Transthoracic versus transhiatal resection for esophageal adenocarcinoma of the lower esophagus: A value‐based comparison

Abstract

Background and Objective Our objective was to compare clinical outcomes, costs, and resource use based on operative approach, transthoracic (TT) or transhiatal (TH), for resection of esophageal cancer. Methods This cohort analysis utilized the Surveillance, Epidemiology, and End Results—Medicare linked data from 2002 to 2009. Only adenocarcinomas of the lower esophagus were examined to minimize confounding. Medicare data was used to determine episode of care costs and resource use. Propensity score matching was used to control for identified confounders. Kaplan–Meier method and Cox-proportional hazard modeling were used to compare long-term survival. Results 537 TT and 405 TH resections were identified. TT and TH esophagectomy had similar complication rates (46.7% vs. 50.8%), operative mortality (7.9% vs 7.1%), and 90 days readmission rates (30.5% vs. 32.5%). However, TH was associated with shorter length of stay (11.5 vs. 13.0 days, P = 0.006) and nearly $1,000 lower cost of initial hospitalization (P = 0.03). No difference in 5-year survival was identified (33.5% vs. 36%, P = 0.75). Conclusions TH esophagectomy was associated with lower costs and shorter length of stay in an elderly Medicare population, with similar clinical outcomes to TT. The TH approach to esophagectomy for distal esophageal adenocarcinoma may, therefore, provide greater value (quality/cost).

Excess Cost and Predictive Factors of Esophagectomy Complications in the SEER-Medicare Database

“…Few details are known regarding the specific costs and factors associated with the costs of complications after esophagectomy [9][10][11]. Such data are needed to improve quality and value after esophagectomy.…”

Comparison of conventional magnetic resonance imaging, cine-magnetic resonance imaging, and operation findings in invasion assessment of esophageal cancer

“…In such cases, second thoracotomy would be a more invasive method for the patients. Another important issue is that, as in our study, many cases with appearance of invasion in the conventional thoracic CT and conventional MRI are not actually T 4 . Surgery operation should not be delayed in suitable patients with the absence of invasion by cine-MRI.…”

“…In addition, favorable preoperative assessment and postoperative care are of utmost importance for the success. [4,5] Staging of esophageal cancer has a major role in determining grade of the disease, planning of treatment, and prognosis. In the preoperative staging of esophageal cancer, endoscopic ultrasonography (EUS), positron emission tomography (PET), computed tomography (CT), multi-detector computed tomography (MDCT), and magnetic resonance imaging (MRI) are used.…”

Prognostic value of right upper mediastinal lymphadenectomy in Sweet procedure for esophageal cancer

“…Whether extensive LND can improve 5-year survival rate remains debatable. Some studies showed that 5-year survival rates were not significantly different between the extended LND via transthoracic and limited LND via transhiatal for esophageal adenocarcinoma (13)(14)(15). Despite no significant difference, other studies showed a trend toward improved 5-year survival with the extended transthoracic approach (6,7,16,17).…”