Abstract Robot assisted minimally invasive esophagectomy (RAMIE) has been reported to be potential advantages in previous reports. Here we demonstrate the difference between these two minimally invasive procedures and investigated the surgical results of RAMIE in comparison with MIE using propensity matched-cohort. Methods We investigated 154 cases of thoracic esophagectomy conducted between 2020/1 to 2021/1. Among these cases, we analyzed 30 cases of RAMIE in comparison with 30 cases of matched-cohort which conducted conventional thoracoscopic esophagectomy (MIE) in the prone. Then we evaluated the surgical results between two groups. Results There were no differences in age (69.2 vs 69.1 yo), gender (M:F = 24:6 vs 24:6), cStage (Stage I,II,III,IV:6,3,14,7 vs 8,3,14,5), and preoperative chemotherapy (70% vs 66.7%) between RAMIE and matched-cohort MIE. There was statistically significant difference in total time of thoracic phase (233.1 vs 173.3 min; p < 0.01). There were no significant differences in postoperative events in RAMIE vs MIE (Clavien-Dindo Grade 1≧; Recurrent laryngeal nerve paralysis (RLNP) (16.7 vs 20.0%; p = 0.19). However, after the learning curve archived, seldom cases were diagnosed postoperative RLNP in RAMIE cases in comparison with MIE (p = 0.06). Conclusion We demonstrated the formalization of our procedure and surgical results of RAMIE. There were no significant differences in postoperative events between two groups. However RLNP was lower after the learning peak. Incidence of RLNP could be reduced in RAMIE.
Abstract Background The transcervical mediastinoscopic esophagectomy is a relative new technique that has gradually demonstrated because of its ease of dissection along the organ sheath and its less invasive nature. However, the conventional cervical approach to mediastinoscopy has been reported to have a relatively high rate of recurrent nerve palsy due to interference in the mediastinum caused by the straight forceps. The robot-assisted transcervical esophagectomy (RACE) approach is novel procedure expected to reduce these interferences and improve maneuverability around the recurrent nerve. In this report, we describe a surgical technique and short-term outcome of RACE. Methods In this study, we included 26 RACE cases performed between Feb 2023 to Feb 2024. Principally, our hospital performs transcervical esophagectomy mainly on patients who are difficult to approach by transthoracic approach due to history of thoracic diseases, etc. In our department, transcervical esophagectomy is usually performed via a bilateral cervical approach, starting from the right neck and continuing to the left neck, and RACE is performed using the da Vinci Xi via a bilateral cervical approach as well. Recently, we have been shortening the operation time by performing simultaneous cervical and abdominal operations without muscle relaxation using NIM. Results Patient background: mean age 74.5, male to female ratio 22:4, cStage I/II/III/IV: 13/3/9/1, NAC: 46.1%, more than 80% had some history of pulmonary disease/systemic history. All patients underwent RACE via bilateral cervical approach, and no intraoperative complications or thoracoscopic conversion were observed. Postoperative complications (CD Grade≥1) included recurrent nerve palsy in 15.6% and respiratory complications in 7.6%. In addition, the recent operation with simultaneous cervical/abdominal NIM and no muscle relaxant has significantly shortened the average total operative time to 4 hours and 40 minutes. Conclusion Robot-assisted Cervical Esophagectomy (RACE) is a relatively safe procedure that offers a natural anatomic approach, fewer respiratory complications, and a significant reduction in operative time due to simultaneous neck and abdominal manipulation. With the advancement of robotics and devices, RACE is expected to become more effective and more widely used in the future.
