Transhiatal oesophagectomy in the management of advanced oesophageal carcinoma

Thirty-seven patients have undergone transhiatal oesophagectomy for tumours in the upper (n = 3), middle (n = 12) and lower (n = 22) thirds of the oesophagus. Four tumours arose in association with Barrett's oesophagus. Dysphagia for solids was the presenting symptom in 95% of cases. Orringer's technique was used and all cervical anastomoses were hand-sewn. The median duration of surgery was 2.9 (range 1.5-4.0) h and the 30-day hospital mortality rate was 16% (six patients). Respiratory complications were considerable (48%) and accounted for three deaths. Median postoperative stay was 21 (range 13-53 days) while median stay in the intensive care unit was 8.5 days. The majority (97%) of patients had stage III disease and 14 (38%) had lymph node involvement. The actuarial survival was 56% at 1 year and 31% at 2 years. Of the operative survivors, 90% resumed normal swallowing although 17 (55%) required outpatient dilatation. Transhiatal oesophagectomy provides safe and efficient palliation while mortality and 1-year survival rates compare with the transthoracic approach.