Journal of Gastrointestinal Surgery

, Volume 18, Issue 2, pp 310–317 | Cite as

Outcomes of Esophagectomy for Esophageal Achalasia in the United States

  • Daniela Molena
  • Benedetto Mungo
  • Miloslawa Stem
  • Richard L. Feinberg
  • Anne O. Lidor
2013 SSAT Poster Presentation



While the outcomes after Heller myotomy have been extensively reported, little is known about patients with esophageal achalasia who are treated with esophagectomy.


This was a retrospective analysis using the Nationwide Inpatient Sample over an 11-year period (2000–2010). Patients admitted with a primary diagnosis of achalasia who underwent esophagectomy (group 1) were compared to patients with esophageal cancer who underwent esophagectomy (group 2) during the same time period. Primary outcome was in-hospital mortality. Secondary outcomes included length of stay, postoperative complications, and total hospital charges. A propensity-matched analysis was conducted comparing the same outcomes between group 1 and well-matched controls in group 2.


Nine hundred sixty-three patients with achalasia and 18,003 patients with esophageal cancer underwent esophagectomy. The propensity matched analysis showed a trend toward a higher mortality in group 2 (7.8 vs. 2.9 %, p = 0.08). Postoperative length of stay and complications were similar in both groups. Total hospital charges were higher for the achalasia group ($115,087 vs. $99, 654.2, p = 0.006).


This is the largest study to date examining outcomes after esophagectomy in patients with achalasia. Based on our findings, esophagectomy can be considered a safe option, and surgeons should not be hindered by a perceived notion of prohibitive operative risk in this patient population.


