Department of Esophageal Surgery

Staff: Hiroyuki Daiko, Junya Oguma, Koshiro Ishiyama
Resident: Kyohei Kanematsu, Kentaro Kubo, Daichi Utsunomiya, Yuto Kubo, Shouta Igaue

Introduction

The Department of Esophageal Surgery deals with neoplasms arising from the esophagus. The surgical management of esophageal cancer has been the main clinical research activity of this department. In particular, our department is striving to establish minimally invasive surgery that consists of neoadjuvant treatment followed by minimally invasive esophagectomy. Our department 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. Moreover, robotic esophagectomy and gastric reconstruction has been introduced since 2018.

The Team and What We Do

The Department of Esophageal Surgery consists of three staff surgeons and five residents. An Esophageal Conference is held every Wednesday 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 & neck surgeons. Approximately four patients are operated upon every week. In 2021, 192 patients underwent esophagectomies. Thoracoscopic and robotic esophagectomy with extended lymph node dissection was performed on 96 and 56 cases, respectively. Bilateral transcervical mediastinoscopic laparoscopic assisted esophagectomy for patients above 80 or patients with multiple complications was undertaken in 18 cases. Postoperatively, within 30 days, no patients died after esophagectomy.

Research Activities

Currently, our department is examining the role of robotic surgery as a minimally invasive esophagectomy that consists of robotic esophagectomy and robotic reconstruction. Even for the patients with radical chemoradiotherapy, robotic esophagectomy and robotic gastric reconstruction is being attempted to make it 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.

Bilateral transcervical esophagectomy has been developed by our institution. We are assessing the efficacy of a novel ultimate surgical approach of bilateral transcervical esophagectomy.

A feasibility study of Nivolumab as neoadjuvant chemotherapy for locally esophageal carcinoma, FRONTiER (JCOG1804E), is ongoing.

Since 2000, our department has started to perform salvage surgery for patients in whom definitive chemoradiotherapy has failed. The operative procedures and postoperative management have been refined gradually. Our department is also studying the role and efficacy of salvage surgery in the multimodal treatment of esophageal cancer.

Table 1. Type of cancer

List of papers published

Journal

1. Nozaki I, Machida R, Kato K, Daiko H, Ito Y, Kojima T, Yano M, Ueno M, Nakagawa S, Kitagawa Y. Long-term survival of patients with T1bN0M0 esophageal cancer after thoracoscopic esophagectomy using data from JCOG0502: a prospective multicenter trial. Surgical endoscopy, 36:4275-4282, 2022

2. Oshima K, Kato K, Ito Y, Daiko H, Nozaki I, Nakagawa S, Shibuya Y, Kojima T, Toh Y, Okada M, Hironaka S, Akiyama Y, Komatsu Y, Maejima K, Nakagawa H, Onuki R, Nagai M, Kato M, Kanato K, Kuchiba A, Nakamura K, Kitagawa Y. Prognostic biomarker study in patients with clinical stage I esophageal squamous cell carcinoma: JCOG0502-A1. Cancer science, 113:1018-1027, 2022

3. Fujita T, Okada N, Sato T, Sato K, Fujiwara H, Kojima T, Daiko H. Propensity-matched analysis of the efficacy of olanexidine gluconate versus chlorhexidine-alcohol as an antiseptic agent in thoracic esophagectomy. BMC surgery, 22:20, 2022

4. Fujita T, Sato K, Ozaki A, Tomohiro A, Sato T, Hirano Y, Fujiwara H, Yoda Y, Kojima T, Yano T, Daiko H. A novel imaging technology to assess oxygen saturation of the gastric conduit in thoracic esophagectomy. Surgical endoscopy, 2022

5. Kanamori K, Kurita D, Hirano Y, Ishiyama K, Oguma J, Masutomi K, Daiko H. Does synchronous early head and neck cancer with esophageal cancer need treatment after preoperative chemotherapy? General thoracic and cardiovascular surgery, 70:280-284, 2022

