Transhiatal and transthoracic esophagectomy: a comparative study.

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Gastrointestinal Surgery

Background:

• Esophageal resection is a critical procedure for esophageal cancer.
• Transhiatal (THE) and transthoracic (TTE) approaches are common surgical methods.
• Patient risk factors can influence surgical outcomes.

Purpose of the Study:

• To compare the outcomes of transhiatal (THE) versus transthoracic (TTE) esophageal resection.
• To evaluate operative mortality, complications, and survival rates between the two surgical approaches.
• To identify patient characteristics associated with higher mortality in the transthoracic group.

Main Methods:

• A retrospective analysis of 55 consecutive patients undergoing esophageal resection between 1981 and 1990.
• Patients were divided into two groups: transhiatal (THE) and transthoracic (TTE).
• Comparison of preoperative risk factors, operative outcomes, and survival data.

Main Results:

• Transhiatal (THE) approach showed significantly lower operative mortality and cardiopulmonary complications compared to transthoracic (TTE).
• Patients undergoing THE had shorter intensive care unit and hospital stays.
• Postoperative survival was significantly better with the THE approach when operative deaths were included.
• Higher mortality in the TTE group was observed in patients over 65, ASA risk class III or higher, or with severe cardiopulmonary impairment.

Conclusions:

• Transhiatal esophageal resection (THE) offers significant advantages over the transthoracic approach (TTE) in terms of safety and survival.
• THE is a preferable surgical option, particularly for elderly patients or those with significant comorbidities.
• Risk stratification is crucial for selecting the appropriate surgical approach in esophageal cancer patients.