Advancement of Colorectal Cancer Surgery in Last Four Decades and its Future Aspect

Masayuki Yasutomi

First Department of Surgery, Kinki University School of Medicine

Personal experience of four decades of evolution of colorectal cancer treatment is reported. Before 1961, abdominoperineal resection with sigmoid colostomy was the sole surgical treatment for 90% of rectal cancers. After 1962, endorectal pull-through (Jinnai), invagination and anterior resection was used for 46% of the patients. In the 1980's instrumentally stapled anterior resection was performed for 75% of the patients. To improve the anal functions after very low anterior resection, such as colo-anal anastomosis, the functional outcome of the colonic J-pouch was compared with end-to-end anastomosis. The colonic J-pouch showed improvement of anal function and the 5-cm pouch resulted in contended function. There is unfortunately a discrepancy between extended surgery for cancer radicality and preservation of organ functions. As a result of pelvic node examination by the clearing method, disease-free survival and postoperative pelvic organ function, the pelvic node dissection should be limited to T3 and T4 cancers of the lower rectum and anal canal. Also there is only a 26% 5-year survival rate and a 48% local recurrence rate in patients with pelvic node metastasis. Therefore adjuvant therapies are considered to be essential. Total preservation of the autonomic nerve resulted in sufficient bladder function and erection; however, ejaculation cannot be completed. As for partial preservation, urination was satisfactory, but sexual functions were poor. Liver metastasis is the largest factor in determining the prognosis of colorectal cancer. The effect of hepatic resection for solitary metastasis was discussed, and hepatic arterial infusion with Interleukin-2, MMC, 5-FU for unresectable metastasis gave a response rate as high as 76% including 20% complete response, and a 5-year survival rate of 28%. Locoregional immunochemotherapy is effective for liver metastasis, because the liver is an extramedullary hematopoietic organ.

Key words
advancement of colorectal cancer treatment, pelvic node dissection, sphincter saving operation, autonomic nerves preseryation, treatment for liver metastasis

Reprint requests
Masayuki Yasutomi First Department of Surgery, Kinki University School of Medicine
337-2 Ono Higashi, Osakasayama, 589 JAPAN

Accepted
June 12, 1996

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