Ways and tradition of Japan in esophageal surgery for cancer
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ORIGINAL ARTICLE
Ways and tradition of Japan in esophageal surgery for cancer Hiromasa Fujita1,2 Received: 6 February 2020 / Accepted: 16 April 2020 © The Japanese Association for Thoracic Surgery 2020
Abstract Objective This report presents the essence in practice of Japanese methods and tradition in surgery for esophageal cancer. Methods The etiology of esophageal cancer and the concepts of lymphadenectomy in esophagectomy, in neoadjuvant treatments, and in stage classifications are compared between Western countries and Japan. Results With respect to the type and relative incidence of esophageal cancer, in Western countries, adenocarcinoma in the lower thoracic esophagus and in the cardia is common, and among esophageal surgeons, there remains some controversy over the extent of lymphadenectomy. On the other hand, in Japan, squamous cell carcinoma in the middle thoracic esophagus is common, and concerning lymphadenectomy, Japanese esophageal surgeons consider that three-field lymphadenectomy is superior to other types of lymphadenectomy. In Japan, surgeons believe that most patients with esophageal cancer even those having lymph node metastasis can be best treated using esophagectomy and lymphadenectomy. Conclusions In Japan, the tradition in esophageal surgery places great significance on lymphadenectomy. The ways and procedures for esophageal cancer surgery, the neoadjuvant and adjuvant treatments, the Japanese Classification of Esophageal Cancer, the Esophageal Cancer Practice Guidelines, and other scientific reports are all based on a close combination of esophagectomy with lymphadenectomy. Keywords Esophageal surgery · Lymphadenectomy · Squamous cell carcinoma · Tradition
History and establishing tradition in Japan Soon after Franz J. Torek in USA successfully resected a tumor in the thoracic esophagus in 1913 [1], Professor Hayari Miyake at Kyushu University, Japan, made initial attempts to achieve similar curative surgery for a cancer in the thoracic esophagus. Two of his first 16 patients with an esophageal cancer underwent esophagectomy, and both those died within 2 days after surgery. The other 14 patients underwent inspection thoracotomy only. These were all reported in 1925 to the 33rd Annual Congress of the Japan Surgical Society [2]. Much later in 1961, Professor Komei Nakayama at Chiba University tried a three-stage operation
This paper was presented at the 72nd Annual Scientific Meeting of the Japanese Association for Thoracic Surgery. * Hiromasa Fujita hfujita@shintakeo‑hp.or.jp 1
Department of Surgery, Shintakeo Hospital, Tomioka 12628, Takeo Town, Takeo, Saga 843‑0024, Japan
Kurume University, Fukuoka, Japan
2
involving gastrostomy, transthoracic esophagectomy, and esophagogastrostomy through a subcutaneous route, and succeeded in achieving the lowest worldwide operative mortality after esophagectomy for cancer [3]. Thus, Japanese esophageal surgery took half a century to catch up, and then reach the top level in the world. During the next half century, Japanese esophageal s
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