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Transhiatal esophagectomy.

Jules Lin1, Mark D Iannettoni

  • 1Department of Surgery, Section of Thoracic Surgery, University of Michigan Medical Center, 2120 Taubman Center, 1500 E. Medical Center Drive, Box 0344, Ann Arbor, MI 48109, USA.

The Surgical Clinics of North America
|June 2, 2005
PubMed
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Transhiatal esophagectomy (THE) offers comparable survival rates to transthoracic esophagectomy for esophageal cancer. THE may reduce complications by avoiding thoracotomy, making it a viable option for both benign and malignant conditions.

Area of Science:

  • Thoracic Surgery
  • Surgical Oncology
  • Gastrointestinal Surgery

Background:

  • The appropriateness of transhiatal esophagectomy (THE) for esophageal cancer remains debated.
  • Critics question THE's ability to provide accurate staging and curative potential without mediastinal lymphadenectomy.
  • Esophageal carcinoma is often diagnosed at advanced stages, suggesting a systemic disease component.

Purpose of the Study:

  • To evaluate the appropriateness and outcomes of transhiatal esophagectomy (THE) compared to transthoracic esophagectomy for esophageal cancer.
  • To assess the impact of operative approach on survival, staging accuracy, and complications in esophageal cancer surgery.

Main Methods:

  • Review of literature comparing transhiatal esophagectomy (THE) and transthoracic esophagectomy.

Related Experiment Videos

  • Analysis of operative margins, staging accuracy, survival rates, and complication profiles.
  • Inclusion of data from meta-analyses and randomized studies comparing the two surgical approaches.

    • Main Results:

    • Operative margins are similar between THE and transthoracic esophagectomy, with high rates of microscopic negative margins.
    • Survival rates after THE are equivalent or superior to transthoracic esophagectomy.
    • THE is associated with significantly lower early morbidity and mortality rates compared to transthoracic resections.

    Conclusions:

    • Transhiatal esophagectomy (THE) is a viable and potentially advantageous approach for esophageal cancer resection.
    • Survival is primarily determined by tumor biology and stage, not the operative approach.
    • THE should be considered for all patients requiring esophagectomy due to decreased respiratory complications and mediastinitis.