title: Re-evaluation of the role of thoracoscopic esophagectomy as a Japanese-style radical surgery.
abstract: OBJECTIVE
  To investigate the value of thoracoscopic surgery in radical esophagectomy with three-field lymphadenectomy.
  
  
  METHODS
  The subjects were 329 consecutive patients who, without preoperative chemoradiotherapy, underwent R0 radical esophagectomy with three-field lymphadenectomy for thoracic squamous cell esophageal cancers during 1998-2013. Open thoracotomy was applied in 212 (O), and thoracoscopic surgery in 117 (V). Survivals according to TNM Stages and Efficacy index (EI) were analyzed.
  
  
  RESULTS
  Hospital death rates of O/V were 1.9/0%. The survivals of V according to TNM Stages had significantly better prognosis in TNM6th cStage III and showed not worse prognosis in general. In the analysis using Cox proportional hazards model, "V or O" was a significant prognostic factor indicating better prognosis of V. More bilateral paratracheal lymph nodes along the recurrent laryngeal nerves tended to be classified as mediastinal instead of cervical in V. Efficacy index of mediastinal paratracheal nodes was higher in V than in O, while cervical lymphadenectomy maintained high EI.
  
  
  CONCLUSIONS
  Though our series have limitations of retrospective study and substantial bias, the feasibility and safety of thoracoscopic esophagectomy with three-field lymphadenectomy was shown. Higher paratracheal lymph nodes along the recurrent laryngeal nerves could be dissected from the mediastinal side in V group. Thoracoscopic esophagectomy, which is regarded as minimally invasive surgery in other countries, is being accepted in Japan mainly in the expectation of more thorough and meticulous lymphadenectomy. At the same time, the dissection range is continuously re-evaluated for safer surgery maintaining radicality.
authors.affiliation: Department of Gastroenterological Surgery, Toranomon Hospital, Okinaka Memorial Institute for Medical Research, 2-2-2, Toranomon, Minato-ku, Tokyo 105-8470 Japan.
authors.forename: Harushi
authors.identifier: 0000-0002-2376-202X
authors.initials: H
authors.lastname: Udagawa
authors.affiliation: Department of Gastroenterological Surgery, Toranomon Hospital, Okinaka Memorial Institute for Medical Research, 2-2-2, Toranomon, Minato-ku, Tokyo 105-8470 Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Ueno
authors.affiliation: Department of Gastroenterological Surgery, Toranomon Hospital, Minato-ku, Tokyo, Japan.
authors.forename: Shusuke
authors.initials: S
authors.lastname: Haruta
authors.affiliation: Department of Gastroenterological Surgery, Toranomon Hospital, Minato-ku, Tokyo, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Tanaka
authors.affiliation: Department of Gastroenterological Surgery, Toranomon Hospital, Minato-ku, Tokyo, Japan.
authors.forename: Aya
authors.initials: A
authors.lastname: Mizuno
authors.affiliation: Department of Gastroenterological Surgery, Toranomon Hospital, Minato-ku, Tokyo, Japan.
authors.forename: Yu
authors.initials: Y
authors.lastname: Ohkura
keywords: Esophageal cancer; Minimally invasive surgery; Squamous cell carcinoma; Thoracoscopic esophagectomy; Three-field lymphadenectomy; Video-assisted esophagectomy