The 78th General Meeting of the Japanese Society of Gastroenterological Surgery

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July 12 - 14, 2023 | in Hakodate
President: Kenichi Hakamada

Program

Symposium

1.Liquid Biopsy in Gastrointestinal and HBP Surgery
detail

Liquid biopsy has been reported as a non-invasive method to evaluate cancer dynamics that overcomes spatial and temporal heterogeneity. It is expected to be applied to early detection, monitoring of treatment, and selection of therapeutic agents. We would like to discuss the latest research results on the topics and clinical applications of liquid biopsy in the field of gastrointestinal and HBP surgery.

2.Surgical Assistance with Latest Digital Technology
detail

Digital imaging technology has been dramatically innovated and is now used not only for preoperative simulation but also for clinical applications such as ICG fluorescence, surgical navigation using mixed reality, and surgical support by introducing artificial intelligence (AI). In this session, we would like to discuss the current status and future prospects of surgical support using the latest digital technologies, regardless of the organ or field.

3.Evolution of ERAS in Gastrointestinal and HBP Surgery
detail

More than 10 years have passed since ERAS was introduced in Japan. During this period, the program has been improved at each institution and has been evolving day by day. In this session, we would like to discuss the practice and results of ERAS, including preoperative management, fluid infusion, drainage, nutritional management, and rehabilitation, with a view to creating new evidence.

4.Current Status and Future Prospects of Postoperative Adjuvant Chemotherapy for Stage III Gastric Cancer
detail

S-1 plus docetaxel has been added to postoperative adjuvant chemotherapy regimens for Stage III gastric cancer. However, the superiority of this regimen over platinum-containing regimens has not been demonstrated, and the choice of treatment has not been consistent. In addition, the indication for preoperative adjuvant therapy has been expanded and new perioperative adjuvant therapies, including immune checkpoint inhibitors, are being developed, complicating the choice of treatment options. In this session, we would like to discuss the current status and future prospects of postoperative adjuvant chemotherapy for Stage III gastric cancer.

5.Optimal Treatment Strategy for Rectal Cancer with Resectable Distant Metastases
detail

Rectal cancer with resectable distant metastases presents a variety of treatment options, with each primary and distant metastatic lesion presenting with varying degrees of tumor extension. In addition, when local stenosis is present, there are options for prior resection of the primary tumor, stoma placement or stenting for pre-treatment, which have not been standardized. We would like to discuss treatment strategies, including primary and distant intervention methods and timing, and combinations of chemotherapy and radiation therapy.

6.Optimal Surgical Procedure for Pancreatic Body-Tail Cancer and its Future Direction
detail

The standard surgical procedure for pancreatic body-tail cancer is distal pancreatectomy directly above the portal vein and D2 lymph node dissection. On the other hand, there are opinions that the extent of resection should be determined with emphasis on preservation of pancreatic function and reliable R0 resection. In this session, we would like to discuss the current status of surgery for pancreatic body-tail cancer and the long-term results including pancreatic function, and clarify the optimal surgical approach and future direction.

7.Optimal Treatment Strategies for Borderline Resectable Liver Metastases from Colorectal Cancer
detail

There is a gap between technically resectable and oncologically resectable colorectal liver metastases. The definition and treatment strategies for such so-called borderline resectable colorectal cancer liver metastases are controversial among institutions. We would like to discuss the optimal treatment strategy based on the results of treatment of borderline resectable colorectal cancer liver metastases at each institution.

8.Current Status and Issues of Liver Transplantation for Hepatocellular Carcinoma after Introduction of 5-5-500 Criteria
detail

In April 2020, a new indication for living donor liver transplantation for hepatocellular carcinoma (HCC), the so-called 5-5-500 criteria, was adopted for insurance coverage. This revision is expected to expand the number of patients who are eligible for transplantation while maintaining the same low recurrence rate and high survival rate as the Milan criteria. In this session, we would like to discuss the effectiveness and challenges of the new criteria based on the changes in the number of cases and treatment outcomes after the introduction of the new criteria.
Video Symposium

1.Current Status and Future Prospects of Robot-Assisted Surgery for Thoracic Esophageal Cancer
detail

Robotic-assisted thoracic esophagectomy for thoracic esophageal cancer is increasingly indicated due to the improved operability and precision of robotic surgery. On the other hand, there is still a lack of evidence regarding its effectiveness in reducing complications and its oncological superiority. In this session, we would like to discuss the position of robot-assisted surgery in the treatment of thoracic esophageal cancer by presenting short- and long-term results when the number of cases has been accumulated at each institution.

