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A prospective follow-up was performed in 50 consecutive patients who had previously undergone transhiatal esophagectomy without thoracotomy (THE) for esophageal carcinoma. The follow-up period ranged from 1 to 5 years (mean, 18.4 monthsh At each control, a clinical, laborat0ry, and radiologic examination including barium esophagography and computed tomographic (CT) scan was obtained in order to assess quality of life and to detect tumor recurrence.Twenty-three patients (46%~ developed recurrent carcinoma, ail but one within 12 months of surgery. The survival rates were 57% at I year. 34% at 2 years, and 23% at 3 years. The median survival time was 15.7 months. Recurrence was initially confined to the mediastinum in 50% of patients, whereas 50% already had systemic metastases when recurrence was first detected.Radiologic examinations, especially CT. were far more sensitive in detecting tumor recurrence than was the clinical evaluation, thus, offering the chance to initiate an appropriate adjuvant therapy at the earliest possible time. Stage I and stage II tumors as well as differentiated tumors showed a significantly lower recurrence rate than tumors of stages III and IV and low-grade tumors. THE offers good quality of life in virtually ail patients and is able to restore a normal food intake in ail but a few patients. Due to the high rate of local tumor recurrence, it is suggested that THE shouid probably be reserved for poor-ri~k patients whereas good-risk patients with limited disease would profit from a thoracoabdominal esophagectomy with lymph node dissection.

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