Centers & Services

Gastroenterological surgery

Overview of the Department of Gastroenterological Surgery

The Department of Gastroenterological Surgery provides comprehensive surgical consultation and care in many specialties including esophageal surgery, gastric surgery, colon and rectal surgery, and so on. Your care will be provided in a clinic that unites several specialties to provide the best possible treatment plan under the motto “safe and reassuring surgery”. Our department prides itself on highly trained expert surgeons. Esophageal surgery is performed by Drs. Shirakawa, Noma, Tanabe and Ninomiya, Gastric surgery is performed by Prof. Fujiwara, Drs. Kagawa, Nishizaki, Kuroda and Kikuchi, and Colorectal surgery is performed by Drs. Tsukuda, Nagasaka, Kishimoto, Asano, Kondo and Mori. Every treatment option is decided in the department conference. Preoperative surveillance and preoperative treatment of patients with disease such as severe diabetes or cardiovascular disease are, if needed, performed in cooperation with other departments including the Department of Anesthesiology and Resuscitology.

Department of Gastroenterological Surgery Faculty Members

Toshiyoshi Fujiwara, Professor
[Gastric surgery, cancer gene therapy]

Staff

Yasuhiro Shirakawa Associate Professor, Vice-Director [Esophageal surgery]
Shunsuke Kagawa Associate Professor (Minimally Invasive Therapy Center) [Gastric surgery]
Kazunori Tsukuda Lecturer (Minimally Invasive Therapy Center) [Gastric and colorectal surgery]
Masahiko Nishizaki Lecturer, Outpatient Clinic Chief [Gastric surgery, Robotic Surgery]
Takeshi Nagasaka Lecturer [Colorectal surgery, Cancer genetic diagnosis, Familial tumor]
Horoyuki Kishimoto Assistant Professor (Minimally Invasive Therapy Center) [Colorectal surgery]
Hiroaki Asano Assistant Professor (Minimally Invasive Therapy Center), Ward Chief [Gastric and colorectal surgery]
Kazuhiro Noma Assistant Professor (Center for Graduate Medical Education) [Esophageal surgery]
Yasuhiro Mandai Assistant Professor (Center for the Development of Medical and Health Care Education) [Gastric and colorectal surgery]
Shunsuke Tanabe Assistant Professor, Chief of Nutrition Support Team [Esophageal surgery]
Shinji Kuroda Assistant Professor (Center for Innovatve Clinical Medicine) [Gastric surgery]
Yoshitaka Kondo Assistant Professor (Minimally Invasive Therapy Center) [Colorectal surgery]
Yoshiko Mori Assistant Professor (Clinical Genomic Medicine) [Colorectal surgery]
Takayuki Ninomiya Assistant Professor (Minimally Invasive Therapy Center) [Esophageal surgery]
Satoru Kikuchi Assistant Professor (Minimally Invasive Therapy Center) [Gastric surgery]

*Specialty shown in [ ]

Outpatient physician schedule

Monday Tuseday Wednesday Thursday Friday
Morning Toshiyoshi Fujiwara Yasuhiro Shirakawa Shunsuke Kagawa Yoshitaka Kondo Kazunori Tsukuda Masahiko Nishizaki Hiroaki Asano Toshiyoshi Fujiwara Yasuhiro Shirakawa Takeshi Nagasaka Kazunori Tsukuda Masahiko Nishizaki Kazuhiro Noma Toshiyoshi Fujiwara Yasuhiro Shirakawa Shunsuke Kagawa Takeshi Nagasaka
Afternoon Yasuhiro Shirakawa Shunsuke Tanabe Yoshitaka Kondo Kazunori Tsukuda Hiroaki Asano Toshiyoshi Fujiwara Yasuhiro Shirakawa Shunsuke Kagawa Takeshi Nagasaka
(familial tumor)
Shunsuke Tanabe

Features

Minimally invasive laparo- or thoracoscopic surgery is actively performed for functional conservation and early recovery after surgery. Endoscopic treatment and chemotherapy are available options, when indicated.

Esophageal surgery


We provide successful treatment for one of the largest esophageal cancer caseloads in Japan. We receive referrals from many institutions throughout western Japan. Esophageal cancer, from superficial cancer mainly treated by endoscopic resection to advanced cancer that requires multidisciplinary treatment, is within the scope of target diseases. In addition to malignant tumors, benign esophageal tumors as leiomyoma, and benign esophageal diseases as reflux esophagitis (GERD), achalasia, and esophageal diverticulum are also included in the scope of diseases that we treat. We also provide treatment for pharyngeal cancer, which is mainly within the scope of endoscopic therapy. Not limited to surgical treatment, we treat esophageal cancer comprehensively at the Department of General Esophagology from diagnostically or therapeutic endoscopy to multidisciplinary treatment for inoperable or recurrent cases as palliative cares. It is generally considered that treatment for esophageal cancer is highly invasive, but we strive for “less invasion” by introducing endoscopic surgery. Additionally, the number of surgery patients tends to increase year by year. We are proud to have treated the highest number of esophageal surgery cases in western Japan, with over 100 cases annually.
  • [Diagnosis]: Superficial cancer in the esophagus and pharynx, which has been difficult to identify previously, currently can be diagnosed using specific wavelength light endoscopy represented by Narrow Band Imaging (NBI). The treatment policy is also decided for advanced cases after proper preoperative diagnosis, using diagnostic imaging by multislice Dynamic CT and PET-CT.
  • [Endoscopic therapy]: Endoscopic Submucosal Dissection (ESD) is applied actively to superficial cancer not only of the esophagus but also of the pharynx.
  • [Surgery]: Based on standard resection and reconstruction, we employ innovation for individual procedures depending on patient conditions. Radical operation with a thoracoscope or a laparoscope is performed actively for esophageal cancer. It is applied in not fewer than two-thirds of surgery cases. Moreover, endoscope-assisted surgery has been introduced for most cases of benign esophageal tumor such as leiomyoma, and benign esophageal disease such as reflux esophagitis, achalasia, and esophageal diverticulum.
  • [Radiotherapy and chemotherapy]: Radiotherapy is performed in collaboration with Department of Radiology. We also provide both neo-adjuvant and adjuvant chemotherapy. Chemo-radiation therapy is also applied to patients depend on their conditions.
  • [Multidisciplinary therapy]: Therapy and treatment policies suitable for each patient are performed under a consensus obtained in joint conferences held regularly with other departments considering the various therapeutic methods described above.

