[Esophagectomy without thoracotomy. Comparison between a retrospective study and a prospective randomized trial]

Area of Science:

• Surgical Oncology
• Thoracic Surgery
• Gastrointestinal Surgery

Background:

• Esophagectomy is a critical procedure for esophageal cancer.
• Thoracotomy-based approaches carry significant risks, especially for comorbid patients.
• Alternative minimally invasive techniques are being explored to improve patient outcomes.

Purpose of the Study:

• To evaluate the outcomes of esophagectomy performed without thoracotomy.
• To compare the safety and efficacy of this approach against traditional methods.
• To identify factors influencing survival in patients undergoing esophagectomy without thoracotomy.

Main Methods:

• Retrospective analysis of 96 esophagectomies performed without thoracotomy between 1983 and 1989.
• Patient selection criteria included age, respiratory disease, heart disease, and superficial lesions.
• Comparison with a prospective randomized study evaluating different surgical approaches.

Main Results:

• Operative mortality was 3.1% and anastomotic fistulization occurred in 7.5% of cases.
• Five-year actuarial survival was 29%, influenced by tumor stage, size, invasion, and TNM classification, but not age.
• A comparative study showed similar mortality and complication rates between esophagectomy with and without thoracotomy.

Conclusions:

• Esophagectomy without thoracotomy is a safe alternative for selected patients, particularly those with contraindications.
• Surgical approach (with or without thoracotomy) does not significantly impact long-term survival.
• Disease stage remains the most critical determinant of long-term survival in esophageal cancer patients.