title: Significance of thoracoscopy-assisted surgery with a minithoracotomy and hand-assisted laparoscopic surgery for esophageal cancer: the experience of a single surgeon.
abstract: BACKGROUND
  This retrospective study evaluated the surgical learning curve and outcomes of thoracolaparoscopic esophagectomy.
  
  
  METHODS
  The study group comprised a series of 92 patients with preoperatively diagnosed resectable thoracic esophageal cancer. Additionally, the surgical outcomes in 79 esophageal cancer patients receiving open esophagectomies were compared. All patients underwent thoracolaparoscopic esophagectomy in the lateral decubitus position. The short- and long-term outcomes were evaluated, and the surgical learning curve was assessed.
  
  
  RESULTS
  The total operation time was 477.8 ± 102.2 min, the thoracoscopic time was 157.9 ± 61.3 min, the total blood loss was 554.4 ± 280.5 ml, and the number of retrieved lymph nodes was 34.3 ± 14.3. Postoperative morbidity was observed in 23 patients. After the surgeon's first 40 cases, the surgical technique and short-term outcomes were stable. The 5-year disease-specific survival was 66.6% and the 5-year overall survival was 64.6% in patients receiving R0 thoracolaparoscopic esophagectomy. Comparison of 5-year disease-specific survival rate according to tumor-node-metastasis stage between patients receiving R0 thoracolaparoscopic esophagectomy and conventional open esophagectomy showed that there were no significant differences in survival in any stage between the two groups. Loco-regional recurrence was observed in 6 patients, distant recurrence in seven, and combined recurrence in nine after R0 thoracolaparoscopic esophagectomy. There was no significant difference in the pattern of recurrence between the two groups.
  
  
  CONCLUSIONS
  Thoracolaparoscopic esophagectomy for esophageal cancer was technically feasible and oncologically satisfactory, according to the surgical learning curve.
authors: Department of Surgery, Gastroenterological Center, Yokohama City University, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan. s0714@med.yokohama-cu.ac.jp
authors: Chikara
authors: C
authors: Kunisaki
authors: Takashi
authors: T
authors: Kosaka
authors: Hidetaka A
authors: HA
authors: Ono
authors: Takashi
authors: T
authors: Oshima
authors: Shoichi
authors: S
authors: Fujii
authors: Ryo
authors: R
authors: Takagawa
authors: Jun
authors: J
authors: Kimura
authors: Motohiko
authors: M
authors: Tokuhisa
authors: Yusuke
authors: Y
authors: Izumisawa
authors: Hirochika
authors: H
authors: Makino
authors: Hirotoshi
authors: H
authors: Akiyama
authors: Itaru
authors: I
authors: Endo
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000473:pathology* / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D058733:Hand-Assisted Laparoscopy / Q000379:methods; D006801:Humans; D053208:Kaplan-Meier Estimate; D059032:Learning Curve; D007902:Length of Stay / Q000706:statistics & numerical data; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D012189:Retrospective Studies; D013906:Thoracoscopy / Q000379:methods; D013908:Thoracotomy; D013997:Time Factors; D016896:Treatment Outcome