Audrius Dulskas reports on the experience he gained in colorectal cancer surgery during his fellowship in Korea. His trip included the International Colorectal Research Summit and visits to different tertiary referral centres in Seoul.

It is a privilege to be selected as the recipient of the 2018 ESCP Korean Travelling Fellow. I read with much interest the fantastic experience from the previous recipients Edgar Furnee and Samson Tou, of their fellowship in Seoul. As colorectal consultant for few years, my primary interest is minimally invasive colorectal cancer surgery. I wanted to see many D3 (or CME as it is called in Western countries) lymphonodectomies for colon cancer, TME with ultralow hand-sewn anastomosis or hemilevator excisions and robotic cases.

My fellowship was very well organised by the KSCP secretariat professor Ji Yeon Kim and ESCP secretariat Vanessa Wise. My fellowship started with a two-day conference (International Colorectal Research Summit 2018) over the weekend, followed by a four-day daily visits to different tertiary referral centres in Seoul.

At conference I was very impressed with the high-quality presentations and video surgeries by presenters from Korea, Japan, UK, France, Netherlands and of course Lithuania. The conference covered the whole spectrum of colorectal diseases.

Apart from the Korean speakers, there were invited speakers including Dion Morton, UK. He gave a talk on preoperative chemotherapy for locally advanced colon cancer. This was a mind-changing presentation. Professor from France talked about GRECCAR trials. There was a session on Korea-Japan joint symposium in which a group of Japan surgeons presented their experience in treatment and surveillance of genetically predisposed colorectal cancers. My presentation was in ESCP-KSCP session on the need of suturing the defect after transanal endoscopic microsurgery. We had great discussion with moderators and the audience.

During the Summit, I met Professor Nam Kyu Kim, a world renowned laparoscopic and robotic surgeon. He was my mentor during my 3 months fellowship at Yonsei Cancer Centre 2 years ago.

Visit to Samsung Medical Center

The following week I visited Samsung Medical Centre (Professor WY), Seoul National University Hospital (Professors KJ Park and SY Jeong), Severance Hospital (Professors NK Kim and BS Min), and the ASAN Medical Centre (Professor SH Kim). A vast number of patients with colorectal cancers are being treated in tertiary centres in Seoul. Most of them are treated in five largest centres – the “big five”. Consequently, the specialists are also centralised and these hospitals have a high volume of cases. For example, in Samsung Medical Centre, they see approximately 2,500 colorectal cancers per year.

Seoul National Asan Severance Medical Centers

During my week, I observed few robotic rectal surgeries. I was impressed with the teamwork from the anaesthetists, scrub nurses, assistants and the fellows. It does highlight the importance of the same team performing high volume surgeries regularly, making the whole process more efficient.

Seoul National University Hospital staff

Apart from the robotic cases, I have seen several complete mesocolic excision (CME) for right hemicolectomies, both open and laparoscopic. CME is the standard approach for right hemicolectomies in this part of the world and using 3D image allows accurate dissection. I also saw few very locally advanced rectal cancer open surgeries performed by prof Park at National Seoul University Hospital. Although the tumors were almost stuck to the pelvis, the procedure was performed with precision and with minimal blood loss.

This exchange program was a really inspiring experience for me and I am very grateful to the Education Committee of the ESCP who offered me this great opportunity as exchange fellow. I would also like to thank the Korean Society of Coloproctology as well as all the hosts of the visiting centres for their hospitality. My stay in Seoul was very well organised and it was an excellent and unforgettable experience.

Audrius Dulskas, MD, PhD
National Cancer Institute, Lithuania
2018 ESCP/KSCP Travelling Fellow

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