外科学の進化

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  • Evolution of Surgery
  • ゲカガク ノ シンカ

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During my 15-year career as a professor, we have tackled the clinical practice of surgery as well as surgical research under the themes of “clarifying the molecular mechanism and pathogenesis of disease and establishing novel diagnostic and therapeutic methods”. Surgery has evolved during this period. The first one is the spread of minimally invasive surgery. Previously, some extended surgeries were proven to be oncologically meaningless (sometimes disadvantageous) and too invasive for patients, but the following changes have occurred : open surgery to endoscopic surgery ; aortic replacement with a vascular prosthesis for aortic aneurysm to endovascular aneurysm repair ; total mastectomy for breast cancer to partial mastectomy, and so on. Second, we have demonstrated that individual cancers have specific molecular characteristics and an individual patient has a physically tolerable range of treatments. Thus, individualized treatment and precision medicine based on a molecular and pathological foundation have progressed. This includes research associated with the following : molecular subtyping of cancer, optimizing the choice of the surgical approach in liver transplantation, and the frailty of patients. The third one is development of therapeutic methods based on scientific evidence. We established the Kyushu Study group of Clinical Cancer (KSCC) and have continuously transmitted evidence concerning cancer therapy from Kyushu to the world. We have also developed some novel therapies such as angiogenic therapy based on basic research. Surgical science has been rapidly progressing, and we surgeons are obligated to provide the best medical care for patients in the context of this dizzying pace of change. We have to preserve the traditional approach, make efforts to connect the clinic and research to each other, and move forward for the further advancement of surgery.

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