Achalasia Esophagectomy Outcomes 


  1. 1.
    Sadowski DC, Ackah F, Jiang B, Svenson LW. Achalasia: Incidence, prevalence, and survival. A population-based study. Neurogastroenterol Motil, 2010; 22:e256-61.Google Scholar
  2. 2.
    Sonnenberg A, Massey BT, McCarty DJ, Jacobsen SJ. Epidemiology of hospitalization for achalasia in the United States. Dig Dis Sci, 1993; 38:233-244.Google Scholar
  3. 3.
    Mayberry JF. Epidemiology and demographics of achalasia. Gastrointest Endosc Clin N Am, 2001; 11:235-48, v.Google Scholar
  4. 4.
    ELLIS FG. The natural history of achalasia of the cardia. Proc R Soc Med, 1960; 53:663-666.PubMedCentralPubMedGoogle Scholar
  5. 5.
    Eckardt VF, Hoischen T, Bernhard G. Life expectancy, complications, and causes of death in patients with achalasia: Results of a 33-year follow-up investigation. Eur J Gastroenterol Hepatol, 2008; 20:956-960.Google Scholar
  6. 6.
    Banbury MK, Rice TW, Goldblum JR, Clark SB, Baker ME, Richter JE, Rybicki LA, Blackstone EH. Esophagectomy with gastric reconstruction for achalasia. J Thorac Cardiovasc Surg, 1999; 117:1077-1084.PubMedCrossRefGoogle Scholar
  7. 7.
    Vela MF, Richter JE, Wachsberger D, Connor J, Rice TW. Complexities of managing achalasia at a tertiary referral center: Use of pneumatic dilatation, Heller myotomy, and Botulinum toxin injection. Am J Gastroenterol, 2004; 99:1029-1036.Google Scholar
  8. 8.
    Richter JE. Update on the management of achalasia: Balloons, surgery and drugs. Expert Rev Gastroenterol Hepatol, 2008; 2:435-445.Google Scholar
  9. 9.
    Patrick DL, Payne WS, Olsen AM, Ellis FH,Jr. Reoperation for achalasia of the esophagus. Arch Surg, 1971; 103:122-128.Google Scholar
  10. 10.
    Atkins BZ, Shah AS, Hutcheson KA, Mangum JH, Pappas TN, Harpole Jr DH, D’Amico TA. Reducing hospital morbidity and mortality following esophagectomy. Ann Thorac Surg, 2004; 78:1170-1176.PubMedCrossRefGoogle Scholar
  11. 11.
    Jamieson GG, Mathew G, Ludemann R, Wayman J, Myers JC, Devitt PG. Postoperative mortality following esophagectomy and problems in reporting its rate. Br J Surg, 2004; 91:943-947.PubMedCrossRefGoogle Scholar
  12. 12.
    Hii MW, Smithers BM, Gotley DC, Thomas JM, Thomson I, Martin I, Barbour AP. Impact of postoperative morbidity on long-term survival after esophagectomy. Br J Surg, 2013; 100:95-104.PubMedCrossRefGoogle Scholar
  13. 13.
    Leibman S, Smithers BM, Gotley DC, Martin I, Thomas J. Minimally invasive esophagectomy: Short- and long-term outcomes. Surg Endosc, 2006; 20:428-433.Google Scholar
  14. 14.
    Overview of the Nationwide Inpatient Sample. Available at: Accessed March 8, 2013.Google Scholar
  15. 15.
    Quan H, Sundararajan V, Halfon P, Fong A, Burnand B, Luthi JC, Saunders LD, Beck CA, Feasby TE, Ghali WA. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care, 2005; 43:1130-1139.PubMedCrossRefGoogle Scholar
  16. 16.
    Santry HP, Gillen DL, Lauderdale DS. Trends in bariatric surgical procedures. JAMA, 2005; 294:1909-1917.PubMedCrossRefGoogle Scholar
  17. 17.
    Romano PS, Roos LL, Jollis JG. Adapting a clinical comorbidity index for use with ICD-9-CM administrative data: Differing perspectives. J Clin Epidemiol, 1993; 46:1075-9.PubMedCrossRefGoogle Scholar
  18. 18.
    Murphy MM, Knaus WJ,2nd, Ng SC, Hill JS, McPhee JT, Shah SA, Tseng JF. Total pancreatectomy: A national study. HPB (Oxford), 2009; 11:476-482.Google Scholar
  19. 19.
    Guo S, Fraser MW. Propensity Score Analysis: Statistical Methods and Applications. Psychometrika, 2010; 75:775-777Google Scholar
  20. 20.
    Devaney EJ, Lannettoni MD, Orringer MB, Marshall B. Esophagectomy for achalasia: Patient selection and clinical experience. Ann Thorac Surg, 2001; 72:854-858.Google Scholar
  21. 21.
    Duranceau A, Liberman M, Martin J, Ferraro P. End-stage achalasia. Dis Esophagus, 2012; 25:319-330PubMedCrossRefGoogle Scholar
  22. 22.
    Molena D, Yang SC. Surgical management of end-stage achalasia. Semin Thorac Cardiovasc Surg, 2012; 24:19-26.PubMedCrossRefGoogle Scholar
  23. 23.
    Lehman MB, Clark SB, Ormsby AH, Rice TW, Richter JE, Goldblum JR. Squamous mucosal alterations in esophagectomy specimens from patients with end-stage achalasia. Am J Surg Pathol, 2001; 25:1413-1418.PubMedCrossRefGoogle Scholar
  24. 24.
    Miller DL, Allen MS, Trastek VF, Deschamps C, Pairolero PC. Esophageal resection for recurrent achalasia. Ann Thorac Surg, 1995; 60:922-5.PubMedCrossRefGoogle Scholar
  25. 25.
    Orringer MB, Stirling MC. Esophageal resection for achalasia: Indications and results. Ann Thorac Surg, 1989; 47:340-345.Google Scholar
  26. 26.
    Gopaldas RR, Bhamidipati CM, Dao TK, Markley JG. Impact of surgeon demographics and technique on outcomes after esophageal resections: A nationwide study. Ann Thorac Surg, 2013; 95:1064-1069.Google Scholar
  27. 27.
    Merkow RP, Bilimoria KY, McCarter MD, Phillips JD, Decamp MM, Sherman KL, Ko CY, Bentrem DJ. Short-term outcomes after esophagectomy at 164 American college of surgeons national surgical quality improvement program hospitals: Effect of operative approach and hospital-level variation. Arch Surg, 2012; 147:1009-1016.PubMedCrossRefGoogle Scholar
  28. 28.
    Parshad R, Devana SK, Panchanatheeswaran K, Saraya A, Makharia GK, Sharma SK, Bhalla AS. Clinical, radiological and functional assessment of pulmonary status in patients with achalasia cardia before and after treatment. European Journal of Cardio-Thoracic Surgery, 2012; 42:e90-e95.PubMedCrossRefGoogle Scholar
  29. 29.
    Sinan H, Tatum RP, Soares RV, Martin AV, Pellegrini CA, Oelschlager BK. Prevalence of respiratory symptoms in patients with achalasia. Diseases of the Esophagus, 2011; 24:224-228.PubMedCrossRefGoogle Scholar
  30. 30.
    Watson TJ, DeMeester TR, Kauer WK, Peters JH, Hagen JA. Esophageal replacement for end-stage benign esophageal disease. J Thorac Cardiovasc Surg, 1998; 115:1241-7; discussion 1247-9.PubMedCrossRefGoogle Scholar
  31. 31.
    D’Journo XB, Martin J, Rakovich G, Brigand C, Gaboury L, Ferraro P, Duranceau A. Mucosal damage in the esophageal remnant after esophagectomy and gastric transposition. Ann Surg, 2009; 249:262-268.PubMedCrossRefGoogle Scholar
  32. 32.
    Triadafilopoulos G, Boeckxstaens GE, Gullo R, Patti MG, Pandolfino JE, Kahrilas PJ, Duranceau A, Jamieson G, Zaninotto G. The Kagoshima consensus on esophageal achalasia. Dis Esophagus, 2012; 25:337-348.PubMedCrossRefGoogle Scholar
  33. 33.
    Klabunde CN, Warren JL, Legler JM. Assessing comorbidity using claims data: An overview. Med Care, 2002; 40:IV-26-35Google Scholar
  34. 34.
    Loviscek MF, Wright AS, Hinojosa MW, Petersen R, Pajitnov D, Oelschlager BK, Pellegrini CA. Recurrent dysphagia after Heller myotomy: Is esophagectomy always the answer? J Am Coll Surg, 2013; 216:736-43.PubMedCrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2013

Authors and Affiliations

  • Daniela Molena
    • 1
  • Benedetto Mungo
    • 1
  • Miloslawa Stem
    • 2
  • Richard L. Feinberg
    • 2
  • Anne O. Lidor
    • 2
  1. 1.Division of Thoracic Surgery, Department of SurgeryJohns Hopkins UniversityBaltimoreUSA
  2. 2.Department of SurgeryJohns Hopkins UniversityBaltimoreUSA

Personalised recommendations