Annual Report 2023

Department of Esophageal Surgery

Staff : Hiroyuki Daiko, Junya Oguma, Koshiro Ishiyama, Daisuke Kurita, Yasuyuki Seto

Resident : Kentaro Kubo, Daichi Utsunomiya, Shota Igaue, Ryoko Nozaki, Ryuta Kakuta

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 have been implemented 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 undergo surgery every week. In 2023, 160 patients underwent esophagectomies. Thoracoscopic and robotic esophagectomy with extended lymph node dissection were performed on 55 and 75 cases, respectively. Bilateral transcervical mediastinoscopic laparoscopic-assisted esophagectomy for patients over 80 years of age or patients with multiple complications was performed in 16 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 patients with radical chemoradiotherapy, robotic esophagectomy and robotic gastric reconstruction 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.

 Bilateral transcervical esophagectomy has been developed in our institution. We are evaluating the efficacy of the novel ultimate surgical approach of bilateral transcervical esophagectomy.

 The feasibility study of HINOTORI for esophageal carcinoma is ongoing.

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

List of papers published in 2023

Journal

1. Hirano Y, Konishi T, Kaneko H, Itoh H, Matsuda S, Kawakubo H, Uda K, Matsui H, Fushimi K, Daiko H, Itano O, Yasunaga H, Kitagawa Y. Early postoperative non-steroidal anti-inflammatory drugs and anastomotic leakage after oesophagectomy. Br J Surg. 2023;110: 260-266.

2. Kadono T, Yamamoto S, Hirose T, Ikeda G, Ohara A, Itoyama M, Yokoyama K, Honma Y, Hashimoto T, Sekine S, Ishiyama K, Oguma J, Daiko H, Kato K. Safety and short-term efficacy of preoperative FOLFOX therapy in patients with resectable esophageal squamous cell carcinoma who are ineligible for cisplatin. Esophagus2023; 20:109-115

3. Matsuzaki J,Kato K, Oono K, Tsuchiya N, Sudo K, Shimomura A, Tamura K, Shiino S, Kinoshita T, Daiko H, Wada T, Katai H, Ochiai H, KanemitsuY, Takamaru H, Abe S, Saito Y, Boku N, Kondo S, Ueno H, Okusaka T, Shimada K, Ohe Y, Asakura K, Yoshida Y, Watanabe SI, Asano N, Kawai A, Ohno M, Narita Y, Ishikawa M, Kato T, Fujimoto H, Niida S, Sakamoto H, Takizawa S, Akiba T, Okanohara D, Shiraishi K, Kohno T, Takeshita F, Nakagama H, Ota N, Ochiya T; Project Team for Development and Diagnostic Technology for Detection of miRNA in Body Fluids. Prediction of tissue-of-origin of early stage cancers using serum miRNomes.  JNCI Cancer Spectr 2023; 7: pkac080.

4. Oguma J, Ishiyama K, Kurita D, Kanematsu K, Kubo K, Utsunomiya D, Yamamoto S, Honma Y, Kato K, Daiko H. Significance of lymphovascular invasion in esophageal squamous cell carcinoma undergoing neoadjuvant chemotherapy followed by esophagectomy. Esophagus 2023; 20:215-224.

5. Hirano Y, Fujita T, Konishi T, Takemura R, Sato K, Kurita D, Ishiyama K, Fujiwara H, Oguma J, ItanoO, 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. 2023; 20(2):246-255.

6. Hirano Y, Konishi T, Kaneko H, Itoh H, Matsuda S, Kawakubo H, Uda K, Matsui H, Fushimi K, Daiko H, Itano O, Yasunaga H, Kitagawa Y. Weight loss during neoadjuvant therapy and short-term outcomes after esophagectomy: a retrospective cohort study. Int J Surg 2023; 109:805-812.

7. Oguma J, Ishiyama K, Kurita D, Kanematsu K, Kubo K, Utsunomiya D, Abe S, Makiguchi M, Nonaka S, Suzuki H, Yoshinaga S, Oda I, Saito Y, Daiko H. Oncologic significance of lymphovascular invasion in patients with superficial esopageal squamous cell carcinoma reaching the muscularis mucosae or with slight invasion of the submucosa. Surgery 2023; 173:1162-1168.

