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Transthoracic Versus Transhiatal Esophagectomy for Esophageal Carcinoma: Experience from a Single Tertiary Care Institution

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Abstract

Background

There is a lot of controversy about the best surgical treatment for esophageal carcinoma.

Methods

In this retrospective study, 382 patients with carcinoma of the mid-to-distal esophagus underwent transthoracic or transhiatal esophagectomy. Early morbidity and mortality were compared. Principal endpoints were disease-free survival (DFS) and overall survival (OS).

Results

A total of 177 patients underwent transthoracic esophagectomy, and 205 patients underwent transhiatal esophagectomy. Demographic characteristics and characteristics of the tumor were similar in the two groups. Perioperative and postoperative morbidity was higher after transhiatal esophagectomy. In-hospital mortality was also higher after transhiatal esophagectomy. The median follow-up was 4.3 years. Estimated 3-year DFS rates were 44.63 and 31.21%, whereas the 3-year OS rates were 57.06 and 41.46% for the transthoracic and transhiatal groups, respectively (statistically significant). Also, the estimated 5-year DFS rates were 26.55 and 21.46%, whereas the 5-year OS rates were 32.76 and 30.24% for the transthoracic and transhiatal groups, respectively (statistically not significant).

Conclusions

Transhiatal esophagectomy was associated with higher perioperative and postoperative morbidity and in-hospital mortality than transthoracic esophagectomy. The DFS and OS were higher in the transthoracic group and were statistically significant at 3 years but statistically insignificant at 5 years.

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References

  1. Greenlee RT, Murray T, Bolden S et al (2000) Cancer statistics, 2000. CA Cancer J Clin 50:7–33

    Article  PubMed  CAS  Google Scholar 

  2. Khuroo M, Zargar S, Mahajan R et al (1992) High incidence of esophageal and gastric cancer in Kashmir in a population with special personal and dietary habits. Gut 33:11–15

    Article  PubMed  CAS  Google Scholar 

  3. Orringer MB, Marshall B, Stirling MC (1993) Transhiatal esophagectomy for benign and malignant disease. J Thorac Cardiovasc Surg 105:265–276

    PubMed  CAS  Google Scholar 

  4. Muller JM, Erasmi H, Stelzner M et al (1990) Surgical therapy of esophageal carcinoma. Br J Surg 77:845–857

    Article  PubMed  CAS  Google Scholar 

  5. Hulscher JBF, Tijssen JGP, Obertop H et al (2001) Transthoracic versus transhiatal resection for carcinoma of the esophagus: a meta-analysis. Ann Thorac Surg 72:306–313

    Article  PubMed  CAS  Google Scholar 

  6. Goldminc M, Maddern G, Le Prise E et al (1993) Esophagectomy by a transhiatal approach or thoracotomy: a prospective randomized trial. Br J Surg 80:367–370

    Article  PubMed  CAS  Google Scholar 

  7. Chu KM, Law SY, Fok M et al (1997) A prospective randomized comparison of transhiatal and transthoracic resection for lower-third esophageal carcinoma. Am J Surg 174:320–324

    Article  PubMed  CAS  Google Scholar 

  8. Jacobi CA, Zieren HU, Muller JM et al (1997) Surgical therapy of esophageal carcinoma: the influence of surgical approach and esophageal resection on cardiopulmonary function. Eur J Cardiothorac Surg 11:32–37

    Article  PubMed  CAS  Google Scholar 

  9. Matoo AR, Kaul HK (1974) Incidences of malignant neoplasms in Kashmir. J Indian Med Assoc 62:309–311

    Google Scholar 

  10. Dhar GM, Shah GN, Naheed B et al (1993) Epidemiological trend in the distribution of cancer in Kashmir Valley. J Epidemiol Community Health 47:290–292

    Article  PubMed  CAS  Google Scholar 

  11. Hulscher JBF, van Sandick JW, de Boer AGEM et al (2002) Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med 347:1662–1669

    Article  PubMed  Google Scholar 

  12. Swisher S, Hunt K, Holmes E et al (1995) Changes in the surgical management of esophageal cancer from 1970 to 1983. Am J Surg 169:609–614

    Article  PubMed  CAS  Google Scholar 

  13. Katlic M, Wilkins E, Grillo H (1990) Three decades of treatment of esophageal squamous carcinoma at the Massachusetts General Hospital. J Thorac Cardiovasc Surg 99:929–938

    PubMed  CAS  Google Scholar 

  14. Jauch KW, Bacha EA, Denecke H et al (1992) Esophageal carcinoma: prognostic features and comparison between blunt transhiatal dissection and transthoracic resection. Eur J Surg Oncol 18:553–562

    PubMed  CAS  Google Scholar 

  15. Pommier RF, Vetto JT, Ferris BL et al (1998) Relationships between operative approaches and outcomes in esophageal cancer. Am J Surg 175:422–425