Gastric surgery

We mainly provide treatment for gastric cancer such as surgery, chemotherapy, radiotherapy and their combination, depending on the individual clinical condition. After diagnosis of the stage of cancer progression through several examinations such as gastrointestinal endoscopy, gastrointestinal imaging and computed tomography (CT) in addition to pathological diagnosis, we provide appropriate treatment based on the gastric cancer treatment guideline. For gastric cancer with possible spread to the lymph nodes or possible invasion over submucosal layer, gastrectomy (distal gastrectomy, proximal gastrectomy or total gastrectomy) with lymph node dissection is required. The procedure and extent of resection is determined depending on the location and staging of cancer. While laparotomy is still a standard surgical technique, we actively apply laparoscopic surgery for early stage of gastric cancer, which is a less-invasive approach with small incisions in the body, allowing early hospital discharge and social rehabilitation. Moreover, we currently apply robotic surgery using da Vinci Surgical System to distal gastrectomy for early gastric cancer as a clinical study, and aim to extend the application to proximal gastrectomy. For early gastric cancer confined to the mucosa, we seek more minimally-invasive treatment method of endoscopic submucosal resection (ESD) in corporation with the department of gastroenterology. For unresectable or recurrent gastric cancer, we provide standard chemotherapy based on the evidence based medicine (EBM). We are also able to provide new treatment strategies as clinical trials. We also conduct surgical treatment for a rare malignant tumor called gastrointestinal stromal tumor (GIST) or benign ulcer of the stomach or the duodenum.

Colorectal surgery


Besides colorectal malignancy, we treat small intestinal tumors, inflammatory bowel diseases such as ulcerative colitis and Crohn’s disease, and rectal prolapse. For inflammatory bowel disease, we take the appropriate measures at the appropriate time in close collaboration with internal medicine doctors. Postoperative recurrence or advanced inoperable cases are also actively treated, aiming at resection using radiotherapy and/or chemotherapy. You are provided standard and the latest chemotherapy safely by our professional chemotherapists. We consider anal preserving surgery such as intersphincteric resection (ISR) for lower rectal cancer, when indicated. We also have outpatient clinic for counseling, diagnosis and treatment of hereditary colon cancer.

State-of the-art medical treatments and examinations

Treatments covered by health insurance

  • Endoscopic surgery for oropharyngeal and hypopharyngeal superficial cancer
  • Function-preserving surgery for early gastric cancer
  • Laparoscopic total colectomy for inflammatory bowel disease (highly advanced medical treatment)
  • Laparoscopic proctopexy (highly advanced medical treatment)

Clinical Trials

  • Development of novel chemo-radiotherapy for Stage III/IVa esophageal cancer
  • Development of perioperative nutritional control and new enteral nutrients for esophageal cancer patients width diabetes
  • A clinical study of a tumor-selective oncolytic adenovirus (Telomelysin) in combination with ionizing radiation for head and neck and thoracic malignant tumors
  • A phase III study of minimally invasive versus open esophagectomy for thoracic esophageal cancer (MONET Trial, JCOG1409)
  • Prospective multicenter study on efficacy of the mediastinal and para-aortic lymph node dissection for esophagogastric junction cancer
  • A multicenter, randomized, double-blind, placebo-controlled, phase 3 study of S-588410 as adjuvant therapy after curative resection in patients with esophageal cancer
  • Exploratory study to determine S-588410-induced tumor infiltrating lymphocytes and changes in the tumor microenvironment in esophageal cancer patients
  • Evaluation of the efficacy and safety profile of robotic gastric surgery with the da Vinci Surgical System
  • Development of a highly sensitive cancer cell detection system using fluorescence molecular imaging
  • Phase III clinical trial to evaluate the efficacy of neoadjuvant chemotherapy of S-1 plus oxaliplatin in locally advanced gastric cancer(JCOG1509)
  • Phase III clinical trial to evaluate the efficacy of anti-PD-1 antibody (Opdivo) with chemotherapy in HER2-negative advanced or recurrent gastric cancer

Special or personalized examinations

  • Non-invasive gastrointestinal cancer screening by detection of epigenetic gene modification in feces.

    We are developing an analyzing system for DNA methylation from exfoliated cancer cells in feces. The fecal DNA methylation assay provides non-invasive screening not only for colorectal but also for other gastrointestinal malignancy. Small amounts of feces as used in the fecal occult blood test are used for the assay. Further improvement of the system is ongoing so that other organ malignancy such as pancreatic cancer or lung cancer, that are difficult to detect by conventional way, could be screened also.

  • Genetic testing for hereditary non-polyposis colon cancer so called “Lynch syndrome”, and familial adenomatous polyposis (FAP). We perform analyse s of the responsible genetic alterations in Lynch syndrome and FAP at no charge.
  • Genetic testing for personalized chemotherapy. Gene mutation analysis is performed to detect microsatellite instability, KRAS and BRAF for colon cancer, and c-kit for GIST to provide best available treatment options. Please feel free to ask for these special tests. Applications are accepted at any time.