[Treatment strategy for cancer of the colorectum--difference with western approach]

In Japan, extensive radical surgery is used for advanced cancer, whereas in western countries the standard operative approach used in Japan 20-30 years ago is used, followed by rather aggressive adjuvant therapy-chemotherapy and irradiation therapy by medical oncologists. The results of the extensive radical operations performed in Japan, called the "Japanese operation," have drawn attention but hesitate to undertake for a big aggression; instead the TME proposed by Heald is gaining ground, although we don't appreciate it. In Japan, more and more cases are being discovered relatively early, and function preserve operations to preserve pelvic nerves, or EMR (endoscopic mucous resection) have been developed and are seeing progressively widespread application. Therapeutic results have been considered to have remained unchanged in the past 20-30 years in western nations, whereas they have much improved in Japan, mainly because of relatively earlier discovery in an increased number of cases and the progress in surgical techniques.