8. Fujii Y, Daiko H, Kubo K, Kanematsu K, Utsunomiya D, Kurita D, Ishiyama K, Oguma J.Non-curative resection for surgical T4b esophageal cancer: esophagectomy or non-esophagectomy? Langenbecks Arch Surg 2023;408(1):201.

9. Hirano Y, Konishi T, Kaneko H, Itoh H, Matsuda S, Kawakubo H, Uda K, Matsui H, Fushimi K, Daiko H, Itano O, Yasunaga H, Kitagawa Y. Impact of prophylactic corticosteroid use on in-hospital mortality and respiratory failure after esophagectomy for esophageal cancer: Nationwide inpatient data study in Japan. Ann Surg 2023; 277: e1247-e1253.

10. Fukushima T, Watanabe N, Okita Y, Yokota S, Matsuoka A, Kojima K, Kurita D, Ishiyama K, Oguma J, Kawai A, Daiko H. The evaluation of the association between preoperative sarcopenia and postoperative pneumonia and factors for preoperative sarcopenia in patients undergoing thoracoscopic-laparoscopic esophageal cancer. Surg Today 2023; 53:782-790.

11. Kojima K, Fukushima T, Kurita D, Matsuoka A, Ishiyama K, Oguma J, Daiko H. Perioperative Decrease in Tongue Pressure is an Intervenable Predictor of Aspiration After Esopagectomy. Dysphagia 2023;38(4):1147-1155.

12. Hirano Y, Konishi T, Kaneko H, Itoh H, Matsuda S, Kawakubo H, Uda K, Matsui H, Fushimi K, Daiko H, Itano O, Yasunaga H, Kitagawa Y. Propotion of early extubation and short-term outcomes after esophagectomy: a retrospective cohort study. Int J Surg 2023;109(10):3097-3106.

13. Shigeno T, Kajiyama D, Sato K, Fujiwara N, Kinugasa Y, Yano T, Daiko H, Fujita T. The feasibility of post-photodynamic therapy salvage esophagectomy in patients with esophageal squamous cell carcinoma treated with definitive chemoradiotherapy. Esophagus 2023;20(4):643-650.

14. Leng X, Kurita D, Zhu Y, Abe S, Zhang R, Guo X, Dai L, Wong IY, Park SY, van der Wilk BJ, Gao X, Chen YC, Zhao R, Lv J, Qing H, Liu Y, Mitcgell KG, Wijnhoven BPL, Han Y, Daiko H. Collaborative multidisciplinary management and expertise of cT2-3 locally advanced operable esophageal squamous cell carcinoma: a report of two cases. J Thorac Dis. 2023;15(11):6362-6372.

15. Cho H, Abe S, Nonaka S, Suzuki H, Yoshinaga S, Okuma K, Yamamoto S, Daiko H, Kato K, Sekine S, Boke N, Saito Y. Lomg-term outcomes after non-curative endoscopic resection for esophageal squamous cell carcinoma followed by additional chemoradiotherapy. Dis Esophagus. 2024; [Online ahead of print.]

16. Fujita T, Shigeno T, Kajiyama D, Sato K, Fujiwara N, Daiko H. A novel device to assess the oxygen saturation and congestion status of the gastric conduit in thoracic esophagectomy. BMC Surg 2024;24(1):17.

17. Kato T, Tsukamoto S, Miyake M, Kudose Y, Takamizawa Y, Moritani K, Daiko H, Kanemitsu Y. Prognostic impact of extramural venous invasion detected by contrast-enhanced CT colonography in colon cancer. BJS Open 2024; 8(1):zrad 121.

18. Daiko H, Ishiyama K, Kurita D, Kubo K, Kubo Y, Utsunomiya D, Igaue S, Nozaki R, Akimoto E, Kakuta R, Horonushi S, Fujita T, Oguma J. Bilateral transcervical mediastinoscopic-assisted transhiatal laparoscopic esophagectomy compared with thoracolaparoscopic esophagectomy for esophageal cancer: a propensity score-matched analysis. Surg Endosc. 2024; 38:5746-5755.

19. Daiko H, Oguma J, Ishiyama K, Kurita D, Kubo K, Kubo Y, Utsunomiya D, Igaue S, Nozaki R, Leng X, Fujita T, Fujiwara H. Technical feasibility and oncological outcomes of robotic esophagectomy compared with conventional thoracoscopic esophagectomy for clinical T3 or T4 locally advanced esophageal cancer: a propensity-matched analysis. Surg Endosc. 2024; 38:3590-3601.