2.Optimal Surgical Procedure for Advanced Esophagogastric Junction Cancer
detail

The extent of surgical resection and lymph node dissection in esophagogastric junction cancer depends on the localization of the tumor center and the length of esophageal invasion. In addition, reconstructive methods are also taken into consideration in determining the approach. However, in patients with advanced cancer or coexisting hiatal hernia, it is often difficult to determine the relationship between the tumor center and esophagogastric junction. In this session, we would like to discuss the actual resection extent, dissection extent, and approach method selection at each institution to guide the selection of the optimal surgical procedure.

3.Current Status and Future Prospects of Robot-Assisted Surgery for Advanced Gastric Cancer
detail

The high precision of robot-assisted surgery has been recognized, and in the 2022 revision of the medical fee schedule, an increase in the reimbursement points for existing robot-assisted surgery for gastric cancer was approved. On the other hand, the evidence of oncological outcomes for advanced gastric cancer is insufficient. In this session, we would like to discuss the advanced gastric cancer surgery utilizing the characteristics of surgical robots, based on the actual results of robot-assisted surgery for advanced gastric cancer at each institution.

4.Current Status of Laparoscopic Surgery for Locally Advanced Rectal Cancer and Strategies to Overcome the Challenges
detail

Laparoscopic surgery for locally advanced rectal cancer is expected to be a sophisticated procedure that achieves both oncologic cure and functional preservation. However, at present, there is insufficient evidence for the usefulness of laparoscopic surgery in achieving these goals. We would like to present the short- and long-term results of laparoscopic, taTME, and robot-assisted rectal surgery from the viewpoints of both radical cure and functional preservation, and discuss the current issues and techniques/strategies to overcome them.

5.Extended Pelvic Surgery Requiring Combined Resection of Other Organs, Blood Vessels, and Bone
detail

Multidisciplinary treatment has markedly improved the local outcome of rectal cancer. However, highly invasive lesions such as direct invasion of the anterolateral region, lateral lymph node metastasis requiring vascular resection, and local recurrence requiring bone resection are the last key factors that determine the patient's life. We would like to report the techniques and results of these surgeries in order to pass them on to future generations and to improve them.

6.Current Status and Future Prospects of Robotic-Assisted Pancreaticoduodenectomy
detail

Since RPD was covered by insurance in April 2020, the number of cases of robot-assisted pancreaticoduodenectomy (RPD) has been increasing, mainly at advanced facilities. While RPD is expected to enable more precise surgery than laparoscopic surgery, there are many issues to be addressed for its safe introduction and dissemination, such as the need to master surgical techniques and methods of visual field development unique to robotic surgery. In this session, we would like to present the actual situation and short-term results of RPD at each institution, and discuss the challenges and future direction of RPD introduction.

7.Toward Standardization of Highly Difficult Laparoscopic Liver Resection
detail

Laparoscopic liver resection has been reported to maintain oncologic cure and good short-term results. On the other hand, subsegmental resections in S1/S7/S8 and complex anatomic resections have not yet been standardized, as various approaches and zone identification methods are utilized. In this session, we would like to discuss the actual surgical techniques for these difficult laparoscopic liver resections, with the aim of standardizing the techniques.
Panel Discussion

1.[Challenges beyond borders] Challenges in applying AI to optimize the treatment of advanced gastrointestinal and HBP cancer
detail

In the treatment of advanced gastrointestinal and HBP cancer, there are a wide variety of pathological scenarios and treatment options, and it is no longer possible to reduce them to simple diagnostic and therapeutic algorithms. In recent years, reports of machine learning of image and genome information for diagnosis and treatment support and development of novel therapies have been recognized. In this session, we would like to share the results of research on the application of artificial intelligence (AI) to diagnosis and treatment support, and discuss strategies to optimize the treatment of advanced gastrointestinal and HBP cancer.

