Fraser Smith furthers his learning about ESD during an anterior resection at a hospital in Osaka. Read Part 5 of Fraser's report.

On Wednesday morning I had some time to myself and so had a look around Osaka. I walked down to the castle which is a famous Japanese landmark. I then walked back up to the hospital where there was another anterior resection to do. This was a lesser affair than the previous day but was very interesting for me as the patient had previously had an ESD for what turned out to be a more advanced rectal cancer and so had elected to undergo radical surgery. This was a low lesion, but similar to the case that I had seen previously, again it was striking was that the mesorectal and low pelvic tissue planes were untouched after the ESD, unlike those of patients who have undergone a TEMS procedure or transanal excision. I think this was one of the main learning points of the trip and now I see ESD as a really important means to get tissue staging but not impair the ability to do low restorative surgery as salvage if required.

Image of a tumour that had lap pelvic exent after neoadjuvant therapy
Tumour that had lap pelvic exent after neoadjuvant therapy

That evening I was taken out for a lovely sushi meal by my hosts. There was even pufferfish on the menu which is something that only certified Japanese chefs can prepare because if done wrong it can be highly poisonous!! Again, this was also something that I had heard about as a small boy and was now experiencing first hand. I then went for a wander in the bustling streets of Osaka with Dr Uemura and one of his residents to take in the bright lights before heading back to the hotel.

Poster warning of the dangers of using a selfie stick
Warning the dangers of using a selfie stick!

On Thursday I had the morning to explore Osaka and went to a very interesting ceramics and pottery museum. What was amazing was that many of the ceramics looked contemporary yet were made over 1000 years ago!

After this I got the bullet train to Fukuoka and got ready for the Gala Dinner of the Japanese Society of Coloproctology. This was a fun experience. They had classical musicians who gave a pre-dinner performance followed by a lovely meal. It was interesting to chat to surgeons from Japan, Korea and Taiwan about rectal cancer and ESD who were experts in these areas and were sitting at my table. I even met Dr Tracy Hull who was one of my mentors during my fellowship in Cleveland Clinic. She too had been asked to give a lecture at the meeting. We had a nice catch up and she took a 'selfie' of us both to go on the Cleveland Clinic noticeboard!!

Read Part 6 here >


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