This study examines the effect of the husband's job loss on childbirth by employing the retro-spective panel data built by the employment history of Keio Household Panel Survey. The following three points are clarified by the results of the fixed effect logit, random effect logit, and linear probability model. First, the estimated results indicated that the decrease in the probability of childbirth was observed at one year after the husband's job loss, which is caused by a considerable drop in the husband's income. In contrast, a persistent decrease in the probability of childbirth was not observed. Second, the estimated results indicated that the decrease in the probability of childbirth was observed only in cases in which the husband's educational qualification was low. This is because re-employment is difficult and the negative effect of the job loss snowballs in the case of the hus-band's low educational qualification. Third, the longer the husband remained unemployed after the job loss, the lower was the probability of childbirth. JEL Classification Codes：J12,J13,J60 Keywords：Childbirth, Husband’s job loss, Retrospective panel data
This thesis examines regional disparities in fertility rates, and analyzes the influence of regional factors on birth trends and continuation in employment. For this analysis, while controlling for individual attributes such as type of work, age, and academic career, by combining microdata and attribute data for the region in which individuals reside, we investigate how differences between regions with regard to the living environment and other factors affect women's birth behavior and continuation in employment. With regard to regional factors, we focus on housing conditions, commuting time, the government's family policies, and the economic climate. In order to consider the concurrence of birth behavior and continuation in employment by wives, we used a bivariate probit model to make estimates, and our findings were that there are correlations between the birth rate of the second child and whether the home is rented or owned, and between the birth of the first child and the father's commuting time and the capacity of daycare centers.
Although minimally invasive procedures such as thoracoscopic surgery and robot-assisted surgery have become increasingly popular in esophageal cancer in recent years, perioperative management remains a very important topic. However, perioperative management is still an extremely important issue, as esophagectomy is still a highly invasive procedure. Especially in recent years, as the patient population ages, it is expected that we will have more and more opportunities to deal with patients with various pre-existing medical conditions in addition to the original decline in physical function. In this article, we discuss the management of infectious complications in the perioperative management of esophageal surgery, with a particular focus on esophagectomy and reconstruction.
The first choice of an esophageal substitute after esophagectomy for cancer is the stomach. However, the colon must be considered for reconstruction in specific situations. The purpose of this study was to clarify the frequency and clinical features of patients who underwent colon interposition in thoracic esophagectomy and to investigate the postoperative complications and survival.We conducted a retrospective case-control study in the National Cancer Center Hospital East, Japan. Patients who underwent colon interposition after esophagectomy for cancer between 2010 and 2020 were analyzed.Eighty-eight patients underwent esophagectomy with colon interposition; 53.2% received preoperative treatment and 52.3% underwent thoracoscopic surgery. Clavien-Dindo grade >III postoperative complications occurred in 42% of the patients; anastomotic leakage was the most common complication, occurring in 26.1% of the cases. Univariate analysis of the factors associated with Clavien-Dindo grade III complications.
International comparison analyses have clarified that the relative poverty rate among working households in Japan is high. Based on this fact, this study analyzed the relationship between poverty and work, using the Keio Household Panel Survey 2004-2010 (KHPS). Our study showed that households where the head of the household is working as a temporary worker have a higher probability of being in poverty than households where the head of the household is unemployed and not engaged in any other income-earning activity. However, concerning the poverty dynamic, households where the head of the household is working in any capacity including temporary work are more likely to exit from poverty than households where the head of the household is not working. Needless to say, households where the head of the household is working as a regular worker have the least probability of falling into poverty, and shifting from temporary work to regular work is an effective solution for the working poor. Because of this fact, our study also analyzed the probability of shifting from temporary workers to regular workers. Results for women showed that those who invest in self-development are more likely to make the shift from temporary workers to regular workers; accordingly, investing in human capital—for instance, in the form of self-training—is important for making this shift. Moreover, among the unemployed who are in poverty, those receiving unemployment benefits and investing in job-training are more likely to get out from poverty than those not eligible for unemployment benefits. This implies that it is necessary to build a support system for those who are not eligible for unemployment benefits.
This study employs the Keio Household Panel Survey (KHPS) to examine the effect of risk preferences on the timing of marriage. While many empirical studies in Japan and other countries have analyzed the effect of risk preferences on smoking and drinking, few studies have explored the effect of risk preferences on the timing of marriage in Japan. Schmidt (2008) and Spivey (2010) use the mate-search model and reveal that a risk-averse person gets married sooner. This study clarifies two results. First, even considering the individual fixed effect, it was found that risk-averse men and women get married sooner. Second, the simulation of Cox’s proportional hazard model and the analysis of marriage conditions at ages 40 and 50 reveal that risk preferences affect not only the timing of marriage but also the marriage rate later in life. JEL Classification Number：J11, J12, J13 Key Word：Risk Preferences, Marriage, Cox’s Proportional Hazard Model
