Transhiatal esophagectomy without thoracotomy for carcinoma of the thoracic esophagus

Transhiatal esophagectomy (THE) without thoracotomy was performed in 100 patients with carcinoma of the thoracic esophagus (7 upper, 45 mid, and 48 lower third). The esophagus was replaced with stomach (96) or colon (4). Intraoperative complications included pneumothorax requiring a chest tube(s) (63) and membranous tracheal tear (2). Blood loss averaged 880 ml. Postoperative complications included transient recurrent laryngeal nerve paresis (31), anastomotic leak (5), and chylothorax (2). There were no intraoperative deaths or re-explorations for postoperative bleeding. Six hospital deaths resulted from aspiration pneumonia (2), retroperitoneal or mediastinal abscess (2), pulmonary embolus (1), and respiratory insufficiency (1). Postoperative hospitalization averaged 14 days. Actuarial survival among the 94 operative survivors is 82% at 6 months, 52% at 12 months, 32% at 24 months, 22% at 36 months, and 17% at 48 months. Of the operative survivors, 15% have lived 2 years or more and 10% are clinically disease free. THE is safe, associated with a low morbidity, and achieves excellent palliation and survival at least as good as that reported in many series of transthoracic esophagectomies for esophageal carcinoma.