Does transthoracic compared to transhiatal resection alter the early postoperative course of oesophagectomy?

• Published in: Diseases of the esophagus 2005-08, Vol.18 (3), p.155-159
• Main Authors: Márton, S., Szakmány, T., Papp, A., Cseke, L., Horváth, P. O.
• Format: Article
• Language: English
• Subjects: Aged; Esophagectomy; Female; Humans; Laparotomy; Male; microalbuminuria; Middle Aged; Postoperative Complications; procalcitonin; Retrospective Studies; systemic inflammatory response; Thoracotomy; transthoracic and transhiatal esophagectomy; Treatment Outcome
• ISSN: 1120-8694; 1442-2050
• DOI: 10.1111/j.1442-2050.2005.00479.x

Several techniques for esophageal resections have been reported. However, clear clinical evidence is still lacking whether any of the procedures is superior to the others regarding morbidity and mortality in the early postoperative period. Two operative approaches for esophageal carcinoma, transhiatal and transthoracic, were compared with respect to operative morbidity, mortality and systemic inflammatory response. In our prospective study between 2000 and 2002 83 patients were investigated. In a retrospective post hoc analysis patients were divided into two groups due to the performed operational procedure, transhiatal (TH) or transthoracic (TT). Multiple Organ Dysfunction Score (MODS) was monitored daily (t1,t2,t3). Serum procalcitonin (PCT) levels were determined on admission to the ICU (t0), then 24 hourly (t24,t48,t72). Microalbuminuria (M:Cr) was measured before (tp), and after surgery (t0,t6,t24,t48,t72). For statistical analysis Wilcoxon rank sum test, Mann–Whitney U‐test and chi‐square test were used as appropriate. We examined 52 patients in the TH group, and 31 patients in the TT group. There was no significant difference between the two groups regarding age, male/female ratio, and SAPS II scores. Operations lasted significantly longer in the TT group: 375 (300–480) min compared to the TH group 240 375 (180–319) min, P