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