It was my privilege to have the opportunity to undertake the Japanese travelling fellowship for 2010. This allowed me to visit the National Cancer Centre (NCC) in Tokyo and attend the 65th Meeting of the Japan Society of Coloproctology (JSCP) in Hamamatsu.
I was given the freedom to suggest the units I would like to visit and, under the guidance of Professor Maeda, an itinerary was constructed which allowed me to spend a week at the NCC prior to the JSCP meeting.
My host at the NCC was Dr Takayuki Akasu, a consultant colorectal surgeon. Other than arranging my flight all other travel and accommodation requirements were arranged by Dr Akasu.
The majority of my stay was in a very pleasant hotel, a short taxi ride from the NCC. On my arrival on my first day Dr Akasu met me at my hotel, assisting with the initial check in and accompanied me to the NCC. Paperwork for my attendance had been sorted prior to my arrival and all the administration was completely with perfect efficiency. During my first day I had a tour of the NCC, including theatres, the wards and the endoscopy department. Here I was introduced to Dr Saito and had the opportunity to observe excision of a very large sessile adenoma by endoscopic submucosal dissection (ESD). Dr Saito took time to discuss the management of large adenomas, and early cancers and the relative indications for EMD or ESD that were used in his department and in Japan as whole.
Dr Akasu had carefully planned my itinerary for the rest of the week. Each day started with a ward meeting, at which, the residents briefly presented all current patients in English, and any appropriate results or imaging were displayed. All records were computerised and fully integrated with radiology and pathology, with ample computer terminals throughout all clinical areas to allow easy viewing.
I had the opportunity to see a variety of cases during my time at the NCC. These included a pelvic exenteration for recurrent rectal cancer, laparoscopic total mesocolic extended right hemicolectomy, SILS right hemicolectomy and laparoscopic sigmoid colectomy. Although there were a lot of similarities in the surgical techniques employed there were also differences in standard care. One noticeable feature of the Japanese patients was the average BMI of 21-22, a feature that was routinely discussed between our hosts and the visiting European surgeons. We had a range of discussions during the course of the operations including the role and selection of patients with rectal cancer for lateral pelvic lymph node dissection, with Dr Akasu describing the selection by MRI criteria, and saw the technique demonstrated during the case of pelvic exenteration. We also had discussions on the role of D3 total mesocolic dissection for all stage II or III colonic cancers. Dr Akasu then proceeded to perform a pristine demonstration of a laparoscopic total mesocolic excision transverse colon cancer, beautifully demonstrating clearance of lymphatic tissue from the superior mesenteric vein truck. This was also a topic of discussion at the JSCP annual meeting, including an invited lecture on the topic by Professor Quirke, exploring the improved 5-year survival in Japanese colorectal cancer patients compared to European outcomes.
Transfer to Hamamatsu for the annual JSCP meeting was a short train journey, with good views of the surrounding countryside, including views of Mount Fugi. This was a very well attended meeting, and Dr Akasu took time to introduce me to a range of surgeons from Japan and also from South Korea. The majority of the meeting was conducted in Japanese, but Dr Akasu kindly translated when required enabling me to partake in the whole meeting. There were a number of key-lectures that were given by a range of international speakers in English. My own presentation was on the role of TEM in circumferential rectal adenomas and chaired by Dr Saito, and discussions were had comparing TEM with ESD and EMR.
I am also very grateful to Dr Akasu for his time he gave me outside of the clinical setting. Dr Akasu took me on a tour of the beautiful city of Tokyo, including a very interesting visit to the Tokyo National Museum and Asakusa Temple. I was also able to sample a very wide range of Japanese cuisine and from my point, numerous novel dishes.
I am extremely thankful to the ESCP, and the JSCP for this opportunity and to both Dr Akasu and Professor Maeda for hosting me during my stay in Tokyo. My fellowship was of great interest and highlighted both similarities and differences in the treatment of colorectal patients and provided inspiration to bring back to my own clinical practice.
Matthew Tutton
