Transthoracic versus transhiatal esophagectomy

ABSTRACT

Due to our geographical area of living, esophageal cancer is one of the most common cancers in gastrointestinal system. Treatment of choice in these diseases is surgery. Because of various kinds of surgical techniques, in this study we tried to compare common techniques in these groups of patients. In a retrospective study between 1990 and 2005 all patients with esophageal cancer in middle and distal third of esophagus whom underwent transhiatal or transthoracic esophagectomy, have been studied about age, sex, pathology of tumor and tumor staging. Then in other study, with considering special parameters of two groups [transhiatal or transthoracic] are studied separately about factors such as intraoperative bleeding, operation time, post-operation morbidity, time of hospitalization, mortality 30 days after surgery, incidence of anastomosis leak and stenosis and survival have been evaluated. 156 patients entered our study with M/F=110/46 ratio. 116 patients with S.C.C and 40 patients with adenocarcinoma. The comparing study between transhiatal groups with Ivor Lewis groups [with similarization] showed intraoperate bleeding, cardiac and pulmonary complications after surgery, mean time of hospitalization, mortality in 30 days after surgery and incidence of late stenosis and survival are similar but the incidence of anastomosis leakage was higher in transhiatal group and mean operation time was longer in Ivor Lewis group. Since the leakage was more common in transhiatal group but mortality rates were the same, it indicates that leaking in neck has a better outcome. According to the results of this study, both of these techniques are similar and choosing one of them depends on surgeon's choice and patient's conditions