It was a great honour for me to be selected as the Japanese Society of Coloproctology (JSCP) travelling fellow for the ESCP meeting in 2016. I would like to express my gratitude to the ESCP for the privilege of being granted a three-week fellowship. All my meetings with great European surgeons during this fellowship were fascinating and important experiences for my surgical career.

Leiden University Medical Center, Leiden, the Netherlands

First, I visited Leiden University Hospital, which I wanted to visit because many important randomized controlled trials are conducted in the Netherlands and Leiden University plays an important role in these RCTs. Dr Peeters and Dr Hollmann kindly took care of me, allowing me to attend their rounds of postoperative patients, morning conferences, and impressive operations, including laparoscopic low anterior resection for rectal cancer and proctectomy and J-pouch reconstruction after total colectomy for ulcerative colitis. They further kindly invited me to dinner and I very much enjoyed discussing future directions in the treatment of rectal cancer surgery, including new preoperative therapeutic regimens, a watch and wait policy, and the significance of lateral lymph node dissection. I was fortunate to be able to discuss a future collaborative study between Leiden University Hospital and our hospital on lateral lymph node metastasis. Furthermore, I also met Professor Van de Velde, who kindly discussed the EURECCA and RAPIDO trials and research into cancer visualization technology with me.

Dr Peeters, Dr Hollmann and Takashi AkiyoshiProfessor Van de Velde and Takashi Akiyoshi

Karolinska University Hospital, Stockholm, Sweden

Next, I went to Karolinska University Hospital, which I wanted to visit because it is one of the most famous hospitals in Sweden, and the world, has also been conducting important RCTs in the field of colorectal cancer. On the first day, Professor Holm was absent, attending an international meeting in the U.K., so Dr Henrik kindly took care of me. I joined the morning conference and was extremely fortunate in being invited to scrub for hi surgical procedure on a patient with a very large and advanced rectal cancer invading the bladder, prostate, and left pelvic sidewall. Dr Henrik performed excellent total pelvic exenteration with en bloc resection of the left internal iliac artery and vein at their roots. His technique, especially when dividing the internal iliac vessels and dorsal vein complex using LigaSure Impact, provided me with some extremely helpful tips. There were no operations scheduled on the following day, so Professor Holm kindly discussed extralevator abdominoperineal excision, extended surgery for locally advanced colorectal cancer, and the Swedish colorectal cancer registry thoroughly with me. I enjoyed all these discussions and was very surprised to hear that 98.5% of Swedish patients with rectal cancer are registered along with detailed clinical data. That evening, Professor Holm and Professor Nilsson kindly invited me to a traditional Swedish restaurant together with Dr Suzuki, a consultant radiologist in Karolinska, and Professor Nilsson’s wife. The dinner and conversation with them was highly enjoyable and will remain in my memory forever.

Professor Holm and Takashi AkiyoshiProfessor Nilsson and Professor Holm with Takashi Akiyoshi

Hospital Clinic Barcelona, Barcelona, Spain

Next, I moved on to the Hospital Clinic in Barcelona because I hoped to watch Professor Lacy perform trans-anal total mesorectal excision. Professor Lacy kindly allowed me to join the trans-anal TME course and I was fortunate in being permitted to watch Professor Lacy perform ta-TME on two patients. I was very impressed with the advanced, high-tech operating room and the standardization of all procedures in ta-TME. He operated with abdominal and trans-anal teams comprising not only surgeons but also highly professional and specialised nurses. I also participated in training using cadavers and attended lectures about ta-TME by the specialized doctors in Barcelona University Hospital. All my experiences in the Hospital Clinic in Barcelona were very informative and provided a useful basis for me to start performing ta-TME in my hospital. I also watched some impressive operations, including laparoscopic gastric bypass surgery and laparoscopic sigmoidectomy.

Akiyoshi with staff at Hospital Clinic Barcelona

National Cancer Institute, Milan, Italy

The following week, I visited the Fondazione IRCCS Instituto Nazionale Tumori in Milan because I wanted to observe cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy for peritoneal surface malignancy, which is rarely performed in Japan. Dr Ermanno, the head of the Colorectal Cancer Department, kindly arranged for me to observe one of these procedures. There were no operations on the first day, but Dr Kusamura kindly took care of me and discussed management of peritoneal surface malignancy thoroughly with me. Because I have no experiences of CRS with HIPEC, his discourse was very informative and helpful for me. The Peritoneal Malignancy Program team consists of Dr Deraco, Dr Baratti and Dr Kusamura and they perform CRS plus HIPEC at least once a week. The following day, I was fortunate in being able to observe this procedure performed for pseudomyxoma peritonei. All three surgeons were very experienced and performed CRS in a sophisticated manner, completing the procedure very smoothly, even though many tumor nodules had disseminated throughout the abdomen. I thus learned that a highly professional team is very important for the success of CRS.

Akiyoshi with Peritoneal Malignancy Program team

11th ESCP meeting, Milan, Italy

Finally, I attended the 11th ESCP meeting in Milan. In the International Travelling Fellow Free Papers session, I presented a paper titled “Oncological Outcomes of Laparoscopic Total Mesorectal Excision with Extended Lateral Pelvic Lymph Node Dissection for Advanced Low Rectal Cancer after Preoperative Chemoradiotherapy”. It was a great honour for me to make a presentation in such a big auditorium. There were many interesting presentations, but the presentation about the watch and wait approach was especially interesting for me. I learned a lot which will prove useful in my daily clinical practice from this ESCP meeting.

Presentation at ESCP Milan 2016

Finally, I wish to express my deepest gratitude to all the European doctors I visited for their kindness and wonderful hospitality. I also thank Ms Nicola Boyle for her careful planning of my detailed itinerary in Europe. Finally, I thank both the ESCP and JSCP for this incredible opportunity, which will have great impact on my surgical career. I hope that strong friendship between the ESCP and JSCP will continue far into the future.

ESCP Affiliates