Table Of ContentRecent Advances
in the Treatment
of Colorectal Cancer
Hideyuki Ishida
Keiji Koda
Editors
123
Recent Advances in the Treatment
of Colorectal Cancer
Hideyuki Ishida • Keiji Koda
Editors
Recent Advances in the
Treatment of Colorectal
Cancer
Editors
Hideyuki Ishida Keiji Koda
Department of Digestive Tract and Department of Surgery
General Surgery Teikyo University Chiba Medical Center
Saitama Medical Center Ichihara
Saitama Medical University Chiba
Kawagoe Japan
Saitama
Japan
ISBN 978-981-13-3049-0 ISBN 978-981-13-3050-6 (eBook)
https://doi.org/10.1007/978-981-13-3050-6
Library of Congress Control Number: 2018965168
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Preface
The number of patients with colorectal cancer has been increasing worldwide, and
there is a high degree of concern among clinicians and investigators around the
globe. The level of colorectal cancer care in Japan is world-class.
Meticulous data has been compiled regarding the indications for endoscopic
therapy, and techniques and findings that have a global impact have been reported
from Japan. Recently, the standard lymph node dissection widely adopted in Japan
has been attracting the attention of colorectal surgeons everywhere. The treatment
strategies for rectal cancer in Japan and other countries differ greatly: in Japan, there
is a history of attaching importance to lateral lymph node dissection for lower rectal
cancer, and lateral lymph node dissection is considered one of the options for effec-
tive local treatment. The views in Western countries regarding perioperative chemo-
radiation therapy for lower rectal cancer also differ from those in Japan. Moreover,
the Japanese technique of sphincter preservation in lower rectal cancer has become
a world leader. Excellent oncological outcomes of laparoscopic surgery and robotic
surgery in the treatment of colorectal cancer have also been reported from Japan. In
the context of chemotherapy for colorectal cancer, Japan’s excellent results for
administering oral agents in combination with injection-based chemotherapy have
been widely used in Western countries. There is also a long history of research in the
field of hereditary colorectal cancer in Japan, and in recent years the findings
obtained using next-generation sequencing have also been reported to the world.
Japanese experts in diagnosing and treating of colorectal cancer have reviewed
this book, Recent Advances in the Treatment of Colorectal Cancer, and they have
added their own experience in 11 relevant areas and real-world clinical situations, as
well as added a discussion based on the foreign literature. We sincerely hope that
readers will peruse this book carefully, and that they will find it useful in the diag-
nosis and treatment of colorectal cancer in their everyday practice.
Saitama, Japan Hideyuki Ishida
Chiba, Japan Keiji Koda
v
Contents
Part I Endoscopic Treatment
1 Endoscopic Resection of Early Colorectal Cancer. . . . . . . . . . . . . . . . . 3
Masayoshi Yamada, Yutaka Saito, Stefano Sansone, Hiroyuki
Takamaru, and Taku Sakamoto
2 Colonic Stent: Bridge to Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Yoshihisa Saida
Part II Surgical Treatment
3 D3 Lymph Node Dissection for Colon and Rectal Cancers . . . . . . . . . . 27
Tatsuro Yamaguchi
4 Laparoscopic Surgery for Colorectal Cancer . . . . . . . . . . . . . . . . . . . . . 39
Tetsuro Tominaga and Tsuyoshi Konishi
5 Robotic-Assisted Laparoscopic Surgery for Rectal Cancer . . . . . . . . . 49
Tomohiro Yamaguchi and Yusuke Kinugasa
6 Intersphincteric Resection for Rectal Adenocarcinoma Near the Anus 59
Yoshito Akagi and Fumihiko Fujita
7 Chemoradiation for Rectal Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Keiji Koda
Part III Chemotherapy
8 Adjuvant Chemotherapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
Toshiaki Ishikawa and Hiroyuki Uetake
vii
viii Contents
9 Chemotherapy for Metastatic Colorectal Cancer . . . . . . . . . . . . . . . . . 101
Takeshi Yamada, Michihiro Koizumi, Seiichi Shinji, Akihisa
Matsuda, Yasuyuki Yokoyama, Goro Takahashi, Takuma Iwai,
Keisuke Hara, Masahiro Hotta, Kohki Takeda, Kohji Ueda, and
Hiroshi Yoshida
Part IV H ereditary Colorectal Cancer
10 Next-Generation Sequencing for Genetic Diagnosis of Hereditary
Colorectal Cancer and Polyposis Syndrome . . . . . . . . . . . . . . . . . . . . . . 115
Hidetaka Eguchi and Yasushi Okazaki
11 Clinical Management of Hereditary Colorectal Cancer . . . . . . . . . . . . 127
Kensuke Kumamoto and Hideyuki Ishida
Part I
Endoscopic Treatment
Chapter 1
Endoscopic Resection of Early
Colorectal Cancer
Masayoshi Yamada, Yutaka Saito, Stefano Sansone, Hiroyuki Takamaru,
and Taku Sakamoto
Abstract Endoscopic diagnosis and treatments have made considerable progress
in recent years. Endoscopic diagnosis aims to predict oncological characteristics of
a lesion based on endoscopic features and also differentiate between malignant and
benign tumors. Detailed inspection of lesions is required in order to pursue an accu-
rate endoscopic diagnosis. This can be achieved with image enhanced endoscopy.
