title: Evaluation of safety profile of thoracoscopic esophagectomy for T1bN0M0 cancer using data from JCOG0502: a prospective multicenter study.
abstract: BACKGROUND
  Thoracoscopic esophagectomy is rapidly and increasingly being used worldwide because it is a less invasive alternative to open esophagectomy. However, few prospective multicenter studies have evaluated its safety profile. This study aimed to evaluate the safety profile of thoracoscopic esophagectomy using perioperative data from the Japan Clinical Oncology Group Study (JCOG0502).
  
  
  METHODS
  JCOG0502 is a four-arm prospective study comparing esophagectomy with chemoradiotherapy for esophageal cancer, with randomized and patient preference arms. Patients with clinical stage T1bN0M0 esophageal cancer were enrolled until patient accrual was completed. Open or thoracoscopic esophagectomy was selected at the surgeon's discretion. Perioperative complications were defined as adverse events of ≥grade 2 as per Common Terminology Criteria for Adverse Events ver. 3.0.
  
  
  RESULTS
  A total of 379 patients were enrolled between December 2006 and February 2013. Of the 210 patients who underwent surgery, 109 patients underwent open esophagectomy, and 101 patients underwent thoracoscopic esophagectomy. Although thoracoscopic esophagectomy decreased the incidence of postoperative atelectasis (open: 22.0%, thoracoscopy: 10.9%; P = 0.041), reoperation was more frequent in the thoracoscopy group (open: 1.8%, thoracoscopy: 9.9%; P = 0.016). The incidence of overall complications did not differ between the two groups (open: 44.0%, thoracoscopy: 44.6%; P = 1.00). There was one in-hospital death in each group (open: 0.9%, thoracoscopy: 1.0 %; P = 1.00).
  
  
  CONCLUSIONS
  Thoracoscopic esophagectomy is a safe procedure with morbidity and mortality comparable with those of open esophagectomy. However, it is associated with a higher frequency of reoperation.
authors: Department of Surgery, Shikoku Cancer Center Hospital, 160 Minami-umemoto, Matsuyama, 791-0280, Japan. isnozaki@shikoku-cc.go.jp.
authors: Isao
authors: I
authors: Nozaki
authors: Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan.
authors: Ken
authors: K
authors: Kato
authors: Department of Esophageal Surgery, National Cancer Center Hospital, Tokyo, Japan.
authors: Hiroyasu
authors: H
authors: Igaki
authors: Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan.
authors: Yoshinori
authors: Y
authors: Ito
authors: Department of Esophageal Surgery, National Cancer Center Hospital East, Chiba, Japan.
authors: Hiroyuki
authors: H
authors: Daiko
authors: Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
authors: Masahiko
authors: M
authors: Yano
authors: Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan.
authors: Harushi
authors: H
authors: Udagawa
authors: JCOG Data Center/Operations Office, Center for Research Administration and Support, National Cancer Center, Tokyo, Japan.
authors: Junki
authors: J
authors: Mizusawa
authors: JCOG Data Center/Operations Office, Center for Research Administration and Support, National Cancer Center, Tokyo, Japan.
authors: Hiroshi
authors: H
authors: Katayama
authors: JCOG Data Center/Operations Office, Center for Research Administration and Support, National Cancer Center, Tokyo, Japan.
authors: Kenichi
authors: K
authors: Nakamura
authors: Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
authors: Yuko
authors: Y
authors: Kitagawa
mesh_terms: D000328:Adult; D000368:Aged; D004938:Esophageal Neoplasms / Q000401:mortality / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D001261:Pulmonary Atelectasis / Q000453:epidemiology; D012086:Reoperation / Q000706:statistics & numerical data; D012449:Safety; D016019:Survival Analysis; D013906:Thoracoscopy / Q000009:adverse effects / Q000379:methods*
keywords: Esophageal cancer; Esophagectomy; Laparoscopy; Minimally invasive surgery; Reoperation; Thoracoscopy