Transhiatal versus Transthoracic Esophagectomy for Distal Esophageal Cancer

Abstract

From 1982 to 1986, 27 of 34 consecutive patients with squamous cell carcinoma of the distal esophagus had resection by the transthoracic approach. From 1987 to 1990, 39 of 48 consecutive patients underwent transhiatal esophagectomy. The two groups were comparable in terms of demographics, preoperative risk factors, and tumor stage. All patients had received one cycle of anterior chemotherapy. The incidence of pneumonia and wound infection was significantly higher following transthoracic compared to transhiatal resection (44% versus 18%). Transhiatal esophagectomy required markedly less operating time (137 versus 327 min) but had a higher incidence of recurrent laryngeal nerve palsy (20% versus 0%). Anastomotic leaks occurred with similar frequency in both groups (23% versus 19%) and intrathoracic disruption carried a very high mortality (80%). Transhiatal resection had lower mortality (10% versus 26%) and both groups had similar survival. These results suggest that compared to transthoracic esophagectomy, the transhiatal approach had fewer complications, a lower mortality rate, and comparable survival, and thus remains an acceptable procedure for resection of squamous cell carcinoma of the distal esophagus.