2019 年 65 巻 2 号 p. 194-202
In this review, we summarize the current status and provide future perspectives on surgery, perioperative treatment, and prognostic factors based on genetic and epigenetic alterations in colorectal cancer (CRC).
Surgery is still the mainstay of treatment for CRC for definitive management and potential cure at an early stage, and effective palliation in advanced cases. Local control and survival have significantly improved in surgical cases because the indication for surgery and perioperative treatment has changed. Based on the results of some randomized control trials, laparoscopic surgery is now considered to be a standard treatment option for advanced colon cancer. The most recent development is robotic surgery using the da Vinci ® surgical system, which consists of a patient-site cart, a surgeon console, and a vision system. This system provides 3 dimensions high definition (3D HD) vision of a clear and magnified operative view and converts the surgeon’s hand movements into smaller, more precise movements of tiny instruments inside the body. Thus, da Vinci ® technology allows surgeons to perform complex procedures through a few small wounds, similarly to conventional laparoscopic surgery.
Genetic effects such as mutations and chromosome instability involve changes in the DNA sequence of a gene, whereas epigenetics refers to potentially heritable changes that are linked to DNA methylation or histone methylation, but do not involve changes in the DNA sequence. Genetic and epigenetic changes are linked with each other and can lead to cancer development and progression. Many recent studies have examined the relationships of these changes to diagnosis, treatment and prevention of CRC.
