TRANSHIATAL ESOPHAGECTOMY FOR CARCINOMA OF THE ESOPHAGUS

One hundred thirty-one patients (107 men and 24 women) underwent trans hiatal esophagectomy for carcinoma of the esophagus. Median age was 65 .3 years (range, 30 to 89 years). Signs and symptoms were present in 1 30 patients, which included dysphagia in 96 (73.3%) and weight loss (m edian, 7.7 kg) in 52 (39.7%). The cancer involved the gastroesophageal junction in 94 patients, the lower half of the intrathoracic esophagu s in 25, the upper half in 10, and multiple sites in 2. An adenocarcin oma was present in 101 patients (77.1%), squamous cell carcinoma in 29 (22.1%), and adenosquamous cell in 1 (0.8%). The cancer was classifie d as stage 0 in 4 patients, stage I in 16, stage IIA in 26, stage IIB in 18, stage III in 65, and stage IV in 1. The stomach was used to rep lace the esophagus in all patients. Operative mortality was 2.3%. Anas tomotic leak developed in 32 patients; 6 leaks were not clinically sig nificant, 12 healed with drainage alone, and 14 required further surgi cal intervention. Follow-up ranged from 1 month to 6.7 years (median, 1.4 years). Currently, 42 patients are alive, 34 without evidence of r ecurrence. Overall 5-year survival was 20.8% and varied according to s tage. Five-year survival was 47.5% for patients with stage I disease c ompared with 37.7% for patients in stage II and only 5.8% 4-year survi val for patients in stage III. Cell type also influenced survival. Fiv e-year survival for patients with adenocarcinoma was 27.1% compared wi th zero for patients with squamous cell carcinoma (p < 0.03). Forty pa tients (33.9%) had development of late dysphagia (23 malignant, 17 ben ign) and 33 required dilation. We conclude that transhiatal esophagect omy for cancer of the esophagus can be performed with low operative mo rtality, satisfactory long-term survival, and good long-term function, but that associated morbidity is substantial.