Objective
To review the authors' clinical experience with transhiatal esophagectomy (
THE) and the refinements in this procedure that have evolved.
Background
Increased use of THE during the past two decades has generated controversy
about the merits and safety of this approach compared with transthoracic es
ophageal resection. The authors' large THE experience provides a valuable b
asis for benchmarking data regarding the procedure.
Methods
The results of THE were analyzed retrospectively using the authors' prospec
tively established esophageal resection database and follow-up information
on these patients.
Results
From 1976 to 1998, THE was performed in 1085 patients, 26% with benign dise
ase and 74% with cancer. The procedure was possible in 98.6% of cases, Stom
ach was the esophageal substitute in 96%. The hospital mortality rate was 4
%. Blood loss averaged 689 cc. Major complications were anastomotic leak (1
3%), atelectasis/pneumonia (2%), intrathoracic hemorrhage, recurrent laryng
eal nerve paralysis, chylothorax, and tracheal laceration (<1% each). Actua
rial survival of patients with carcinoma equaled or exceeded that reported
after transthoracic esophagectomy, Late functional results were good or exc
ellent in 70%, With preoperative pulmonary and physical conditioning, a sid
e-to-side stapled cervical esophagogastric anastomosis (<3% incidence of le
ak), and postoperative epidural anesthesia, the need for an intensive care
unit stay has been eliminated and the length of stay reduced to 7 days,
Conclusion
THE is possible in most patients requiring esophageal resection and can be
performed with greater safety and fewer complications than the traditional
transthoracic approaches.