title: Advances in esophageal cancer surgery in Japan: an analysis of 1000 consecutive patients treated at a single institute.
abstract: BACKGROUND
  In Japan, most esophageal cancers are squamous cell carcinomas, and the results of esophagectomy have improved remarkably in recent years. The object of this study was to evaluate advances in operative therapy for esophageal cancer in Japan.
  
  
  METHODS
  We evaluated mortality, morbidity, and prognosis in 1000 consecutive patients who underwent esophagectomy for esophageal cancer at a single institution in Japan. The patients were divided into 3 groups according to the period when esophagectomy was performed: Group I (n = 197), 1964-1980; group II (n = 432), 1981-1993; and group III (n = 371), 1993-2006.
  
  
  RESULTS
  The incidence of squamous cell carcinoma was 94%. The morbidity rates were 62%, 38%, and 33 %, in groups I, II, and III, respectively (P < 0.01, groups I vs II and III), and the in-hospital mortality rates were 14.2%, 5.1%, and 2.4%, respectively (P < 0.01, between each group). The 5-year overall survival rate was 30% (14%, 27%, and 46% in groups I, II, and III, respectively; P < 0.0001). Multivariate analysis revealed age, gender, depth of invasion, node metastasis, distant metastasis, curability, extent of lymphadenectomy, resectability, and the period when the operation was performed as independent prognostic factors.
  
  
  CONCLUSIONS
  Generally, esophagectomy has been performed safely without critical complications; however, the prognosis has improved remarkably with advances in surgical techniques and treatment modalities.
authors: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors: Masaru
authors: M
authors: Morita
authors: Rintaro
authors: R
authors: Yoshida
authors: Keisuke
authors: K
authors: Ikeda
authors: Akinori
authors: A
authors: Egashira
authors: Eiji
authors: E
authors: Oki
authors: Noriaki
authors: N
authors: Sadanaga
authors: Yoshihiro
authors: Y
authors: Kakeji
authors: Takeharu
authors: T
authors: Yamanaka
authors: Yoshihiko
authors: Y
authors: Maehara
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016019:Survival Analysis