Carcinoma of the esophagus: A comparison of the results of transhiatal versus transthoracic resection

Abstract The cases of 78 patients with primary esophageal carcinoma treated from 1977 to mid-1987 were retrospectively analyzed. Fifty-two of the patients underwent transthoracic esophagogastrectomy (TTE) and 26, transhiatal esophagectomy (THE). The two groups were statistically similar in preoperative characteristics except that more of the THE group had received chemotherapy; this group had relatively more tumors of the upper esophagus; and 20 (77%) of the THE group, compared with 50 (96%) of the TTE group, had tumors in stages III and IV. The incidence of major postoperative complications did not differ significantly between the two groups. There were five (19%) anastomotic leaks in the THE group, but only one led to a prolongation of hospital stay by more than 14 days, whereas all three (6%) of the leaks in the TTE group caused hospital stay to be prolonged several weeks. Overall morbidity was high: 75% ( 39 / 52 ) for the TTE patients and 85% ( 22 / 26 ) for the THE patients ( p > 0.10). Hospital mortality was 6% ( 3 / 52 ) in the TTE group and 8% ( 2 / 26 ) in the THE patients ( p > 0.10). There was no significant difference in actuarial survival either between the two groups as a whole or between those patients in each group who had stage III or IV tumors. We conclude that THE, among the types of patients for whom we used the procedure, provides long-term survival comparable with that provided by TTE without causing a significant increase in hospital mortality or morbidity. In our hands, THE has been particularly useful in extending the indications for resection to poorrisk patients, such as those with chronic pulmonary disease, whom we formerly did not regard as being surgical candidates.