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Medical Care

Gastrointestinal surgery

Features of the Gastrointestinal surgery

We eat, absorb nutrients and excrete every day to maintain our lives. The gastrointestinal tract is an important organ responsible for these functions and consisting of the esophagus, stomach, intestine duodenum, small bowel, large bowel (colon, rectum) and anus. Our group is specialized in cases of malignant/benign tumors and inflammatory diseases (e.g., Crohn's disease, ulcerative colitis) that require surgical treatment. We also treat intra-abdominal tumors occurring in areas other than the gastrointestinal tract, hernias and functional disorders such as reflux esophagitis. We actively use laparoscopic surgery as a less invasive and highly accurate approach and commit ourselves to finding and providing the most suitable treatment for each patient by combining multidisciplinary approaches based on basic and clinical cancer research.

Laparoscopic surgery

Laparoscopic surgery is performed with general anesthesia, employing the same approach used for open abdominal surgery. To begin the procedure, a small incision is made in the patient's belly button to insert a thin tube (called a port) of approximately 1 cm in length through which carbon dioxide gas is introduced to inflate the abdominal cavity (a space between the abdominal wall and organs). A thin high-performance camera specially developed for this surgical approach (laparoscope) is then inserted. At the same time, a total of four or five incisions (5 – 10 mm) are made on both sides of the belly button for inserting surgical instruments and ports are placed through these incisions. An image from the camera of inside the abdomen is shown on a monitor display and the gastrointestinal tract and surrounding lymph nodes are excised.

This operation is performed while watching an enlarged image from a special high-performance camera, which gives a better view of small blood vessels and nerves than using the naked eye as the open abdominal surgery, enabling precise surgery to be performed. The extent of the excision of the gastrointestinal tract and lymph nodes depends on the degree of disease, as with open abdominal surgery.

Laparoscopic surgery is said to offer a faster recovery time for the gastrointestinal tract after an operation because it requires smaller cuts, causes less pain and has a lesser effect on other abdominal organs such as the intestinal tract. Patients are able to start eating again about 1 – 2 days after the operation and return to full activities soon due to the short hospital stay required. These are among the advantages of laparoscopic surgery. We also proactively consider the use of reduced port surgery, which uses two ports (one of them is through an incision in the belly button) instead of the conventional method of using four or five ports, to further reduce invasion.

Multidisciplinary treatment

Cancers (malignant tumors) begin when cells in the body mutate and become cancerous. Cancers remain in the place where they first formed for a while after occurrence; however, they then enter the bloodstream or lymph system and spread to remote locations in the body. Tumor cells are visible when they are colonized, but individual metastatic tumor cells are invisible.

Surgical treatment is an approach to remove cancer tissue. Typically, cancer tissue is removed along with some surrounding normal tissue to be sure that all the cancer is removed. This approach is the most direct method to treat cancer because the disease is cured if the whole cancer is removed. For example, early-stage stomach cancer without any metastasis is almost 100% curable. In advanced cancers, more lymph nodes are removed from an area that is slightly wider than the area encompassing the cancer nest (the primary tumor) and tissues where the cancer might have spread. In this way, surgery can cure the cancer if the cancer has remained where the primary tumor has been developed or has spread to just a few lymph nodes. However, cancer cells may enter the bloodstream or lymph system and spread to lymph nodes beyond the areas to be treated by surgery and to organs in remote sites, such as the liver, lungs, bones or brain. To treat such cases, a therapy using anticancer drugs is also provided before or after the surgery. Radiation therapy may also be used in combination with surgery. The comprehensive process of treatment that combines different treatment methods is called multidisciplinary treatment.

Major medical conditions and treatment methods

Stomach cancer

In the early stages of stomach cancer, there are often no symptoms. Some patients, however, may have symptoms that include an uncomfortable feeling in the epigastrium, stomach upset, indigestion, loss of appetite, nausea or vomiting. A detailed examination is conducted to decide how much stomach can be saved and how many lymph nodes should be removed depending on the location, size and the spread to surrounding tissues as well as metastasis to other organs.

Colorectal cancer

The symptoms of colorectal cancer vary according to where in the large bowel the cancer is located. In sigmoid cancer and rectal cancer, which are located close to the anus, symptoms are often seen in stools because they are sold. That includes blood in the stool, narrowing of the stool, a feeling of incomplete evacuation and abdominal pains. On the other hand, in cecal cancer and ascending colon cancer, which are located away from the anus, stools are in liquid form and therefore patients often are not aware of blood in their stools or constipation. They may notice the development of colorectal cancer from symptoms of anemia due to the slow loss of blood over a long period of time, as well as symptoms which appear as the cancer progresses, including intestinal obstruction (e.g., vomiting, abdominal pain, a feeling of abdominal fullness) and the feeling of a lump.

Inflammatory bowel disease

Inflammatory bowel disease (IBD) is a collective term for unexplained diseases that cause chronic inflammation or ulcers on the mucous membranes of the small and large bowels. The two major types of IBD are ulcerative colitis and Crohn's disease. Patients with these diseases may experience a recurrence of symptoms such as mucous and bloody stools, abdominal pain, diarrhea, fever, anemia, and weight loss. Surgery is necessary when medical therapies are not successful or when malignant diseases associated with IBD occur.

To Patients

Medical guidelines for stomach cancer, colorectal cancer and other diseases, which have been created based on statistics collected by specialized academic societies or research associations, have been made available in recent years. The development of a disease is evaluated by a detailed examination before surgery and the treatment is suggested based on the relevant guidelines. However, we may also suggest multidisciplinary treatment, including chemotherapy before and/or after surgery, depending on the stage of cancer progression. We will help patients find the best treatment in consideration of their physical strength, age, medical conditions and other related conditions. Please feel free to ask outpatient clinic doctors any questions you may have about your treatment.