Since robot-assisted esophagectomy was covered by health insurance in Japan, it has been actively introduced mainly at high-volume centers and is gradually becoming more popular. On the other hand, in the 5th edition of the Esophageal Disease Guidelines published in 2022, robot-assisted esophagectomy for thoracic esophageal cancer was weakly recommended, but there is no clear evidence that it is useful, and future medical fees will be added. In aiming to achieve this goal, accumulating strong evidence is becoming an issue. In this session, we would like you to present the short-term and long-term results of robot-assisted esophagectomy and clarify the advantages and challenges of this surgical method.

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Clinical trials conducted mainly in Asia, including the JLSSG0901 trial, have shown that laparoscopic surgery for advanced gastric cancer has non-inferiority to open surgery in terms of long-term outcomes. However, the safety and usefulness of laparoscopic surgery for highly advanced gastric cancer, such as type 4, large type 3 gastric cancer, and cases of advanced lymph node metastasis, are unknown. Furthermore, with the recent advances in chemotherapy, the number of cases of laparoscopic surgery after neoadjuvant chemotherapy is increasing, but the evidence for this has not yet been established.
In this session, we would like you to present the indications for laparoscopic gastrectomy and short-term and long-term treatment results for patients with highly advanced gastric cancer at each institution, and discuss the issues involved.

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As a result of a multicenter prospective study conducted by the joint working group of the Japanese Gastric Cancer Association and the Japan Esophageal Society, data on the lymph node metastasis rate of esophagogastric junction cancer has been collected, and an algorithm for the optimal lymph node dissection range and approach has been presented in guidelines. On the other hand, future data accumulation is awaited regarding treatment strategies based on medium- to long-term results for esophagogastric junction cancer.
In this session, we would like to have report about medium- to long-term results regarding multidisciplinary treatment, lymph node dissection range, approach method, esophagus/gastric resection range, etc. for esophagogastric junction cancer, and present treatment strategies from each facility.

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In the treatment of inflammatory bowel disease (IBD), advanced drugs such as anti-inflammatory drugs, immunosuppressants, and biological agents are used, which are effective in improving symptoms and preventing recurrence, and the indications for surgery have also changed significantly. . On the other hand, the role of surgical treatment is becoming increasingly important in patients who do not respond to medical treatment or who have complications. Surgery is also used as an emergency treatment for inflammatory bowel disease, and is performed to resolve complications such as intestinal obstruction and bleeding.
In this session, we will examine the significance of surgical treatment for IBD, and we would like to invite you to propose and discuss a wide range of topics, including surgical indications, preoperative management, prevention of postoperative complications, management ideas, and efforts to prevent postoperative recurrence.

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Locally advanced rectal cancer is one of the most surgically difficult types of colorectal cancer, and a standard surgical approach has not yet been established. Particularly in recent years, transanal approach surgeries such as robotic surgery and TaTME have become more common, and the reality is that even minimally invasive surgery, the approach chosen differs depending on the facility. On the other hand, there are facilities that provide pre-treatment such as chemotherapy and radiation therapy, and facilities that precede surgery.
In this session, we would like to present minimally invasive surgery for locally advanced rectal cancer and its treatment results, and to introduce each institution’s efforts and treatment strategies to reduce local recurrence and distant metastasis, in each institution.

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Among colorectal cancer surgeries, surgery for transverse colon cancer has not yet been standardized, and the approach and surgical method currently differ depending on the case and facility. Transverse colon cancer surgery is highly difficult due to operations around the surgical trunk, dissection/CME according to lymph flow, preservation of nearby important organs, and complex membrane structure.
In this session, we would like to hear tips on safe approach methods, dissection methods, and anastomosis methods in surgery for transverse colon cancer, as well as tips on pitfalls and their countermeasures, at each facility.

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In the treatment of biliary tract cancer, curative resection is considered to be the only treatment that can be expected to result in long-term survival. On the other hand, it is difficult to diagnose the extent of biliary tract cancer before surgery, and setting the optimal cutting line for R0 resection is a point at issue. In recent years, the surgical resection rate has improved even for advanced cancers due to the induction of extended surgery that involves resection of blood vessels, but on the other hand, the range of indications for extended surgery is still unclear in many areas, and the postoperative results are still unsatisfactory.
In this session, we will understand the current state of surgical treatment for biliary tract cancer, and in addition to exploring the limits of surgical resection, we will consider multifaceted approaches such as pre- and post-operative chemotherapy, genomic medicine, immune checkpoint inhibitors, and liver transplantation. I would like you to discuss the future prospects you have included in this section.

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Based on the RCT (Prep-02/JSAP-05) study conducted in Japan, preoperative chemotherapy has been proposed for resectable pancreatic cancer. However, the effectiveness of this treatment in patients aged 80 years or older and patients with poor PS is not clear, and there is insufficient evidence for early stage 0 and stage I pancreatic cancer. In addition, there is room to reconsider preoperative chemotherapy for biological BR with high CA19-9 levels, which are considered to be a factor in poor prognosis.
In this session, we would like you to present the indications and approaches to preoperative chemotherapy and treatment results for resectable pancreatic cancer at each institution and discuss strategies to maximize the prognosis-improving effects of preoperative chemotherapy.

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Robot-assisted surgery in the field of gastrointestinal surgery became covered by Japan health insurance for gastric, rectal, and esophageal cancers in April 2018, and its indications are rapidly expanding to include hepatobiliary and pancreatic surgery. However, even within these, there are restrictions on disease stage and surgical method, as well as strict facility standards, and there is not enough evidence that this technology is more effective than existing technologies. The method has the same score as laparoscopic surgery, except for gastric cancer.
In this session, we will present the current status of robot-assisted surgery in the field of hepatobiliary and pancreatic surgery, as there are a limited number of facilities that can perform it due to facility standards and costs. I would like to have a discussion about the prospects for Robot-assisted surgery.

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