6. Akutsu T, Fujita T, Kajiyama D, Ozaki A, Sato K, Fujiwara H, Kojima T, Daiko H. Operative outcomes and long-term survival of patients undergoing colon interposition after esophagectomy for cancer. Thoracic cancer, 13:844-852, 2022

7. Daiko H, Fujita T, Oguma J, Sato T, Sato A, Sato K, Hirano Y, Kurita D, Ishiyama K, Fujiwara H. Novel minimally invasive approach to lymph node dissection around the left renal vein in patients with esophagogastric junction cancer. Esophagus: official journal of the Japan Esophageal Society, 18:420-423, 2021

8. Daiko H, Oguma J, Fujiwara H, Ishiyama K, Kurita D, Sato K, Fujita T. Robotic esophagectomy with total mediastinal lymphadenectomy using four robotic arms alone in esophageal and esophagogastric cancer (RETML-4): a prospective feasibility study. Esophagus: official journal of the Japan Esophageal Society, 18:203-210, 2021

9. Ego M, Abe S, Nakatani Y, Nonaka S, Suzuki H, Yoshinaga S, Oda I, Kato K, Honma Y, Itami J, Daiko H, Saito Y, Boku N. Correction to: Long-term outcomes of patients with recurrent squamous cell carcinoma of the esophagus undergoing salvage endoscopic resection after definitive chemoradiotherapy. Surgical endoscopy, 35:1777, 2021

10. Kurokawa Y, Takeuchi H, Doki Y, Mine S, Terashima M, Yasuda T, Yoshida K, Daiko H, Sakuramoto S, Yoshikawa T, Kunisaki C, Seto Y, Tamura S, Shimokawa T, Sano T, Kitagawa Y. Mapping of Lymph Node Metastasis From Esophagogastric Junction Tumors: A Prospective Nationwide Multicenter Study. Annals of surgery, 274:120-127, 2021

11. Abe S, Oguma J, Nonaka S, Suzuki H, Yoshinaga S, Oda I, Saito Y, Daiko H. Novel hybrid endoscopy-assisted larynx-preserving esophagectomy for cervical esophageal cancer (with video). Japanese journal of clinical oncology, 51:1171-1175, 2021

12. Kubo K, Kanematsu K, Kurita D, Ishiyama K, Oguma J, Itami J, Daiko H. Feasibility of conversion thoracoscopic esophagectomy after induction therapy for locally advanced unresectable esophageal squamous cell carcinoma. Japanese journal of clinical oncology, 51:1225-1231, 2021

13. Ishiyama K, Fujita T, Fujiwara H, Kurita D, Oguma J, Katai H, Daiko H. Does staged surgical training for minimally invasive esophagectomy have an impact on short-term outcomes? Surgical endoscopy, 35:6251-6258, 2021

14. Kato K, Ito Y, Nozaki I, Daiko H, Kojima T, Yano M, Ueno M, Nakagawa S, Takagi M, Tsunoda S, Abe T, Nakamura T, Okada M, Toh Y, Shibuya Y, Yamamoto S, Katayama H, Nakamura K, Kitagawa Y. Parallel-Group Controlled Trial of Surgery Versus Chemoradiotherapy in Patients With Stage I Esophageal Squamous Cell Carcinoma. Gastroenterology, 161:1878-1886.e2, 2021

15. Ego M, Abe S, Nakatani Y, Nonaka S, Suzuki H, Yoshinaga S, Oda I, Kato K, Honma Y, Itami J, Daiko H, Saito Y, Boku N. Long-term outcomes of patients with recurrent squamous cell carcinoma of the esophagus undergoing salvage endoscopic resection after definitive chemoradiotherapy. Surgical endoscopy, 35:1766-1776, 2021

16. Daiko H, Oguma J, Fujiwara H, Ishiyama K, Kurita D, Sato T, Sato K, Faiz Z, Fujita T. Novel universally applicable technique for performing bilateral transcervical mediastinoscopic-assisted transhiatal laparoscopic esophagectomy: a truly minimally invasive procedure. Surgical endoscopy, 35:5186-5192, 2021