Mediastinoscopy-assisted Transhiatal Esophagectomy for Esophageal Cancer: A Single-Institutional Cohort Study

We compared the therapeutic outcomes of mediastinoscopy-assisted transhiatal esophagectomy (MATHE) with transthoracic esophagectomy (TTE), and with video-assisted thoracoscopic esophagectomy (VATS-E) for the treatment of esophageal cancer. Twenty patients underwent MATHE in our institute from 2001 to 2005 were enrolled. We evaluated the therapeutic outcomes, including perioperative complications and long-term prognosis after surgery, and compared these with 15 patients who underwent TTE during the same time period and 15 who underwent VATS-E at a later date. MATHE was performed safely and the long-term prognosis were satisfactory compared with TTE. However, the number of dissected mediastinal lymph nodes, total blood loss, and sophistication of the procedure were inferior to VATS-E. MATHE represents a less invasive surgical procedure. However, in light of the risk of leaving lymph node metastasis around the tracheal bifurcation in patients with tumor invasion beyond the muscularis mucosa, MATHE should only be adopted in a minority of patients.