Transthoracic versus Transhiatal Esophagectomy: A Permanent Dilemma. Our 15-year Experience

Objective: Controversy still exists regarding the optimalsurgical management of esophageal cancer. This study wasperformed to determine and compare early and late morbidity,mortality and overall survival after transthoracic (TTE) andtranshiatal esophagectomies (THE).Methods: Between 1997-2011, 100 patients underwent TTEor THE for squamous esophageal carcinoma (90 patients)and adenocarcinoma (10 patients). Assessed parametersincluded patient demographics, operative data, pathologyresults, postoperative morbidity and mortality and 1-3 yearsurvival.Results: Thoracic approach was preferred in cases of moreadvanced tumors, located in the upper and mid-third of theesophagus, in patients with a better cardiopulmonary status. Perioperative blood loss was significantly higher aftertransthoracic resections (p=0.0004) and these surgeries tooksignificantly longer than transhiatal esophagectomies(p=0.02). We identified complications in 70.7% patients whounderwent TTE and in 59.3% patients with transhiatalapproach. Respiratory complications were statisticallysignificant in the TTE- group (p-0.0003). The 30-daymortality rates were 12.2% for patients in TTE group and10.1% in THE patients group, respectively. The mortality ratefor the entire period of the study has been calculated at 84.4%.We have identified a survival rate after 1 year of 62.2%, after2 years of 39.3% and after 3 years â€" 15.1%.Conclusions: According to the results of this study, bothprocedures appear to be acceptable depending on surgeonpreference and appropriate patient selection.

• Timeviewed: 1765 times
• Download

• Rezumat
• Abstract