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Transhiatal versus Ivor-Lewis oesophagectomy: is there a difference?
R Rindani1, C J Martin, M R Cox
1Department of Surgery, Nepean Hospital, Penrith, New South Wales, Australia.
The Australian and New Zealand Journal of Surgery
|March 13, 1999
Summary
Comparing transhiatal (THO) and Ivor-Lewis (ILO) oesophagectomy for esophageal cancer, this review found no significant difference in overall survival. THO had more anastomotic issues and nerve injuries, while ILO had higher mortality.
Area of Science:
- Surgical Oncology
- Gastrointestinal Surgery
Background:
- Esophageal cancer resection can be performed using transhiatal (THO) or Ivor-Lewis transthoracic (ILO) techniques.
- This study aimed to compare morbidity, mortality, and survival between THO and ILO for esophageal carcinoma.
Purpose of the Study:
- To compare the morbidity, 30-day mortality, and long-term survival of transhiatal and Ivor-Lewis oesophagectomy techniques.
- To provide data for sample size calculation in future prospective randomized trials.
Main Methods:
- A systematic review of 44 series published between January 1986 and December 1996.
- Analysis of data from 2675 patients undergoing THO and 2808 patients undergoing ILO.
Main Results:
- No significant differences in postoperative respiratory, cardiovascular complications, wound infection, or chylothorax.
- THO showed higher rates of anastomotic leaks (16% vs 10%), strictures (28% vs 16%), and recurrent laryngeal nerve injuries (11.2% vs 4.8%).
- 30-day mortality was 6.3% for THO and 9.5% for ILO; 5-year survival was similar (24% vs 26%).
Conclusions:
- Surgical approach (THO vs ILO) is not a major determinant of morbidity or long-term survival in esophageal carcinoma.
- THO is associated with increased anastomotic complications and nerve injuries; ILO has higher mortality.
- A prospective trial requires approximately 3100 patients per arm to detect significant differences.