2.[Challenges beyond borders] Current Status of Conversion Surgery for Unresectable Esophageal Cancer and New Treatment strategies
detail

Conversion surgery is an option for patients with initially unresectable esophageal cancer due to cT4 or distant metastasis but become resectable after successful chemotherapy or radiation therapy. While a long-term prognosis is expected at the time of completion of conversion surgery, it requires a high level of surgical skill to overcome the influence of previous treatment, and there is a high risk of perioperative complications. Early recurrence is also a concern in cases of distant metastasis. In this session, we would like to discuss multidisciplinary treatment strategies to improve the conversion rate and surgical safety based on short- and long-term results.

3.[Challenges beyond borders] Current Status and New Treatment Strategies of Conversion Surgery for Highly Advanced Gastric Cancer
detail

Advances in chemotherapy, molecular-targeted agents, and immune checkpoint inhibitors have increased the opportunities for conversion surgery for unresectable advanced gastric cancer. The prognostic value of conversion surgery has become increasingly clear, and aggressive resection including oligometastasis resection and No. 16 lymph node dissection is now being performed when the tumor is under control. On the other hand, there is no clear consensus on the indications for surgery, timing, surgical techniques, and postoperative adjuvant therapy. In this session, we would like to present the current status and results of conversion surgery for gastric cancer at each institution, and discuss future multidisciplinary treatment strategies including conversion surgery.

4.[Challenges beyond borders] New Multidisciplinary Treatment Strategies for Locally Advanced Rectal Cancer
detail

The TNT strategy of sequential preoperative radiation therapy and chemotherapy is currently the most promising strategy for the multimodality treatment of locally advanced rectal cancer. However, there have been cases of inadequate response and persistent adverse events with radiation or chemotherapy, and individualized strategies are needed to maximize the safety and efficacy of multimodality treatment. We would like to discuss new treatment strategies that go beyond the current outcomes and challenges.

5.[Challenges beyond borders] New Multidisciplinary Treatment Strategies for Advanced Biliary Tract Cancer
detail

Diagnostic and surgical techniques and perioperative management of hilar cholangiocarcinoma, distal cholangiocarcinoma, advanced gallbladder cancer, and intrahepatic cholangiocarcinoma have progressed, and safe surgery is now possible. However, it is still difficult to say that a good long-term prognosis has been achieved, and as with other cancers, the development of multidisciplinary treatment is expected. In this session, we would like to discuss the future direction of multidisciplinary treatment for advanced biliary tract cancer based on new approaches and treatment results at each institution.

6.[Challenges beyond borders] Current Status and New Treatment Strategies of Conversion Surgery for Locally Advanced Pancreatic Cancer
detail

Conversion surgery after chemotherapy or chemoradiotherapy for locally advanced pancreatic cancer such as BR-A and UR-LA pancreatic cancer is increasing. Long-term prognosis is expected in a certain percentage of patients who complete conversion surgery. However, there are many issues to be addressed, such as optimal preoperative treatment regimen and duration of treatment, decision criteria for resection, safe surgical techniques, necessity of postoperative adjuvant therapy, and how to treat R1/R2 surgery patients. In this session, we would like to present the current status of conversion surgery at each institution, and discuss treatment strategies aimed at improving the conversion surgery achievement rate and long-term outcomes.

7.[Challenges beyond borders] New Surgical Treatment Strategies for Hepatocellular Carcinoma Brought about by Recent Advances in Drug Therapy
detail

Recent advances in drug therapy for hepatocellular carcinoma (HCC) using molecular targeted drugs and immune checkpoint inhibitors have brought about a paradigm shift in the overall treatment of HCC. They are expected to play a role not only as conversion surgery in unresectable cases but also as preoperative and postoperative adjuvant therapy in cases in which resection is indicated. We would like to discuss new surgical treatment strategies and their outcomes at each institution in response to advances in drug therapy.
Workshop

1.How to Use Online Systems for Surgical Education and Work-Style Reform
detail

The construction of new social systems utilizing digital and communication technologies is progressing in various fields. In surgical education, cloud sharing of surgical videos, video clinics, webinars, and virtual conferences have become routine. In this session, we would like to learn new ways of using online systems for surgical education and work style reform at each institution to help gastroenterological surgeons enhance their work and life.

