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Department of Esophageal Surgery

Hiroyuki Daiko, Takeo Fujita

Introduction

The Esophageal Surgery Division deals with neoplasms arising from the esophagus. The surgical management of esophageal cancer has been the main clinical as well as research activity of this Division. In particular, the Division is striving to establish minimally invasive surgery that consists of neoadjuvant treatment followed by minimally invasive esophagectomy. The Division is conducting a study to define the role of surgery in the multimodal approach to the treatment of esophageal cancer, and is aiming for thoracolaparoscopic esophagectomy, which consists of thoracoscopic esophagectomy and laparoscopic reconstruction, to become a standard surgical procedure.

Routine activities

The Esophageal Surgery Division consists of two staff surgeons and four residents. An Esophageal Conference is held every Tuesday evening to discuss the diagnosis, staging, and treatment strategy for each patient and is attended by surgeons, medical oncologists, endoscopists, radiologists, radiation oncologists, and head and neck surgeons. Approximately four patients are operated upon every week. In 2014, 153 patients underwent esophagectomies. Transthoracic esophagectomies with extended lymph node dissection were performed on 39 non-treated cases. Thoracoscopic esophagectomies in the prone position with radical lymph node dissection were undertaken in 114 cases. A two-stage surgical procedure divided into resection and reconstruction for patients more than 80 years old or patients with multiple complications was undertaken in 12 cases. Postoperatively, within 30 days, 1 patient died due to complications after a salvage operation.

Clinical trials

Currently, the Division is examining the role of thoracolaparoscopic esophagectomy as a minimally invasive esophagectomy that consists of thoracoscopic esophagectomy and laparoscopic reconstruction. For patients without radical chemoradiotherapy, thoracoscopic esophagectomy in the prone position with radical lymph node dissection and laparoscopic reconstruction after esophagectomy for patients without a history of laparotomy are being attempted to become a standard surgical procedure for esophageal cancer.

For treating patients aged over 80 years or at high risk, a two-stage surgical procedure divided into resection and reconstruction is being attempted.

A randomized controlled phase III study comparing Cisplatin and 5-fluorouracil versus Cisplatin and 5-fluorouracil plus Docetaxel versus Cisplatin and 5-fluorouracil concurrent radiation as a neoadjuvant treatment for locally advanced esophageal cancer is ongoing.

A randomized controlled phase III study of minimally invasive versus open esophagectomy for thoracic esophageal cancer (JCOG1409, MONET trial) is ongoing.

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.

Table 1. Type of procedure

List of papers published in 2015

Journal

  1. Fujita T, Daiko H. Optimal duration of prophylactic antimicrobial administration and risk of postoperative infectious events in thoracic esophagectomy with three-field lymph node dissection: short-course versus prolonged antimicrobial administration. Esophagus, 12:38-43, 2015
  2. Daiko H, Fujita T. Laparoscopic assisted versus open gastric pull-up following thoracoscopic esophagectomy: A cohort study. Int J Surg, 19:61-66, 2015
  3. Nozaki I, Kato K, Igaki H, Ito Y, Daiko H, Yano M, Udagawa H, Mizusawa J, Katayama H, Nakamura K, Kitagawa Y. Evaluation of safety profile of thoracoscopic esophagectomy for T1bN0M0 cancer using data from JCOG0502: a prospective multicenter study. Surg Endosc, 29:3519-3526, 2015