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Related Experiment Videos

Esophagectomy with or without thoracotomy. Is there any difference?

H W Tilanus1, W C Hop, B L Langenhorst

  • 1Department of Surgery, Erasmus University Hospital, Rotterdam, The Netherlands.

The Journal of Thoracic and Cardiovascular Surgery
|May 1, 1993
PubMed
Summary

Transhiatal esophageal resection without thoracotomy offers reduced morbidity and mortality for distal esophageal carcinoma. Long-term survival remains comparable to traditional thoracotomy approaches.

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Area of Science:

  • Surgical Oncology
  • Gastrointestinal Surgery
  • Thoracic Surgery

Background:

  • Esophageal carcinoma necessitates surgical intervention with varying operative approaches.
  • Comparing operative morbidity and mortality is crucial for optimizing patient outcomes.

Purpose of the Study:

  • To compare the operative morbidity and mortality of two distinct surgical techniques for esophageal carcinoma.
  • To evaluate the oncological justification and patient outcomes of transhiatal versus thoracotomy approaches.

Main Methods:

  • Multivariable analysis of 152 patients undergoing laparotomy and thoracotomy (1980-1986).
  • Comparison with 141 patients undergoing transhiatal blunt dissection (1986-1989).
  • Analysis included operative complications, in-hospital mortality, and long-term survival, with stomach reconstruction as preferred method.

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Main Results:

  • Transhiatal approach showed significantly higher rates of recurrent laryngeal nerve paresis and cervical anastomosis leakage.
  • Pulmonary complications were less frequent in the transhiatal group.
  • In-hospital mortality was 9% (thoracotomy) vs. 5% (transhiatal), increasing with age and colonic interposition.

Conclusions:

  • Transhiatal esophageal resection without thoracotomy is oncologically justifiable for distal esophageal carcinomas.
  • This approach offers reduced morbidity and mortality compared to thoracotomy.
  • Long-term survival rates were similar between the two surgical methods.