2.How to Educate Young Gastroenterological Surgeons in the Era of Robot-Assisted Surgery
detail

Although the number of surgical robots is limited at present, it is expected that robot-assisted surgery will become the standard in the future due to society's demand for minimally invasive surgery and rapid technological innovation. In robot-assisted surgery, which has many elements of solo surgery, it is an important issue how young surgeons, who will be responsible for the future of gastroenterological surgery, can be trained as surgeons. It is also an issue how to integrate the training into the overall training of gastroenterological surgeons. In this session, we would like to discuss the roadmap for training young surgeons in gastroenterological surgery, as well as the timing, specific methods, and challenges of robot-assisted surgical training, with examples from each institution.

3.Intracorporeal Anastomosis: Challenges and Solutions
detail

Intracorporeal anastomosis of the gastrointestinal tract is a technique that has the advantage of reducing surgical invasiveness by reducing the size of the wound and the extent of organ mobilization. However, there is still room for improvement due to concerns about intracorporeal infection and peritoneal seeding, and the complexity of the limited field of view. In this session, we would like to share the advantages of intracorporeal anastomosis and its surgical outcomes at each institution, regardless of the organ, to help improve the technical level of intracorporeal anastomosis.

4.Perioperative and Outpatient Management of Sarcopenia and Frailty
detail

Sarcopenia/frailty has been reported to affect not only short-term surgical outcomes but also long-term prognosis, and its countermeasures are essential for improving gastrointestinal surgical outcomes. However, it is not easy to establish countermeasures against the background of advanced age, underlying diseases, and long-term deterioration of physical functions. In this session, we would like to share sarcopenia/frailty measures and their evaluation at each institution to improve short- and long-term surgical outcomes, and discuss effective intervention methods including outpatient supportive care.

5.Current Status and Challenges of Multidisciplinary Treatment for Oligometastasis other than Colorectal Cancer
detail

Oligometastasis is a condition with a small number of distant metastases. Although it has been reported that long-term prognosis can be achieved by multimodality treatment including surgery, a clear treatment strategy for each primary disease has not been established. In this session, we would like to share the current status and results of multidisciplinary treatment of oligometastasis other than colorectal cancer at each institution, and discuss prognostic factors, optimal intervention methods and timing of treatment for primary tumors and metastases.

6.Avoiding Failure to Rescue after Postoperative Complications
detail

Failure to rescue (FTR) refers to in-hospital deaths that could not be prevented after an adverse event and is related to the quality of hospital safety. The incidence of postoperative death due to complications has been reported to be influenced not only by patient and surgeon factors, but also by qualitative factors such as the number of staff, hospital organization such as closed ICUs, early recognition of complications and appropriate response, safety awareness, and team collaboration. In this session, we would like to learn the efforts to avoid FTR after postoperative complications at each institution and propose interventions that can be implemented in many hospitals.

7.Current Status and Future Prospects for Bariatric and Metabolic Surgery
detail

Bariatric and metabolic surgeryis now considered a treatment option for type 2 diabetes, but there are still many issues to be addressed, such as assuring the safety of surgery for severely obese patients and its long-term effectiveness. In this session, we would like to share the results of weight loss, control of complications, and improvement of quality of life at each institution, and discuss the validity and future prospects of this surgery.

8.Surgical Techniques and Innovations of Mediastinoscopic Esophagectomy for Thoracic Esophageal Cancer
detail

The mediastinoscopic approach to thoracic esophageal cancer has the advantage of not requiring an open chest, but it is necessary to overcome difficulties in visual field development and anatomical recognition in the early stages of introduction. In this session, we would like to share the innovations and results of the mediastinoscopic approach at each institution and discuss the standardization of this technique.

9.Postoperative Outpatient Nutritional Intervention and Long-Term Outcomes after Esophageal Cancer Surgery
detail

The importance of perioperative nutritional therapy in esophageal cancer surgery is widely recognized, but there is still a lack of evidence regarding the effect of outpatient nutritional therapy on long-term outcomes. In this session, we would like to share the long-term results of perioperative and outpatient nutritional therapy at each institution, and discuss how nutritional therapy contributes to long-term prognosis.

