[The history of surgical treatment for esophageal carcinoma in the 20th century in Japan].

In the 20th century surgical results in the treatment of esophageal carcinomas significantly improved in Japan. For the reason, I review the trends in esophageal cancer surgery in Western countries and discuss the reasons for the choice of surgical procedures. In Japan, esophageal cancer surgery was initiated with the reports of surgical results presented by Professors Seo and Osawa at the Congress of the Japan Surgical Society held in 1933. Subsequently, the results in esophageal cancer patients undergoing surgical resection were improved with the progress in anesthesia. Subsequent to the establishment of the Japan Society of Esophageal Diseases in 1965, any institutes performed esophagectomy for esophageal carcinomas, and the procedure accounted for less than 2% of all operative deaths in Japan. The main reason for this reduction in the number of surgical deaths was improved perioperative care for major complications (cardiopulmonary failure and anastomotic leakage). In particular, the surgical procedure for curative lymphadenectomy called three-field dissection significantly improved surgical prognosis. In the last 10 years, the relationship between the number of positive lymph nodes and surgical prognosis was demonstrated in advanced esophageal cancers, while endoscopic mucosal resection was also performed for early esophageal cancers as a curative treatment. In the next century, better treatment should be designed for individual patients based on fundamental studies and clinical trials.