A prospective randomized comparison of transhiatal and transthoracic resection for lower-third esophageal carcinoma

The question whether transhiatal (TH) or transthoracic (TT) resection is most suited for the extirpation of an esophageal cancer remains unresolved. The present study compared the two approaches in a prospective randomized manner.

Thirty-nine patients with carcinoma of the lower third of the esophagus who were clinically fit for either TH or TT resection were prospectively randomized to TH (20 patients) and TT (19 patients) resection. Patients of the two groups were comparable in age, sex, preoperative tumor staging, and pulmonary and cardiac risks for surgery.

There was no significant difference in the amount of blood loss between the two groups although intraoperative hypotension (systolic <80 mm Hg) occurred more frequently in the TH group (P <0.001). The mean operating time for the TH and TT groups were 174 minutes and 210 minutes, respectively (P <0.001). There was no difference in postoperative ventilatory requirements, cardiopulmonary complication rates, and, mean hospital stay between the two groups. There was no 30-day mortality in either group but there were 3 hospital deaths in the TH group from bronchopneumonia (2 patients) and disseminated malignancy (1 patient). The median survival rates were 16 and 13.5 months, respectively, for the TH and TT groups (P = NS).

Although there was no demonstrable statistical difference in results between TH and TT approaches, the TT approach is preferred as it allowed for a more controlled operation.