Multiple strategies are available to achieve endoscopic resection of colorectal
lesions, including polypectomy, endoscopic mucosal resection, endoscopic mucosal
dissection, and full-thickness resection.
Each technique requires different skill-sets and has different frequency of com-
plications. Selection of the appropriate endoscopic treatment is based on oncologi-
cal indication and technical aspects of each strategy. All endoscopic procedures
require expertise which is achieved through adequate training and the availability of
appropriate equipment.
Keywords Endoscopic resection · Endoscopic submucosal dissection
Colorectal cancer
1.1 Introduction
With the development of new devices and technologies, both endoscopic diagnosis
and treatments have made considerable progress. Endoscopic resection is a proce-
dure to remove a lesion under direct vision using an endoscope and endoscopic
devices. Since it is a less invasive procedure than conventional surgery, endoscopic
resection has attracted attention as an alternative treatment with shorter in-hospital
M. Yamada · Y. Saito (*) · H. Takamaru · T. Sakamoto
Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
e-mail: [email protected]; [email protected]; [email protected]; [email protected]
S. Sansone
NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University
Hospitals NHS Trust and University of Nottingham, Nottingham, UK
e-mail: [email protected]
© Springer Nature Singapore Pte Ltd. 2019 3
H. Ishida, K. Koda (eds.), Recent Advances in the Treatment of Colorectal
Cancer, https://doi.org/10.1007/978-981-13-3050-6_1
4 M. Yamada et al.
stays. In the late 1960s, Tsuneoka and Uchida firstly described a successful endo-
scopic resection of 43 gastric polyps using mechanical cutting with a looped wire.
Although the low retrieval rate (57%) of the resected specimen was recognized as
an issue, their report led to a breakthrough of endoscopic resection [1]. Subsequently,
the application of electrocautery has been introduced. Once the polyp stalk is cap-
tured with a looped wire (currently known as snare) coagulation can be delivered by
high-frequency electrical current from an electrosurgical generator. In addition to
pedunculated polyps, endoscopic resection has also been adopted for sessile, flat,
and depressed lesions by using an injection of saline into the submucosa under the
lesion. This procedure can lift the lesions up making them more amenable to snare
resection [2]. Currently, three types of endoscopic resection are mainly performed:
(1) polypectomy, (2) endoscopic mucosal resection (EMR), (3) endoscopic submu-
cosal dissection (ESD).
1.2 Treatment Selection
Endoscopic diagnosis plays a crucial role in determining treatment strategy
(Table 1.1). Treatment pathways are selected according to both oncological and
technical aspects. Endoscopic diagnosis aims to predict oncological characteristics
of a lesion based on endoscopic features, such as size, and also differentiate between
malignant and benign tumors. Endoscopic resection technique is dependent on the
endoscopist’s technical skill, with each technique requiring different skill-sets and
having different frequency of complications. Therefore, the decision-making pro-
cess should take into consideration these technical aspects.
Endoscopic treatment is only indicated for tumors with no lymph node metasta-
sis. Therefore, endoscopic resection is considered only for adenomas or invasive
tumors confined to the superficial layer of the submucosa (less than 1 mm in depth)
[3]. Cancers infiltrating the deeper submucosal layers carry a risk of lymph node
metastasis; therefore, a surgical intervention is required. Endoscopic treatment can
also be offered for rectal neuroendocrine tumors (carcinoid tumors).
Table 1.1 Strategy of endoscopic treatment in colorectum
Strategy
Endoscopic diagnosis Lesion size Polypectomy EMR ESD
Adenoma or low grade dysplasia <10 mm ◎a ○ ×
10~20 mm × ◎ ∆b
>20 mm × ○ ○
High grade dysplasia or adenocarcinoma ~10 mm × ◎ ×
(superficial submucosal invasion) 10~20 mm × ◎ ○b
>20 mm × ○c ◎
aIncluding cold polypectomy
bRecurrent lesion
cIf en-bloc resection is possible
