{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T11:14:37Z","timestamp":1788347677951,"version":"build-2803163510"},"reference-count":26,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T00:00:00Z","timestamp":1778112000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T00:00:00Z","timestamp":1778112000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Annals of Gastroent Surgery"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>While esophagectomy is a high\u2010difficulty procedure, minimally invasive esophagectomy (MIE) requires even more advanced surgical skills, necessitating analysis of factors affecting surgical outcomes. This study examined the relationship between the postoperative mortality and complication rates of MIE and the annual hospital volume of esophagectomy to identify a threshold volume serving as a safety benchmark.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed data from 22\u2009712 patients registered in the National Clinical Database who underwent esophagectomy (MIE or open esophagectomy [OE]) at 1 037 hospitals in Japan between January 1, 2012, and December 31, 2015. Hospitals were stratified into five categories according to average annual volume of esophagectomies (MIE and OE). The primary outcome was operative mortality, and the secondary outcome was the incidence of postoperative complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The 22\u2009712 cases consisted of 9 739 cases (42.9%) of MIE and 12\u2009973 cases (57.1%) of OE. Regarding MIE outcomes, the overall crude perioperative mortality and perioperative complication rates were 2.1% and 40.9%, respectively. Multivariable analysis performed using very\u2010high\u2010volume hospitals as reference revealed an odds ratio for mortality in very\u2010low\u2010volume hospitals of 2.70 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The postoperative mortality rate in patients undergoing MIE was relatively low in hospitals with a higher annual average volume of esophagectomy cases. Mortality was significantly higher in hospitals performing five or fewer esophagectomies annually. However, residual confounding due to differences in baseline patient characteristics cannot be excluded, although key clinical factors were adjusted for. Therefore, careful attention must be paid to the surgical and perioperative management techniques when performing MIE, particularly in very\u2010low\u2010volume hospitals.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ags3.70229","type":"journal-article","created":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T06:10:21Z","timestamp":1778220621000},"page":"1518-1526","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Relationship Between Hospital Volume and Outcomes of Minimally Invasive Esophagectomy for Esophageal Cancer: Analysis of the National Clinical Database in Japan"],"prefix":"10.1002","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6130-1753","authenticated-orcid":false,"given":"Soji","family":"Ozawa","sequence":"first","affiliation":[{"name":"Department of Surgery Tamakyuryo Hospital  Machida Japan"},{"name":"Tokai University School of Medicine  Isehara Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9759-6191","authenticated-orcid":false,"given":"Hiraku","family":"Kumamaru","sequence":"additional","affiliation":[{"name":"Department of Health Data Science, Yokohama City University Graduate School of Data Science  Yokohama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0271-5670","authenticated-orcid":false,"given":"Yuko","family":"Kitagawa","sequence":"additional","affiliation":[{"name":"Department of Surgery Keio University School of Medicine  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8010-8630","authenticated-orcid":false,"given":"Kazuo","family":"Koyanagi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery Tokai University School of Medicine  Isehara Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3865-0514","authenticated-orcid":false,"given":"Junya","family":"Oguma","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal and Pediatric Surgery Tokyo Medical University  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2376-202X","authenticated-orcid":false,"given":"Harushi","family":"Udagawa","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery Toranomon Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroaki","family":"Miyata","sequence":"additional","affiliation":[{"name":"Keio University School of Medicine  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8808-0740","authenticated-orcid":false,"given":"Yasushi","family":"Toh","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery NHO Kyushu Cancer Center  Fukuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2335-4704","authenticated-orcid":false,"given":"Hisahiro","family":"Matsubara","sequence":"additional","affiliation":[{"name":"Department of Frontier Surgery, Graduate School of Medicine Chiba University  Chiba Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,7]]},"reference":[{"issue":"1","key":"e_1_2_12_2_1","first-page":"7","article-title":"Endoscopic Oesophagectomy Through a Right Thoracoscopic Approach","volume":"37","author":"Cuschieri A.","year":"1992","journal-title":"Journal of the Royal College of Surgeons of Edinburgh"},{"key":"e_1_2_12_3_1","unstructured":"The Japan Society for Endoscopic Surgery. 17th Nationwide Survey of Endoscopic Surgery in Japan 2025available from https:\/\/www.med\u2010amc.com\/jcs_society\/member\/info\/?cont=no17_index3&societyCode=jses."},{"issue":"5","key":"e_1_2_12_4_1","first-page":"406","article-title":"Thoracic and Cardiovascular Surgery in Japan During 1996: Annual Report by the Japanese Association for Thoracic Surgery. 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