10.Frontiers in Multidisciplinary Treatment of Resectable Advanced Esophageal Cancer
detail

The JCOG1109 trial and the international CheckMate 577 trial have revealed the prognostic value of perioperative chemotherapy, radiation therapy, and immune checkpoint inhibitors. In this session, we would like to share the efforts and results of each institution based on these latest findings, and discuss treatment strategies for further improvement of prognosis.

11.Multidisciplinary Treatment for Advanced Esophagogastric Junction Cancer
detail

The prognosis of advanced esophagogastric junction cancer is poor, and the development of multidisciplinary treatment is expected. However, perioperative adjuvant therapy has not yet been established in Japan, and various attempts are being made based on the results of overseas clinical trials. In this session, we would like to share the approaches and results of perioperative adjuvant therapy at each institution, and to build evidence for the development of multidisciplinary treatment.

12.New Treatment Strategies for Gastric Cancer with Advanced Peritoneal Metastases
detail

Gastric cancer with advanced peritoneal metastases is highly refractory to treatment and has a poor prognosis, and the PHOENIX-GC trial suggested some clinical benefit of intraperitoneal chemotherapy with paclitaxel over standard therapy, although it did not demonstrate a survival advantage, and was included in guidelines. In addition, new treatment options such as molecular-targeted agents and drug selection based on cancer gene panel tests have been introduced. In this session, we would like to explore the possibility of new treatment for gastric cancer with advanced peritoneal metastasis by sharing the efforts of each institution.

13.Surgical Indication and Selection of Surgery for Very Elderly Patients with Gastric Cancer
detail

With the increase in the number of elderly patients with gastric cancer and advances in perioperative management, the age of indication for surgery is expanding. However, the selection of surgical indications and procedures must be done carefully, taking into consideration various co-morbidities, frailty, and family environment. In this session, we would like to discuss the indications for surgery for the very elderly (over 85 years old), the selection of surgical procedures, and creative ideas to overcome the difficulties of surgery.

14.Optimal Reconstruction Method for Proximal Gastrectomy
detail

Proximal gastrectomy is increasingly being performed for early-stage cancer of the epigastric region and esophagogastric junction. However, postoperative complications such as reflux esophagitis, stricture, and anastomotic failure have been reported. In this session, we would like to discuss the optimal reconstruction method after proximal gastrectomy to avoid postoperative complications by sharing the innovations and results of each institution.

15.Indications for residual stomach preservation from a long-term perspective
detail

With the aging of gastric cancer patients and the increase in early-stage gastric cancer due to improved diagnostic capabilities, the avoidance of total gastrectomy and the preservation of residual gastric volume are attracting attention. Specifically, there are various possibilities, such as pylorus-preserving gastrectomy with minimal residual stomach for upper gastric cancer, preservation of the pyloric residual stomach less than half of that during proximal gastrectomy, and preservation of the minimal stomach in residual gastric cancer. On the other hand, no evidence has been obtained for the improvement of long-term quality of life by the preservation of the residual stomach. In this session, we would like to discuss the innovations of each institution for the preservation of the residual stomach, aiming at improving long-term postoperative quality of life.

16.Current Status of Colorectal Cancer Treatment for Elderly Patients with Systemic Comorbidities of ASA 3 or Higher
detail

Elderly patients with colorectal cancer, especially those with severe systemic comorbidities such as emphysema, cirrhosis, diabetes, long-term steroid use, and dialysis, face the challenge that once complications develop, quality of life may be significantly reduced and surgical mortality may increase. Therefore, surgeons are often faced with the choice of surgical technique and stoma placement. In this session, we would like to share surgical experiences for elderly patients with colorectal cancer with systemic comorbidities of ASA3 or higher and the surgical outcomes including quality of life at each institution, and discuss how to select colorectal cancer treatment based on host factors.

