Transhiatal versus transthoracic esophagectomy for esophageal cancer

We retrospectively analyzed 238 patients with esophageal carcinoma treated between 1983 and 1991; 120 underwent transthoracic esophagectomy, and 118 underwent transhiatal esophagectomy. The two groups were statistically similar in preoperative characteristics, except that upper esophageal cancer was more frequent in the transhiatal esophagectomy group than in the transthoracic esophagectomy group (p < 0.01). The rate of postoperative complications differed significantly in wound infection (21% in patients who underwent transthoracic esophagectomy, 10% in those who underwent transhiatal esophagectomy; p < 0.05) and empyema (11% with transthoracic esophagectomy, 1% with transhiatal esophagectomy; p < 0.01). Pneumothorax was detected in 24% of the transhiatal esophagectomy cases. Intraoperative blood loss was 1340 +/- 490 ml in the transthoracic esophagectomy group and 930 +/- 340 ml in the transhiatal esophagectomy group (p < 0.001). Hospital mortality was 11% in the transthoracic esophagectomy group and 6.7% in the transhiatal esophagectomy group. Late complication rate was lower with transhiatal esophagectomy than with transthoracic esophagectomy (11% and 51%, respectively). There was no significant difference in actuarial survival of patients in both groups. Transhiatal esophagectomy, which can be performed in almost all levels of the esophagus, is the safer of the two operations.