ESOPHAGECTOMY WITHOUT THORACOTOMY - FIRST 250 PATIENTS

Objective: To evaluate morbidity, mortality and cure rate after transh iatal oesophagectomy for carcinoma of the oesophagus. Design: Prospect ive audit. Setting: University hospital, India. Subjects: From Decembe r 1986 to June 1993 a total of 250 consecutive patients underwent one stage transhiatal oesophagectomy with cervical oesophagogastrostomy fo r carcinoma of the oesophagus. Interventions: Transhiatal oesophagecto my. Main outcome measures: Morbidity and mortality. Results: The morta lity was 6% (14/250) and complications included recurrent laryngeal ne rve palsy (n = 35, 14%), anastomotic leak (n = 38, 15%), respiratory f ailure (n = 8, 3%), anastomotic stenosis (n = 44, 18%) and anastomotic recurrence (n = 3, 1%). The actuarial survival at one year was 45% an d at five years was 5%. Conclusions: Transhiatal oesophagectomy is saf e and well tolerated for the treatment of carcinoma of the oesophagus when done with care. Avoidance of thoracotomy, adequate longitudinal c learance, cervical anastomosis, and a short operating time are its mai n advantages.