[Esophageal carcinoma: surgery using transhiatal esophagectomy without thoracotomy]

During the period between 1982 and 1984, 25 patients with carcinoma of the esophagus underwent esophageal resection by the technique of blunt transhiatal esophagectomy without thoracotomy. The esophagus was replaced with stomach. The indications for blunt dissection of the esophagus are discussed and the operative technique is described. There was no postoperative mortality. Complications included pulmonary complications (19), anastomotic leak (9), left vocal cord paralysis (5) and stenosis of the cervical anastomosis (7). Postoperative hospitalization averaged 18 days. Following discharge from hospital patients are seen in follow-ups at 3-month intervals for 1 year, then at 6-month intervals. Quality of life is good. In the majority of patients with esophageal carcinoma, the goal of esophagectomy is palliation, not cure. Therefore, long-term prognosis of esophageal carcinoma is poor. Actual survival among the patients is 49% at 12 months, and mean survival 10.2 months. Transhiatal esophagectomy without thoracotomy is a safe procedure and far better tolerated by elderly and debilitated patients than a combined transthoracic and abdominal operation. We believe that this procedure is the treatment of choice for esophageal carcinoma at all levels.