The Esophageal Surgery Division deals with esophageal neoplasms, and their surgical management has been the main clinical and research activity of the Division. In particular, the Division is striving to further improve transthoracic esophagectomy with 3-field lymphadenectomy as a surgical procedure for esophageal cancer, the procedure having become more safe, reliable and radical. This is aimed at decreasing the high incidence of postoperative mortality and morbidity following such procedure. Moreover, the Division is conducting a study to define the role of surgery in the multimodal approach to the treatment of esophageal cancer.
The Division consists of 2 staff surgeons and 1 resident. An Esophageal Conference is held every Tuesday evening to discuss the diagnosis, staging, and treatment strategy for each patient. This conference is actively attended by surgeons, medical oncologists, endoscopists, radiologists, radiation oncologists, and head & neck surgeons. Approximately 2 patients are operated on every week. In 2008, 94 patients underwent esophagectomy. Transthoracic esophagectomy with extended lymph node dissection was performed on 59 nontreated patients or neoadjuvant chemotherapy before surgery, and modified transthoracic esophagectomy was performed as a salvage procedure in 14 patients in whom other therapeutic modalities had failed. Video-assisted thoracoscopic esophagectomy with radical lymph node dissection was performed in 10 patients for stage I esophageal cancer. No patients died due to complication postoperatively within 30 days. Recently, salvage esophagectomy has been demonstrated to be a safe and reliable surgical procedure for treating residual or recurrent tumors in patients where other therapeutic modalities have failed.
The prognosis of patients with intramural metastasis or with involvement of more than 4 lymph nodes is very poor compared with patients without these factors. Currently, the Division is examining the role of pre- or postoperative chemotherapy in patients with these factors. These patients are administered 2 cycles of 5-fluorouracil and cisplatin preoperatively and postoperatively.
Patients with stage II/III esophageal cancer are administered cisplatin and 5-fluorouracil preoperatively according to the outcome of the JCOG 9907 study.
For patients with stage I esophageal cancer, video-assisted thoracoscopic esophagectomy in the prone position with radical lymph node dissection is being attempted.
For treating patients aged over 80 years who are unable to receive definitive chemoradiotherapy or undergo surgery, transhiatal esophagectomy with upper and middle to lower mediastinal lymph node dissection up to as much extent as possible is being attempted.
Since 2000, the Division has started to perform salvage surgery for patients in whom definitive chemoradiotherapy has failed. The operative procedures and postoperative management have been refined gradually. The Division is also studying the role and efficacy of salvage surgery in the multimodal treatment of esophageal cancer.
JCOG trial 0502: This is a randomized controlled trial of esophagectomy versus chemoradiotherapy in patients with clinical stage I esophageal carcinoma.
● H. Daiko ●
| Table 1. Tumor type and number of patients | |
| Squamous cell carcinoma Adenocarcinoma Basaloid squamous carcinoma Endocrine cell carcinoma Carcinosarcoma Malignant melanoma | 82 6 2 2 1 1 |
| Total | 94 |
| Table 2. Procedures for esophageal cancer treatment | |
| RT. Thoracotomy with 3-field Transhiatal esophagectomy VATS esophagectomy Salvage esophagectomy | 59 11 10 14 |
| Total | 94 |
| VATS, video-assisted thoracoscopic surgery | |
| Table 3. Clinical Staging of Nontreated Cases | |
| Stage I IIA IIB III IV | 16 32 5 34 7 |
| Table 4. Postoperative morbidity and mortality | |
| No. of patients (%) | |
| Recurrent nerve paralysis Leakage Wound infection Pneumonia Chylothorax Others Death within 30 days postoperatively | 26 (28) 13 (14) 13 (14) 5 (5) 1 (1) 3 (3) 0 (0) |
Table of Contents