title: Learning curve of video-assisted thoracoscopic esophagectomy and extensive lymphadenectomy for squamous cell cancer of the thoracic esophagus and results.
abstract: BACKGROUND
  The efficacy of thoracoscopic radical esophagectomy for cancer of the thoracic esophagus and the learning curve required have yet to be clearly established.
  
  
  METHODS
  Eighty treatment-naive patients with esophageal cancer without contiguous spread underwent esophageal mobilization and extensive mediastinal lymphadenectomy through a 5-cm minithoracotomy and four trocar ports. The outcomes in the first 34 patients (group 1) and the last 46 patients (group 2) were compared.
  
  
  RESULTS
  There were no differences in background or clinicopathologic factors between the two groups. The duration of the thoracoscopic procedure and blood loss were less (p <0.0001), the incidence of postoperative pulmonary infection was less (p = 0.0127), and the number of mediastinal nodes retrieved was greater (p = 0.0076) in group 2. Multivariate analysis demonstrated that surgical experience (number of cases performed) predicted the risk of pulmonary infection (p = 0.0331).
  
  
  CONCLUSIONS
  Video-assisted thoracoscopic radical esophagectomy can be performed with safety and efficacy comparable to those of open esophagectomy. Morbidity decreases with the surgeon's experience.
authors.affiliation: Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abenoku, Osaka 545-8586, Japan. m9940414@msic.med.osaka-cu.ac.jp
authors.forename: H
authors.initials: H
authors.lastname: Osugi
authors.forename: M
authors.initials: M
authors.lastname: Takemura
authors.forename: M
authors.initials: M
authors.lastname: Higashino
authors.forename: N
authors.initials: N
authors.lastname: Takada
authors.forename: S
authors.initials: S
authors.lastname: Lee
authors.forename: M
authors.initials: M
authors.lastname: Ueno
authors.forename: Y
authors.initials: Y
authors.lastname: Tanaka
authors.forename: K
authors.initials: K
authors.lastname: Fukuhara
authors.forename: Y
authors.initials: Y
authors.lastname: Hashimoto
authors.forename: Y
authors.initials: Y
authors.lastname: Fujiwara
authors.forename: H
authors.initials: H
authors.lastname: Kinoshita
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D016063:Blood Loss, Surgical; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects / Q000379:methods / Q000592:standards*; D005260:Female; D006801:Humans; D007858:Learning; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D008875:Middle Aged; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000592:standards*