Laparoscopic colorectal cancer surgery: Japanese experience

Abstract

AbstractIn Japan, laparoscopic colectomy for cancer started in 1992. A national survey has revealed that, since that time, the number of cases that have undergone this procedure has steadily increased, and by 2007, there were over 9000 cases. This figure includes an increase in the percentage of more advanced cases, which has occurred due to technical improvements in lymph node dissection.A Japanese randomized controlled trial comparing laparoscopic to open surgery started in November 2004, with enrollment ending in April 2009 with 1050 cases. For this study, preoperative stage T3 and T4 cases were selected for inclusion, and D3 dissection was required.To assess the technical skill of surgeons, the Japan Society of Endoscopic Surgery established the Endoscopic Surgical Skill Qualification System to encourage high‐level surgical techniques. Assessment is conducted by reviewing unedited videos. The success rate for colon and rectal surgeries has ranged between 37%–40%. The Endoscopic Surgical Skill Qualification System has contributed to the establishment of standard technical skills in laparoscopic surgery, the development of an educational system for laparoscopic surgeons, and a reduction in the number complications. Technical difficulties still exist in laparoscopic rectal cancer surgery, but with the technical progress in laparoscopic colorectal surgery, the number of laparoscopic rectal cancer surgeries has been gradually increasing in number.A multicentric phase II study on the feasibility and long‐term outcome for stage I and II rectal cancer started in 2008. In this study, the short‐term outcomes including anastomotic leakage rate and long‐term survival, will be clarified.Combined with continuously improved technologies, training techniques and surgical standards, laparoscopic colorectal surgery is steadily progressing in Japan.