TRANSHIATAL VERSUS TRANSTHORACIC ESOPHAGECTOMY FOR ESOPHAGEAL CANCER

We retrospectively analyzed 238 patients with esophageal carcinoma tre ated between 1983 and 1991; 120 underwent transthoracic esophagectomy, and 118 underwent transhiatal esophagectomy. The two groups were stat istically similar in preoperative characteristics, except that upper e sophageal cancer was more frequent in the transhiatal esophagectomy gr oup than in the transthoracic esophagectomy group (p < 0.01). The rate of postoperative complications differed significantly in wound infect ion (21% in patients who underwent transthoracic esophagectomy, 10% in those who underwent transhiatal esophagectomy; p < 0.05) and empyema (11% with transthoracic esophagectomy, 1% with transhiatal esophagecto my; p < 0.01). Pneumothorax was detected in 24% of the transhiatal eso phagectomy cases. Intraoperative blood loss was 1340 +/- 490 ml in the transthoracic esophagectomy group and 930 +/- 340 ml in the transhiat al esophagectomy group (p < 0.001). Hospital mortality was 11% in the transthoracic esophagectomy group and 6.7% in the transhiatal esophage ctomy group. Late complication rate was lower with transhiatal esophag ectomy than with transthoracic esophagectomy (11% and 51%, respectivel y). There was no significant difference m actuarial survival of patien ts in both groups. Transhiatal esophagectomy, which can be performed i n almost all levels of the esophagus, is the safer of the two operatio ns.