Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the distal esophagus

Abstract

There is much controversy about the surgical approach to esophageal carcinoma: should an extensive resection be done to optimize long term survival or should the extent of the operation be limited to obtain lower perioperative morbidity and mortality rates? Thirty-one patients with carcinoma of the lower third of the esophagus who were clinically fit for either transhiatal resection (THR) or transthoracic resection (TTR) were prospectively randomized to THR (16 patients) and TTR (15 patients). 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 operative complications among both groups. However, the amount of blood loss was significantly more in the TTR group (P <0.05), and the mean operating time was significantly longer in the TTR group (P <0.00l). There was no difference in postoperative ventilatory requirements, and mean hospital stay between the two groups. There were higher pulmonary complications in the TTR group compared to higher incidence of anastomotic leakage and unilateral vocal cord paralysis in the THR group. However the differences were not statistically significant (P >0.05). There was no 30-day mortality in the THR group but there were 2 mortalities in the TTR group from mediastinitis (1 patients) and pulmonary embolism (1 patient). The median survival rates were 19 and 16.5 months, respectively, for the THR and TTR groups (P>0.05). In conclusion, although there was no demonstrable statistical difference in results between THR and TTR approaches, the THR approach is preferred as early survival rate are better and should be considered for all cases with adenocarcinoma of the lower end of the oesophagus.