Annual Report 2022
Department of Esophageal Surgery
Takeo Fujita M.D./Ph.D./F.A.C.S,Naoto Fujiwara M.D./Ph.D.,Kazuma Sato M.D./Ph.D.
Introduction
The Department of Esophageal Surgery deals with neoplasms arising from the esophagus. The surgical management of esophageal cancer has been the primary clinical and 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 thoraco-laparoscopic esophagectomy, which consists of thoracoscopic esophagectomy and laparoscopic reconstruction, to make it a standard surgical procedure.
The Team and What We Do
Our team performed 168 thoracic esophagectomies in 2022. Additionally, we conducted 17 cervical esophageal cancer procedures (5 cases of total phayngolaryngoesophagectomies and 12 cases of larynx-preserving esophagectomies). We also focused on the postoperative care. In recent years, we have also actively introduced robot-assisted esophageal surgery to make it even less invasive, and in FY2022, we performed nearly 60 procedures with robot-assisted surgery. Patient support multidisciplinary classroom lessons have been held continuously for some years. Furthermore, regarding the academic activities, we attended and delivered speech at 11 domestic academic conferences and 3 international academic conferences in 2022.
Table 1. Type of Procedures for Thoracic Esophageal Cancer
Table 2. Type of Procedures for Cervical Esophageal Cancer
Research Activities
To achieve the best practice for patients, we are investigating several aspects of tissue perfusion imaging study. First, we used the O2 saturation imaging to explore the best gastric conduit and the most suitable anastomotic site during surgery. Second, we used AI deep learning technology to focus on AI-guided real time surgery particularly for the anatomical recognition of recurrent laryngeal nerves to avoid unexpected injury and subsequent recurrent nerve palsy, which greatly impair the patient’s quality of life after surgery. Third, conferring with the preoperative patients and their families, we are conducting a case control, investigating whether or not an active preoperative rehabilitation program with a nutrition program would improve the postoperative patients’ status, particularly skeletal mass index (which is vital to avoid sarcopenia), and reduce the postoperative fatigue. Several other research activities are planned at this point. We are also currently submitting a paper on intraoperative AI analysis of the recurrent nerve.
Clinical Trials
Currently, our department 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 performed to determine their role as standard surgical procedures 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 conducted.
A randomized controlled phase III study comparing cisplatin and 5-fluorouracil versus cisplatin and 5-fluorouracil plus docetaxel versus cisplatin and 5-fluorouracil with 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.
Furthermore, a randomized controlled phase III study comparing induction treatment with cisplatin and 5-fluorouracil plus docetaxel and subsequent conversion surgery versus cisplatin and 5-fluorouracil with concurrent radiation as a definitive treatment for locally advanced (cT4b or borderline tumor) esophageal cancer is ongoing. A randomized controlled phase III study of minimally invasive versus open esophagectomy for thoracic esophageal cancer (JCOG1510, TRIANgLE trial) is ongoing. Since 2000, our department has started performing salvage surgery for patients with unsuccessful definitive chemoradiotherapy. 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.
Education
In academic training, we teach our residents not only about surgical practice but also several aspects of academic activities for PhD course students. One of our residents achieved a PhD degree in 2022. We are also teaching two PhD course students about research activities. Two staff members obtained esophageal surgery specialists. Additionally, one of our staff obtained certifications, and one as a specialist in gastrointestinal cancer surgery for treating of gastrointestinal cancer.
Future Prospects
We are exploring the best clinical practice for patients and their families. To achieve this mission, we will continue to explore the best surgical practice and future research activities conducted in cooperation with other domestic and international research institutes.