17.Update on Treatment Strategies for Obstructive Colorectal Cancer
detail

The revised ESGE guidelines include stenting as a bridge to surgery for obstructive colorectal cancer as a treatment option. On the other hand, multimodality treatment with a view to improving prognosis is also necessary in cases of advanced local extension or distant metastasis. We would like to discuss optimal treatment strategies for obstructive colorectal cancer from the viewpoint of improving oncological outcomes. We also welcome reports on the economic aspects of each strategy.

18.Prediction of treatment response and recurrence risk in rectal cancer
detail

The introduction of high-resolution MRI for Stage II-III rectal cancer has led to detailed risk classification and stratification of patients from upfront surgery to multimodality treatment. On the other hand, there are cases that are resistant to multimodality treatment and cases of early recurrence. Therefore, a new diagnostic modality is required to stratify cases in which multimodality treatment is useful, unnecessary, or inadequate. We would like to discuss appropriate risk stratification for personalized treatment of rectal cancer.

19.Standardization of Robot-Assisted Colon Cancer Surgery
detail

Robotic-assisted surgery for colon cancer is now covered by insurance, and is expected to be utilized for dissection of the surgical trunk, left-sided transverse colon cancer surgery, and descending colon cancer surgery, which are considered difficult to perform by laparoscopic surgery. On the other hand, the disadvantage of robotic surgery is the limited surgical field, which requires a strategy to smoothly perform a wide range of surgical operations. In this session, we would like to discuss the challenges and innovations for the standardization of robot-assisted colon cancer surgery.

20.Multidisciplinary Treatment Strategies for Locally Advanced Colorectal Cancer with Unresectable Distant Metastases
detail

Based on the results of JCOG1007, the standard of care for colorectal cancer patients with unresectable metastases and no symptoms from the primary tumor is immediate chemotherapy without resection of the primary tumor. On the other hand, for rectal cancer and bulky tumors where tumor remnants impair quality of life, some centers aggressively resect the primary tumor along with multimodality therapy. We would like to discuss the optimal treatment strategy for this condition based on the treatment strategy and results at each institution.

21.Role of Adjuvant Therapy in High-Risk Group for Postoperative Recurrence of Simultaneous Liver Metastases from Colorectal Cancer
detail

The results of JCOG0603 suggest that adjuvant chemotherapy is of limited benefit in the treatment of resectable liver metastases of colorectal cancer. On the other hand, the necessity of adjuvant chemotherapy for patients at high risk of postoperative recurrence, especially for simultaneous liver metastases, is a matter of debate. We would like to discuss the significance of adjuvant chemotherapy for high-risk patients in this complicated situation.

22.Current Status and Challenges of Watch and Wait Strategies for Rectal Cancer
detail

The watch-and-wait strategy for rectal cancer has attracted much attention and is being actively introduced in Europe and the United States for patients with early-stage cancer who can be cured by surgery alone. However, re-proliferation is also observed at a certain frequency, and it is important to determine not only the clinical remission but also the indications for watch and wait, but these criteria are not clear. We would like to discuss the indicaions and limitations of the current watch-and-wait strategy for rectal cancer and its efforts to maximize its potential.

23.Optimal Treatment Strategy for Colonic Diverticulitis with Abscess or Fistula Formation
detail

Resection is curative for colonic diverticulitis with abscess or fistula formation, but often results in extensive surgery because of the wide extent of inflammation and diverticula. In the case of sepsis, radical surgical strategy after damage control such as drainage and stoma creation may be appropriate, and in such cases, options such as laparoscopic approach are also available. We would like to discuss optimal treatment strategies for colonic diverticulitis with perforation or fistula formation.

24.Toward Improving the Surgical Rescue Rate of Acute Diffuse Peritonitis
detail

According to NCD analysis, the 90-day postoperative mortality rate for acute diffuse peritonitis in 2019 was 11.4%, with no significant improvement over the past decade. It is true that host factors, facility environmental factors, and treatment factors have complex influences, and improving the life-saving rate is not a simple matter. However, recent advances in intensive surgical care, sepsis treatment, damage control strategies, open abdominal management, in-hospital collaboration, and consolidation of facilities have been reported to improve outcomes. In this session, we would like to discuss the treatment strategies to improve the survival rate of acute diffuse peritonitis by sharing the experiences of treatment for colorectal perforation at each institution.

