is appropriate for 83–99% of the patients with stage I–III localized colon carcinoma. Adequate lymphadenectomy, including paracolic, intermediate and principal node dissection (D3 lymphadenectomy), is of critical importance for both the accurate staging and local control of the disease. This treatment protocol has now been accepted as a ‘standard’ operation by Japanese colorectal surgeons. For patients undergoing a curative resection for colon cancer, the 5-year survival rates vary between 62 (stage III) and 91% (stage I). Adjuvant chemotherapy using 5-FU/leucovorin or oral compounds is commonly administered to patients with stage III disease. Laparoscopic surgery for colonic cancer yielded a comparable oncological outcome to that reported for conventional open surgery in the Japanese registry for all disease stages. Conclusion: Radical resection with a D3 lymphadenectomy provided satisfactory 5-year survival for patients with stage I–III colon cancer in Japan. However, the survival of patients with stage IV disease is still unsatisfactory (only a 14% 5-year survival). Any further improvements depend on both identifying such patients at an earlier stage as well as developing new and effective treatment modalities.