Esophageal resection through a translaparotomic-transcervical approach

The authors present their experience obtained from January/78 to March/90 with transhiatal esophagectomy. Two hundred and eighty-nine patients were operated on using this procedure; 171 of them underwent the operation for cancer of the esophagus, 76 for cancer of the cardia, 11 for cancer of the hypopharynx, and 31 for benign conditions. The esophageal replacement was made with stomach in 63.6% of the cases, ileo-ceco-coloplasty in 28.5%, left colon in 7.6%, jejunum in 0.3%. Cancer patients were mainly in advanced stages (stage III in 67.3% of esophageal cancer, and in 69.7% of cardial cancer). Average blood requirements for the different diseases ranged between 500 and 1,100 cc. Only 16 patients required admission in the ICU. Mean hospital stay ranged from 16.7 to 20.6 days. Surgical complications were hemorrhage (0.3%), and tracheal injury (0.6%). Overall operative mortality (at 30 days) was 5.8%, as a result of respiratory insufficiency (35.2%), pulmonary sepsis (17.8%), and others (23.5%). Long term survival at five years was 11.8% for cancer of the esophagus, 48.5% for cancer of the cardia, and 57.1% for cancer of the hypopharynx.