Thirty-four years as an esophageal surgeon: A recollection

Abstract

The esophagus is a simple organ located between the pharynx and the stomach but it sometimes causes many difficulties when it is involved by disease. Here is my frank impression as an esophageal surgeon with experience spannins more than thirty years. After graduation from Tokyo University, I worked at Takeda General Hospital in Aizuwakamatsu City and encountered a couple of cases of esophageal diseases, which led me to become an esophageal surgeon. I studied hepatofugal collaterals in portal hypertension at the second Department of Tokyo University Hospital. I analyzed intraoperative radiographies of the portal system and collaterals in the thorax and concluded that the paraesophageal veins communicating with the hypertensive portal system should be perfectly separated from the esophageal wall to prevent the recurrence of esophageal varices after an esophageal transection. Since 1977, I worked in Toranomon Hospital for 21 years under the supervision of a world famous esophageal surgeon, Prof. Akiyama. While there, I treated 1344 cases by esophageal resection for cancer. Cancer recurrence to the lymph nodes developed in the superior mediastinum or neck region at considerable rate after 2-field lymph node dissection. Analysis of the mode of postoperative cancer recurrences concluded that precise lymph node dissection should be performed in 3 fields to improve the 5-year survival rate. Consequently we adopted the 3-field lymph node dissection as a routine procedure for cancer of the thoracic esophagus. I moved to Juntendo University in 1998 and have since performed 925 esophagectomies. Some improvement of therapeutic modalities and surgical procedures provided a better 5-year survival rate of 55.2 %. My team performed more than one hundred esophageal cancer resections every year during the last four years and we were the highest volume center for esophageal cancer resection in Japan in 2005. I feel this level of excellence was achieved by well-harmonized cooperation with my colleagues. I would like to take this opportunity to express my sincere gratitude to them and to Juntendo University.