[Different strategies between Japan and other countries for the diagnosis and treatment of rectal cancer].

In the treatment of rectal cancer, various attempts have been made to reduce the local recurrence rate. In Japan, lateral node dissection (LND) has been widely performed as a standard procedure for lower rectal cancers. Studies since the 1980s have shown that LND reduces the local recurrence rate and improves the survival rate. However, significant sexual or urinary dysfunction has been reported due to impairment of autonomic nerves by LND. To overcome these problems, autonomic nerve-preserving LND has been introduced. At present, autonomic nerve-preserving LND is the standard procedure for the treatment of lower rectal cancers in Japan. On the other hand, radiotherapy combined with total mesorectal excision is the standard procedure in other countries. Survival data also differ between Japan and elsewhere. In Japanese series, the postoperative survival rate is higher than those in other countries. This may be due to differences in the method of lymph node examination, surgical technique, etc. However, this is a very important issue in determining the postoperative adjuvant chemotherapy. In Japan, these differences need to be taken into account in determining the postoperative adjuvant chemotherapy regimen.