THE RESULTS OF TRANSHIATAL ESOPHABECTOMY WITHOUT THORACOTOMY FOR SUPERFICIAL ESOPHAGEAL CARCINOMA

Two operative approaches for superficial esophageal carcinoma were compared with respect to operating time, intraoperative blood loss, operative morbidity and long-term survival. From 1991 to 1997, of 31 patients with superficial esophageal carcinoma, 21 underwent resection by transhiatal esophagectomy (THE) without thoracotomy and ten resection by transthoracic esophagectomy (TTE). The operating time was 4.9±1.1 hours (mean±SD) in the THE group and 7.5±1.9 hours in the TTE group (p<0.01). Intraoperative blood loss was 620±240ml in the THE group and 1990±240ml in the TTE group (p<0.01). Six anastomotic leak-ages, two cases of transient recurrent laryngeal nerve paresis, and two occurrence of pneumothorax occurred in the THE group. Six of the eleven patients with submucosal carcinomas were recurrent, two of them fatal. The sites of recurrence were distant metastasis in four patients and nodal metastasis in two patients. None of the ten patients with intramucosal carcinomas mere recurrent. Transhiatal esophagectomy (THE) without thoracotomy should be performed for superficial esophageal carcinoma, especially intramucosal carcinomas without indications for endscopic mucosal resection, because of the lower morbidity and better survival.