Transhiatal and Transthoracic Resection in Adenocarcinoma of the Esophagus: Does the Operative Approach Have an Influence on the Long-term Prognosis?

Overview

Journal World J Surg Oncol

Publisher Biomed Central

Specialties General Surgery
Oncology

Date 2005 Jun 28

PMID 15978128

Citations 13

Authors

Ines Gockel

Sina Heckhoff

Claudia M Messow

Werner Kneist

Theodor Junginger

Affiliations

Soon will be listed here.

Abstract

Background: The goal of the present analysis was to investigate the long-term prognosis for adenocarcinoma of the esophagus treated with either the transhiatal (TH) or the transthoracic (TT) operative approach.

Methods: Between September 1985 and March 2004, esophageal resection due to carcinoma was performed on a total of 424 patients. This manuscript takes into account the 150 patients suffering from adenocarcinoma of the esophagus in whom a transhiatal resection of the esophagus was performed. In the event of transmural tumor growth and a justifiable risk of surgery, the transthoracic resection was selected. An extended mediastinal lymph node dissection, however, was only carried out in the course of the transthoracic approach.

Results: The transthoracic resection of the esophagus demonstrated a higher rate of general complications (p = 0.011) as well as a higher mortality rate (p = 0.011). The mediastinal dissection of the lymph nodes, however, revealed no prognostic influence. Considering all of the 150 patients with adenocarcinoma, as well as only those patients who had undergone curative resections (R0), the transhiatal approach was seen to demonstrate a better five-year survival rate of 32.1% versus 35.1%, with a median survival time of 24 versus 28 months, as compared with those who had undergone a transthoracic approach with a five-year survival rate of 13.6% (all patients) versus 17.7% (R0 resection) with a median survival time of 16 versus 17 months (p < 0.05).

Conclusion: The prognosis in patients with adenocarcinoma of the esophagus is influenced by the depth of the tumor (pT) and the pM-category, as shown in the multivariate analysis. The present analysis did not demonstrate a relevant difference in survival for patients with N0 and N1 stages undergoing transhiatal or transthoracic esophagectomy. It is questionable, if a more extensive mediastinal lymph node dissection, in addition to the clearance of abdominal lymph nodes, offers prognostic advantages in adenocarcinoma of the esophagus. However, the morbidity and mortality associated with the transthoracic approach is higher.

Citing Articles

Mediastinoscopy-assisted transhiatal esophagectomy versus thoraco-laparoscopic esophagectomy for esophageal cancer: a single-center initial experience.

Liu W, Guo X, Zhao H, Yu X, Wang C, Du L J Thorac Dis. 2020; 12(9):4908-4914.

PMID: 33145064 PMC: 7578494. DOI: 10.21037/jtd-20-1328.

Robot-assisted mediastinoscopic esophagectomy for esophageal cancer: the first clinical series.

Nakauchi M, Uyama I, Suda K, Shibasaki S, Kikuchi K, Kadoya S Esophagus. 2018; 16(1):85-92.

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Transthoracic versus transhiatal esophagectomy - influence on patient survival.

Lochowski M, Lochowska B, Kozak J Prz Gastroenterol. 2017; 12(2):118-121.

PMID: 28702100 PMC: 5497126. DOI: 10.5114/pg.2016.64609.

Pros and cons of the gasless laparoscopic transhiatal esophagectomy for upper esophageal carcinoma.

Yu L, Wu J, Gao Y, Li J, Zhang Y, Ke J Surg Endosc. 2015; 30(6):2382-9.

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Short-term outcomes of robotic radical esophagectomy for esophageal cancer by a nontransthoracic approach compared with conventional transthoracic surgery.

Mori K, Yamagata Y, Aikou S, Nishida M, Kiyokawa T, Yagi K Dis Esophagus. 2015; 29(5):429-34.

PMID: 25809390 PMC: 5132031. DOI: 10.1111/dote.12345.

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