maeda kotaro

A rare case of metastasis to the vagina from rectal cancer is described. An 81-year-old woman was admitted to our hospital because of melena. She underwent a super-low anterior resection (inter sphincter resection) for rectal cancer. Pathological diagnosis revealed well-differentiated adenocarcinoma with T3, N0, M0 (final stage II). A small SMT was found at the anastomotic site by digital examination 2 years after the initial operation. It was removed trans-anally, and local recurrence from rectal cancer was confirmed pathologically. Upon further examination for vaginal bleeding, a tumor 3cm in diameter was confirmed in the left posterior wall of the vagina 26 months after the initial surgery. The tumor was removed trans-vaginally. The pathological diagnosis was metastasis of rectal cancer and cancer cells were found in the vessels around the tumor.

The number of surgeon is decreasing in Japan. However, the new female members of Japan surgical society is increasing, year by year, and 22% of new members in 2008 were female. Japanese women working rate by age shows M-shaped curve and many of them stop working in their 30s and 40s. This tendency is in the same state.To have the female doctors continue to work, the supporting committee for female surgeon in Japan Society of Surgery and Japan Association of Women Surgeons performed anquet about specialty of doctors, councillars and male-female perticipation together, and female doctor support for the branch society of Japan Medical Society from June to August in 2011.As results, many branch societies are trying to support female doctors. However, the rate of female in decision making societies, such as councillars, and committee members, is still low.Having female doctors to participate in all decision making society could accerarate the female participation into the society.

Surgery for rectal cancer is required dense surgical operation in a narrow pelvis. Using robotic system for rectal surgery may facilitate more accurate and safe operations. However, in Japan robotic surgery is an early stage and have many problems. All of medical staff with the correct knowledge for the features of robotic system and skills for rectal surgery must be performed. In the future, the robotic surgery will be recognized as the best operations.

直腸癌外科治療の対するこれまでの取り組みを概説した．自律神経温存手術の妥当性に関しては，拡大郭清標本を用いて自律神経周囲組織への微小癌を確認した．10％の直腸癌症例で微小癌が見られたが，転移が見られた症例の予後が不良であり全自律神経温存は根治性に影響ないと考えられた．直腸内には手術操作時に遊離癌細胞がほぼ全例で存在するが，直腸内洗浄により除去できる．結腸内にもこれらが見られるので術中操作に注意が必要である．直腸癌手術の体位は，大腿開脚水平位が視野の面から適切な体位であり，この体位を使用して低位の吻合ではIO-DSTによるdouble stapling techniqueは有用で，K式開肛器を使用して安全に施行できる．E式開肛器と種々の技術を併用したMITASによる局所切除はtotal biopsyの手技として低侵襲な手術であり，2012年より保険収載された．直腸癌手術では解剖を十分熟知して手術にあたる必要があり，若い外科医には臨床から出た発想で工夫されることを希望したい．