Esophageal carcinoma: Patient selection for transhiatal esophagectomy. A prospective analysis of 50 consecutive cases

• Published in: World journal of surgery 1988-04, Vol.12 (2), p.263-268
• Main Authors: Barbier, Peter A., Becker, Christoph D., Wagner, Hans E.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Como; Esophageal Carcinoma; Esophageal Neoplasms - diagnosis; Esophageal Neoplasms - pathology; Esophageal Neoplasms - surgery; Esophagus; Female; Gastroenterology. Liver. Pancreas. Abdomen; Geriatric Patient; Humans; Male; Medical sciences; Methods; Middle Aged; Postoperative Complications; Preoperative Compute Tomographic; Prospective Studies; Thoracic Esophagus; Tumors
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/BF01658071

Fifty patients underwent transhiatal esophagectomy (THE) without thoracotomy with gastric interposition for esophageal carcinoma. Resection was considered curative in 15 patients with stage I or II, and palliative in 35 patients classified as stage III or IV. Postoperative morbidity was 42%. The frequency of complications was significantly higher following palliative surgery than after curative surgery. The mortality rate was 2%. On the basis of the clinical, diagnostic, surgical, and histologic data for all patients, criteria for patient selection are defined. Patients with tumors of the pretreatment T3 category and those with systemic metastases were excluded from the study. Differentiation between the pretreatment T1 and T2 categories was without importance in determining the suitability for THE. In advanced tumors of the upper thoracic esophagus, involvement of the tracheobronchial system may preclude complete removal of the tumor. Sharp dissection, which is often required in these cases, increases the risk of THE. Because such involvement can be recognized accurately on computed tomographic (CT) examination of the mediastinum, tumors of the upper thoracic esophagus should only be treated by THE if there are no signs of involvement of the tracheobronchial system on preoperative CT. Respiratory impairment rarely constitutes a contraindication, and THE is well tolerated even by geriatric patients. THE is a safe procedure for both curative and palliative resection of esophageal carcinoma provided that candidates for this operation are selected properly. Résumé Cinquante malades présentant un cancer de l'oesophage ont été traités par oesophagectomie trans‐hiatale sans thoracotomie, l'exérèse étant suivie de l'interposition de l'estomac. La résection a été pratiquée à titre curatif chez 15 malades présentant une tumeur de stade I ou II et à titre palliatif chez 35 malades présentant une tumeur de stade II ou III. La morbidité postopératoire a été de 42%; elle a été plus importante lorsque l'opération a été pratiquée à titre palliatif. La mortalité fut de 2%. Les critères de sélection des malades ont été définis à partir des données cliniques, diagnostiques, chirurgicales, et histologiques. Les malades qui présentaient des tumeurs de stade III ou des métastases ont été exclus de l'étude. La différenciation entre tumeur de stade I et tumeur de stade II a été sans importance eu égard à la possibilité de l'intervention. L'envahissement de l'arbre trachéo‐bronch