COMPARISON OF 3 TECHNIQUES OF ESOPHAGECTOMY WITHIN A RESIDENCY TRAINING-PROGRAM

Residency training programs commonly emphasize a single technique of e sophagectomy, as the safety and the efficacy of teaching or performing more than one type of esophagectomy are unclear. Between 1986 and 199 2, 248 patients were explored for possible esophageal resection. Thora cic surgical residents or fellows performed major components of all re sections. Two hundred twenty-one patient's (adenocarcinoma, 146; squam ous cell carcinoma, 72; and other, 3) underwent transthoracic esophage ctomy (n = 134), transhiatal esophagectomy (n = 42), or total thoracic esophagectomy (n = 45), a respectability rate of 89.1% (221/248). Com plications occurred in 75% of patients with transthoracic esophagectom y, in 69% with transhiatal esophagectomy, and in 80% with total thorac ic esophagectomy. The overall operative mortality rate was 6.8% (15/22 1). Patients with a cervical anastomosis had a higher leak rate (13%) than those with an intrathoracic anastomosis (6%). Median survival was 22 months (19% 5-year survival) and did not differ by operation type di stage. No patient with unresectable disease (n = 27) survived longe r than 10 months. Survival for patients with adenocarcinoma stages 3 a nd 2a suggested a trend toward improved survival after transthoracic e sophagectomy despite similar rates of local and distant recurrence. Tr ansthoracic esophagectomy, transhiatal esophagectomy, and total thorac ic esophagectomy performed within a residency training program have si milar morbidity, mortality, and recurrence rates as those in other mod ern series. A specific technique of esophagectomy can be selected for individual patients. Survival and sites of recurrence primarily reflec t disease stage, not the technique of esophagectomy used.