Fraser Smith summarises his learning and experiences in the final part of his report as ESCP 2017 Japan Travelling Fellow.

After being immersed in ESD and magnification chromoendoscopy, and seeing how effective and efficient it can be in getting a proper diagnosis of rectal lesions, this I think will be a big focus in the future for me. Also, the fact that it does not seem to affect follow on surgery even when performed for low lesions is a big advantage over TEMS which is a more commonly used approach in these settings currently.

I also found it very interesting to see the Japanese approach to lymph nodes - D3 lymph node dissection for right colon cancer and lateral pelvic nodal dissection. These were techniques that I had little to no exposure to prior to my trip but I now understand how they are performed and may consider using them in the future. It was also a real and unexpected pleasure and learning experience to see how skilled all Japanese surgeons were as laparoscopic surgeons. In fact I did not see one open procedure when I was there!

I was also pleased that many Japanese surgeons showed an interest in my own work in organ preservation and watch and wait for rectal cancer and I believe that this may be the next big thing in Japan.

Lastly, it was fantastic to meet so many Japanese surgeons and share our experiences. Many of my hosts were my own age and so we had lots of things in common and so I am sure that all of the friendships that I made, although brief in this encounter, will hopefully be lasting friendships. I have already offered an open invite to all of my hosts to come to visit my unit in Liverpool and since my trip have already met Dr Konishi from the Tokyo Cancer Institute at another international meeting.

In all I agree 100% with the reports of the previous recipients of this fellowship. It far exceeds your expectations, provides a deep and unique learning experience, allows you to meet some of the most skilled and at the same time friendliest and hospitable surgeons on the planet and also allows you to be immersed in a very different and fascinating culture. Thank you so much to all concerned for selecting me as the JSCP fellow 2017, thank you to all of my hosts and especially Dr Akiyoshi who organised such a fantastic itinerary.

This has without a doubt been one of the best experiences of my life so far.

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