Esophageal resection through a translaparotomic-transcervical approach

Area of Science:

• Surgical Oncology
• Gastrointestinal Surgery
• Thoracic Surgery

Background:

• Transhiatal esophagectomy is a surgical technique for esophageal and upper gastrointestinal conditions.
• Experience with this procedure spans over a decade, involving a significant patient cohort.

Purpose of the Study:

• To present the surgical experience with transhiatal esophagectomy.
• To analyze outcomes including operative mortality, complications, and long-term survival for different indications.

Main Methods:

• Retrospective review of 289 patients undergoing transhiatal esophagectomy from January 1978 to March 1990.
• Indications included esophageal cancer, cardia cancer, hypopharyngeal cancer, and benign conditions.
• Esophageal replacement utilized various techniques: stomach, ileo-ceco-coloplasty, left colon, and jejunum.

Main Results:

• The majority of cancer patients presented with advanced-stage disease (Stage III).
• Average blood transfusion requirements ranged from 500 to 1,100 cc.
• Overall operative mortality was 5.8%, primarily due to respiratory insufficiency and pulmonary sepsis. Five-year survival rates were 11.8% for esophageal cancer, 48.5% for cardia cancer, and 57.1% for hypopharyngeal cancer.

Conclusions:

• Transhiatal esophagectomy is a viable option for selected patients with esophageal and hypopharyngeal cancers, as well as benign conditions.
• Outcomes are influenced by the stage of cancer and the specific reconstruction method used.
• While operative mortality exists, careful patient selection and management can optimize results.