25.New Treatment Strategies for Mesenteric Artery Occlusive Diseases
detail

In mesenteric artery occlusion, thrombectomy or bowel resection is selected based on contrast-enhanced computed tomography findings of blood flow and intestinal necrosis. Recently, IVR thrombus aspiration, intraoperative blood flow evaluation by ICG fluorescence, and two-stage surgery have been introduced to avoid massive resection of the intestine, but the response has not been consistent from institution to institution or case to case. In this session, we woud like to discuss treatment strategies to avoid massive resection of the intestinal tract and to improve postoperative quality of life (QOL) and prognosis.

26.Current Status and Prospects of Surgical Treatment for Inflammatory Bowel Disease
detail

Inflammatory bowel disease treatment strategies have changed significantly with the advent of new biologics and new endoscopic diagnostic and therapeutic modalities, but there are still many unknowns regarding optimal management with a view to long-term prognosis. In addition, there are still some conditions that are beyond the scope of these advances, such as untreated or undiagnosed emergency surgery and refractory cases with multiple co-morbidities. In this session, we woud like to discuss the indications and optimal methods of surgical intervention in the new treatment system for inflammatory bowel disease, based on the results of each institution.

27.Reevaluation of treatment outcomes of distal cholangiocarcinoma based on the 7th edition of the General Rules for Clinical and Pathological Studies on Cancer of the Biliary Tract.
detail

In the 7th edition of the Japanese Biliary Cancer Code, the definition of T-factor for distal cholangiocarcinoma has been substantially changed, and the evaluation by depth and thickness of cancer invasion has been incorporated. However, the results of treatment based on the new definition and comparison with the old definition are not clear enough. In this session, we would like to share the results of treatment before and after the revision of the new protocol at each institution, and discuss the validity of the 7th edition of the General Rules for the treatment of distal cholangiocarcinoma.

28.New Strategies to Improve Safety and Long-Term Prognosis of Simultaneous Hepato-Pancreatic Resection
detail

Hepatopancreatic resection (HPD) is selectively adopted to pursue R0 resection of advanced biliary tract cancer. However, postoperative complication rates and perioperative mortality rates are still high, and long-term outcomes are not fully clear. In this session, we would like to discuss how to maximize the effectiveness of HPD by sharing the surgical techniques, perioperative management, and short-term and long-term postoperative outcomes at each institution.

29.Improved Treatment Strategies for Acute Cholecystitis
detail

Although early cholecystectomy is recommended for acute cholecystitis, percutaneous transhepatic gallbladder drainage (PTGBD) may be the treatment of choice depending on the patient's general condition and the facility. There is still disagreement regarding the timing of cholecystectomy after PTGBD, and there are many issues such as the risk of iatrogenic biliary injury due to the difficulty of the procedure. In this session, we would like to share the current status and results of acute cholecystitis treatment at each institution, and discuss how surgical treatment strategies for acute cholecystitis can be improved.

30.Optimal Strategy of Preoperative Chemotherapy for Resectable Pancreatic Cancer
detail

Various guidelines for the treatment of pancreatic cancer suggest preoperative chemotherapy for resectable pancreatic cancer. However, preoperative chemotherapy may cause a decrease in PS and disease progression during the preoperative period, which may result in a missed opportunity for radical resection. In addition, there is insufficient evidence for a prognostic benefit of chemotherapy. In this session, we would like to share the long-term results of patients with resectable pancreatic cancer treated with preoperative chemotherapy and discuss strategies to maximize the prognostic value of preoperative chemotherapy.

31.Perioperative and Outpatient Management to Improve Long-Term Outcomes after Pancreatectomy
detail

While perioperative management methods for pancreatectomy have improved, long-term complications such as malnutrition, deterioration of quality of life, and poor glycemic control caused by pancreatic insufficiency associated with pancreatectomy have not yet been resolved. We would like to share the perioperative and outpatient management of pancreatectomy at each institution and discuss appropriate intervention to avoid long-term complications and to maintain and improve quality of life.

