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Background
Transhiatal esophagectomy is a popular method of resection because of its reported
lower morbidity and mortality and similar survival rates compared to transthoracic
esophagectomy. A review of recent experience with these two procedures for resection
of distal esophageal and cardia adenocarcinoma is reported.
Methods
F rem 1988 to 1994, 48 patients with adenocarcinoma of the distal esophagus and gastric
cardia were resected with intent to cure, 32 by transhiatal esophagectomy (group I)
and 16 by transthoracic esophagectomy (group II). The two groups were comparable in
terms of patient demographics, preoperative risk factors, tumor stage, tumor differentiation,
and involvement of resection margins (all not significant [NS]).
Results
There was no significant difference in median intensive care unit stay, median hospital
stay, incidence of postoperative anastomotic leak, and stricture. Respiratory complications
were higher in group I (41% versus 6%, P = 0.01). Hospital mortality was not significantly different for the two groups (group
I 3.1% versus group II 0%, NS). Actuarial 5-year survival rates (Kaplan-Meier) were
12% for group I and 39% for group II (NS).
Conclusions
These results suggest that when compared with transhiatal esophagectomy, the transthoracic
approach is at least as safe, has comparable complication and survival rates, and
remains an acceptable procedure for resection of adenocarcinomas of the distal esophagus
and gastric cardia.
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Article info
Footnotes
*Presented at the 48th Annual Meeting of the Southwestern Surgical Congress, Scottsdale, Arizona, April 28–May 1, 1996.
Identification
Copyright
© 1996 Excerpta Medica, Inc. All rights reserved. Published by Elsevier Inc.