List of papers published in 2022
Journal
1. Hirano Y, Fujita T, Konishi T, Takemura R, Sato K, Kurita D, Ishiyama K, Fujiwara H, Oguma J, Itano O, Daiko H. Impact of pre-diabetes, well-controlled diabetes, and poorly controlled diabetes on anastomotic leakage after esophagectomy for esophageal cancer: a two-center retrospective cohort study of 1901 patients. Esophagus, 20:246-255, 2023
2. Sato K, Fujita T, Matsuzaki H, Takeshita N, Fujiwara H, Mitsunaga S, Kojima T, Mori K, Daiko H. Real-time detection of the recurrent laryngeal nerve in thoracoscopic esophagectomy using artificial intelligence. Surgical endoscopy, 36:5531-5539, 2022
3. Fujita T, Sato K, Ozaki A, Akutsu T, Fujiwara H, Kojima T, Daiko H. Propensity-Matched Analysis of the Short-Term Outcome of Robot-Assisted Minimally Invasive Esophagectomy Versus Conventional Thoracoscopic Esophagectomy in Thoracic Esophageal Cancer. World journal of surgery, 46:1926-1933, 2022
4. Ito R, Nakamura Y, Sunakawa H, Fujiwara H, Hojo H, Nakamura N, Fujita T, Yano T, Daiko H, Akimoto T, Yoshino T, Kojima T. Tumor response and survival outcomes of salvage concurrent chemoradiotherapy with three-dimensional conformal radiotherapy and 5-fluorouracil/platinum-based chemotherapy for postoperative locoregional recurrence of esophageal squamous cell carcinoma. Esophagus, 19:645-652, 2022
5. Adachi M, Aoyama N, Kojima M, Sakamoto N, Miyazaki S, Taki T, Watanabe R, Matsuura K, Kotani D, Kojima T, Fujita T, Tabuchi K, Ishii G, Sakashita S. The area of residual tumor predicts esophageal squamous cell carcinoma prognosis following neoadjuvant chemotherapy. Journal of cancer research and clinical oncology, 2022
6. Okunaka M, Kotani D, Demachi K, Fujiwara H, Sakashita S, Yoshino T, Fujita T, Kojima T. Significance of chemotherapy-free interval and tumor regression grade in patients with recurrent esophageal squamous cell carcinoma receiving chemotherapy with fluorouracil and platinum after esophagectomy following preoperative chemotherapy. Esophagus, 19:240-249, 2022
7. Sato D, Kadota T, Inaba A, Nishihara K, Takashima K, Nakajo K, Sawada K, Kotani D, Fujiwara H, Yoda Y, Kojima T, Fujita T, Fujii S, Yano T. Long-term clinical outcome after endoscopic resection of esophageal squamous cell carcinoma invading the muscularis mucosae without lymphovascular invasion. Gastrointestinal endoscopy, 95:634-641.e3, 2022
8. 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
9. 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, 36:7597-7606, 2022
10. Harada T, Tatematsu N, Ueno J, Koishihara Y, Konishi N, Hijikata N, Ishikawa A, Tsuji T, Fujiwara H, Fujita T. Prognostic Impact of Postoperative Loss of Skeletal Muscle Mass in Patients Aged 70 Years or Older with Esophageal Cancer. Annals of surgical oncology, 29:5638-5645, 2022
11. Harada T, Tsuji T, Fujita T. ASO Author Reflections: Significance of Postoperative Loss of Skeletal Muscle Mass in Older Patients with Esophageal Cancer. Annals of surgical oncology, 29:5646-5647, 2022
12. Sawada K, Kotani D, Yukami H, Mishima S, Fujiwara H, Kadota T, Nakajo K, Yoda Y, Nakamura M, Hojo H, Yano T, Fujita T, Kojima T. Definitive chemoradiotherapy has comparable survival outcomes to esophagectomy in patients with clinical T1N0M0 esophageal squamous cell carcinoma: real-world data. International journal of clinical oncology, 27:1279-1288, 2022
13. Harada T, Tsuji T, Fujita T. ASO Author Reflections: Significance of Loss of Skeletal Muscle Mass During Neoadjuvant Chemotherapy in Older Patients with Esophageal Cancer. Annals of surgical oncology, 29:8140-8141, 2022
14. Harada T, Tsuji T, Ueno J, Koishihara Y, Konishi N, Hijikata N, Ishikawa A, Kotani D, Kojima T, Fujiwara H, Fujita T. Prognostic Impact of the Loss of Skeletal Muscle Mass During Neoadjuvant Chemotherapy on Older Patients with Esophageal Cancer. Annals of surgical oncology, 29:8131-8139, 2022
15. Harada T, Tsuji T, Ueno J, Koishihara Y, Konishi N, Hijikata N, Ishikawa A, Kotani D, Kojima T, Fujiwara H, Fujita T. ASO Visual Abstract: Prognostic Impact of the Loss of Skeletal Muscle Mass during Neoadjuvant Chemotherapy on Older Patients with Esophageal Cancer. Annals of surgical oncology, 29:8142-8143, 2022
16. Sato K, Fujita T, Matsuzaki H, Takeshita N, Fujiwara H, Mitsunaga S, Kojima T, Mori K, Daiko H. Correction to: Real-time detection of the recurrent laryngeal nerve in thoracoscopic esophagectomy using artificial intelligence. Surgical endoscopy, 36:9483, 2022