Evolution and Execution of Colorectal Cancer Treatment

16:00-16:20, Room 101 (101講堂)



Po-Li Wei


魏柏立 教授

Vice superintendent, Taipei Medical University Hospital



Jin-Tung Liang


梁金銅 教授

Director,  Division of Colorectal Surgery, National Taiwan University Hospital

Abstract - 

Evolution and Execution of Colorectal Cancer Treatment

Colorectal cancer is the third most common cancer in both men andwomen in the United States and is the second leading cause ofdeaths from cancer. It is also the most common diagnosed malignancy in Taiwan. Clinically, colorectal cancer can be surgically cured when confined to a primary sitewhich is around 82% in Taiwan.


The benefit of laparoscopic surgery for coloncancer has been demonstratedafter prospective randomized trials. its benefits and disadvantages in the real world setting should be further assessed with population-based studies. Through Taiwan National Health Insurance Research Database, our study demonstrated that laparoscopic surgery for colon cancer was associated with improved perioperative outcomes and the long-term survival was not compromised.With implementation of laparoscopic surgery, the number of CRC patients increased with improved post-operative outcomes in TMUH.


Rectal cancer is accounting for around 30% of the total colorectal cancer incidence. Two improvement of rectal cancer treatments include Pre-operative radiation and total mesorectal excision (TME). Patients with preoperative radiotherapy had a lower risk of local recurrence (8.2%vs2.4% or 10.9%vs5.6%, P<0.001), confirming the benefit of radiation (short course). Our study showed neoadjuvant nCRT could be valuable for lower 3rd rectal cancer patients. For TME, laparoscopyistechnically challenging to perform for middle to lower rectal cancer.Robotic platform may be a solution to overcome technical difficulty of laparoscopic approach. Evidence from meta-analysis demonstrated that the overall pooled conversion rate was significantly lower for patients who underwent robotic surgery. From our experience, robotic surgery for patients with advanced rectal cancer after nCRT is safe and feasible. Furthermore, robotic procedure was performed in patients with more clinically advanced diseases but the perioperative outcomes of robotic surgery was comparable to those with laparoscopic surgery.


For low rectal cancer, there are two conflicting aims: successful eradication of disease and preservation of normal anal sphincter function. Inter-sphincteric resection (ISR) was introduced by Schiessel et al since 1994 and has been increasingly performed as an ultimate surgicaltreatment for extremely low rectal cancer. Our data show that laparoscopic ISR for low rectal cancer is feasible and safe. Robotic platform was also used to perform ISR successfully. For better quality of life, robotic TAMIS was demonstrated to be a feasible and safe technique for the local excision of selected rectal cancers.