Early Outcomes of Transhiatal Esophagectomy: Experience From an Oncology Center in Nepal

Esophagectomy is a highly morbid surgical procedure. Both transhiatal and transthoracic esophagectomies are performed for carcinoma of the lower third of the esophagus and gastroesophageal (GE) junction. Compared with transthoracic esophagectomy, transhiatal esophagectomy (THE) is considered relatively less morbid, as thoracotomy is not performed. However, THE is associated with less lymph node retrieval compared to the transthoracic procedure. This study was conducted to assess the feasibility, safety, and early postoperative outcomes of THE.

This study was conducted by a retrospective review of 10 patients who underwent THE between July 2022 and July 2024 in the Department of Gastrointestinal Surgery, B.P. Koirala Memorial Cancer Hospital, Bharatpur, Nepal. The preoperative, intraoperative, and postoperative variables were analyzed. The postoperative complications within 30 days were evaluated, and the Comprehensive Complication Index (CCI) was calculated.

The most common indication for THE was carcinoma of the GE junction, observed in eight patients (80%), while the remaining patients had carcinoma of the lower third of the esophagus. Adenocarcinoma was the histological subtype in all patients. The mean duration of surgery was 267 ± 53.23 minutes, with a mean intraoperative blood loss of 380 ± 112.7 mL. There was no intraoperative bleed requiring thoracotomy. Intraoperatively, six patients (60%) required chest tube placement due to pleural breach. Postoperatively, the mean CCI was 18.65 ± 11.91, and major complications (CCI > 23) occurred in two patients (20%). Vocal cord paresis was the most common complication, occurring in six patients (60%) who recovered within the third to fourth postoperative day, followed by pneumonia in five patients (50%) and surgical site infection in five patients (50%). One patient developed an anastomotic leak that was managed conservatively. On histopathological examination, all resection margins were negative (R0 resection), with a mean lymph node retrieval of 14 ± 5.12.

THE is a feasible surgery as an initial approach in a dedicated center. It is associated with minimal major complications and low mortality. However, lymph node retrieval remains below the recommended standard. Therefore, a large-scale prospective study is warranted to validate these findings in our population.