32.Aiming to Reduce Pancreatic Fistula after Pancreaticoduodenectomy
detail

Various measures have been taken to avoid pancreatic fistula after pancreatoduodenectomy, including improvement of anastomosis, drain management, and appropriate antimicrobial therapy. However, pancreatic fistula continues to occur with a certain frequency, and there is still no clear consensus on the ideal surgical technique and management. In this session, we would like to discuss the safest surgical technique and perioperative management of pancreaticoduodenectomy to overcome pancreatic fistula.

33.Current Status and Future Prospects of Robotic-Assisted Liver Resection
detail

Robotic-assisted liver resection is now covered by insurance and is being introduced mainly at advanced facilities. Although it is expected to overcome the problems of laparoscopic hepatectomy and expand the indications for minimally invasive liver resection, its superiority over laparoscopic surgery is not fully clear at present. In this session, we would like to share the actual situation of robot-assisted hepatectomy at each institution, and discuss the challenges and future prospects for the widespread use of this procedure and the expansion of its application to more difficult procedures.
Requested Title
  1. Issues in the Treatment of Post-transplant Gastrointestinal and HBP Cancers
  2. Gastroenterological Surgery Learning from Acute Care Surgery
  3. Palliative Medicine in the Treatment of Recurrent Gastrointestinal Cancer
  4. Operational Issues in Robotic Surgery
  5. Off the Job Training for Surgical Techniques
  6. Perioperative Management Issues in Dialysis Patients
  7. Treatment Strategies for Elderly (80+) Esophageal Cancer Patients
  8. Efforts to Improve Techniques for Laparoscopic Gastrectomy
  9. Treatment Strategies after Resection for CY1 Gastric Cancer
  10. Passing on The Skills of Open Gastric Cancer Surgery to the Next Generation
  11. Evidence for Laparoscopic Surgery for Advanced Gastric Cancer
  12. Current Findings and Treatment Strategies for Colitic Cancer
  13. Treatment Strategies for Complicated Acute Appendicitis
  14. Treatment Strategies for Non-Obstructive Mesenteric Ischemia (NOMI)
  15. Optimal Recovery Method for Iatrogenic Biliary Injury/Stenosis
  16. New Treatment Strategies for IPMN
  17. Indications and Limitations of Pancreaticoduodenectomy for Elderly Pancreatic Cancer Patients
  18. Prevention of Posthepatectomy Bile Leakage
  19. Surgical Indications and Outcomes of Pancreatic Neuroendocrine Tumors
Requested Title Video
  1. Tips for Laparoscopic Inguinal Hernia Surgery
  2. Surgical Tips for Inguinal Hernia after Lower Abdominal Surgery or Recurrent Cases
  3. Minimally Invasive Surgery for Acute Abdomen and Trauma
  4. Technical Tips for Mid-Lower Mediastinal Lymph Node Dissection in Esophageal and Esophagogastric Junction Cancer Surgery
  5. Surgical Treatment for Hiatal Hernia and Reflux Esophagitis
  6. Tips for Reconstruction after Esophagectomy to Avoid Postoperative Complications
  7. Surgical Treatment for Gastric Submucosal Tumors
  8. Tips on How to Build and Close Stomas
  9. Tips for Decreasing Anastomotic failure after Rectal Resection
  10. Tips for Laparoscopic and Robot-Assisted Colorectal Surgery after Preoperative Chemo- and Chemoradiotherapy
  11. Tips for Laparoscopic and Robot-Assisted Colorectal Surgery for Difficult Cases (Obesity, Splenic Flexure, Multiple Cancers, etc.)
  12. Surgical Technique for LaparoscopicTotal Colorectal Resection and Ileal Pouch-Anal Anastomosis
  13. Extended Hepatobiliary Surgery with Vascular Resection and Reconstruction
  14. Laparoscopic and Robot-Assisted Surgery for Biliary Tract Cancer
  15. Minimally Invasive Surgery for Biliary Dilatation
  16. Dos and Don'ts to Avoid Complications in Laparoscopic Cholecystectomy
  17. Indication and Surgical Technique of Laparoscopic Distal Pancreatectomy for Pancreatic Cancer
  18. Tips for Standardization of Laparoscopic Pancreaticoduodenectomy
  19. Troubleshooting for Laparoscopic Hepatectomy
  20. Indications and Tips for Laparoscopic Repeat Hepatectomy
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