Langenbeck's Archives of Surgery

, Volume 403, Issue 8, pp 967–975 | Cite as

Thoracoscopic esophagectomy with total meso-esophageal excision reduces regional lymph node recurrence

  • Yuji AkiyamaEmail author
  • Takeshi Iwaya
  • Fumitaka Endo
  • Haruka Nikai
  • Kei Sato
  • Shigeaki Baba
  • Takehiro Chiba
  • Toshimoto Kimura
  • Takeshi Takahara
  • Koki Otsuka
  • Hiroyuki Nitta
  • Masaru Mizuno
  • Yusuke Kimura
  • Keisuke Koeda
  • Akira Sasaki



We investigated the operative outcomes of thoracoscopic esophagectomy (TE) in the prone position, using the concept of total meso-esophageal excision for esophageal cancer.


The medical records of 140 consecutive patients with esophageal cancer who underwent radical esophagectomy by TE were reviewed retrospectively, and operative outcomes were compared between patients treated before (non-meso-esophagus; non-ME group) and after (ME group) the introduction of total meso-esophageal excision (ME).


There were no significant differences between the groups in postoperative morbidity (non-ME group vs. ME group, 28.3% vs. 41.4%, p = 0.119), 30-day mortality (non-ME group vs. ME group, 0% vs. 1.1%; p = 0.433), and in-hospital mortality (non-ME group vs. ME group, 1.9% vs. 0%, p = 0.199). Although overall survival and relapse-free survival did not differ significantly between the groups, the overall recurrence rate was significantly lower in the ME group than the non-ME group (non-ME group vs. ME group, 43.4% vs. 23%, p = 0.011). In particular, the rate of regional lymph node recurrence in the mediastinum was lower in the ME group (non-ME group vs. ME group, 11.3% vs. 2.3%; p = 0.026).


Our results suggest that the ME procedure might be one of the procedures that reduce regional lymph node recurrence in the mediastinum without any deterioration in short-term outcomes.


Thoracoscopic esophagectomy Minimally invasive esophagectomy Esophageal cancer Meso-esophagus Preceding anterior approach 


Author’s contributions

Study conception and design: Yuji Akiyama and Takeshi Iwaya. Acquisition of data: Fumitaka Endo, Haruka Nikai, Kei Sato, Shigeaki Baba, and Takehiro Chiba. Analysis and interpretation of data: Toshimoto Kimura, Takeshi Takahara, Koki Otsuka, and Hiroyuki Nitta. Drafting of manuscript: Yuji Akiyama and Takeshi Iwaya. Critical revision of manuscript: Masaru Mizuno, Yusuke Kimura, Keisuke Koeda, and Akira Sasaki.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Yuji Akiyama
    • 1
    Email author
  • Takeshi Iwaya
    • 1
  • Fumitaka Endo
    • 1
  • Haruka Nikai
    • 1
  • Kei Sato
    • 1
  • Shigeaki Baba
    • 1
  • Takehiro Chiba
    • 1
  • Toshimoto Kimura
    • 1
  • Takeshi Takahara
    • 1
  • Koki Otsuka
    • 1
  • Hiroyuki Nitta
    • 1
  • Masaru Mizuno
    • 1
  • Yusuke Kimura
    • 2
  • Keisuke Koeda
    • 3
  • Akira Sasaki
    • 1
  1. 1.Department of SurgeryIwate Medical University School of MedicineIwateJapan
  2. 2.Department of Palliative MedicineIwate Medical University School of MedicineIwateJapan
  3. 3.Department of Medical Safety ScienceIwate Medical University School of MedicineIwateJapan

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