    Article  PubMed  CAS  Google Scholar 

  16. Orringer MB, Orringer JS (1983) Esophagectomy without thoracotomy: a dangerous operation? J Thorac Cadiovasc Surg 85:72–80

    CAS  Google Scholar 

  17. Ellis FH, Gibb SP, Watkins E Jr (1983) Esophagogastrectomy: a safe, widely applicable, and expeditious form of palliation of patients with carcinoma of esophagus and cardia. Ann Surg 198:531–540

    Article  PubMed  Google Scholar 

  18. Mathisen DJ, Grillo HC, Wilkinson EW et al (1988) Transthoracic esophagectomy: a safe approach to carcinoma of esophagus. Ann Thorac Surg 45:137–143

    Article  PubMed  CAS  Google Scholar 

  19. Hulscher J, Van Sandick J, DeVriese P et al (1999) Vocal cord paralysis after subtotal esophagectomy. Br J Surg 86:1583–1587

    Article  PubMed  CAS  Google Scholar 

  20. Vigneswaran W, Trastek V, Pairolero P et al (1994) Extended esophagectomy in the management of carcinoma of the upper thoracic esophagus. J Thorac Cardiovasc Surg 107:901–907

    PubMed  CAS  Google Scholar 

  21. McLarty A, Deschamps C, Trastek V et al (1997) Esophageal resection for cancer of the esophagus: long-term function and quality of life. Ann Thorac Surg 63:1568–1572

    Article  PubMed  CAS  Google Scholar 

  22. Tilanus HW, Hop WC, Langenhorst BL et al (1993) Esophagectomy with or without thoracotomy. is there any difference? J Thorac Cardiovasc Surg 105:898–903

    PubMed  CAS  Google Scholar 

  23. Rahul R, Christopher J, Michael R (2002) Transhiatal versus Ivor Lewis esophagectomy: is there a difference? Aust N Z J Surg 69:187–194

    Google Scholar 

  24. Stark SP, Romberg MS, Pierce GE et al (1996) Transhiatal versus transthoracic esophagectomy for adenocarcinoma of the distal esophagus and cardia. Am J Surg 172:478–481; discussion 481–482

    Google Scholar 

  25. Iannettoni MD, Whyte RI, Orringer MB (1995) Catastrophic complications of the cervical esophagogastric anastomosis. J Thorac Cardiovasc Surg 110:1493–1501

    Article  PubMed  CAS  Google Scholar 

  26. Patti M, Corvera C, Glasgow R et al (1998) A hospital’s annual rate of esophagectomy influences the operative mortality rate. J Gastrointest Surg 2:186–192

    Article  PubMed  CAS  Google Scholar 

  27. Miller J, Jain M, De Gara C et al (1997) Effect of surgical experience on results of esophagectomy for esophageal carcinoma. J Surg Oncol 65:20–21

    Article  PubMed  CAS  Google Scholar 

  28. Horstmann O, Verreet PR, Becker H et al (1995) Transhiatal esophagectomy compared with transthoracic resection and systematic lymphadenectomy for the treatment of esophageal cancer. Eur J Surg 161:557–567

    PubMed  CAS  Google Scholar 

  29. Ninh T, David M, Bruce M et al (2000) Comparison of minimally invasive esophagectomy with transthoracic and transhiatal esophagectomy. Arch Surg 135:920–925

    Article  Google Scholar 

  30. Sabanathan S, Shah R, Mearns AJ et al (1996) Results of surgical treatment of esophageal cancer. J R Coll Surg Edinb 41:295–301

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiothoracic and Vascular Surgery, Sher i Kashmir Institute of Medical Sciences (SKIMS), Soura, Srinagar, Kashmir, 190011, India

    Nadeem UlNazeer Kawoosa, Abdul Majeed Dar, Mukand Lal Sharma, Abdul Gani Ahangar, Ghulam Nabi Lone, Mohammad Akbar Bhat & Shyam Singh

Authors
  1. Nadeem UlNazeer Kawoosa
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  2. Abdul Majeed Dar
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  3. Mukand Lal Sharma
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  4. Abdul Gani Ahangar
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  5. Ghulam Nabi Lone
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  6. Mohammad Akbar Bhat
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  7. Shyam Singh
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Correspondence to Nadeem UlNazeer Kawoosa.

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Kawoosa, N.U., Dar, A.M., Sharma, M.L. et al. Transthoracic Versus Transhiatal Esophagectomy for Esophageal Carcinoma: Experience from a Single Tertiary Care Institution. World J Surg 35, 1296–1302 (2011). https://doi.org/10.1007/s00268-011-1020-z

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  • DOI: https://doi.org/10.1007/s00268-011-1020-z

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