Two thousand transhiatal esophagectomies: changing trends, lessons learned

• Published in: Annals of surgery 2007-09, Vol.246 (3), p.363-374
• Main Authors: Orringer, Mark B, Marshall, Becky, Chang, Andrew C, Lee, Julia, Pickens, Allan, Lau, Christine L
• Format: Article
• Language: English
• Subjects: Aged; Chi-Square Distribution; Early Ambulation; Esophageal Diseases - mortality; Esophageal Diseases - surgery; Esophageal Neoplasms - mortality; Esophageal Neoplasms - surgery; Esophagectomy - methods; Female; Humans; Length of Stay - statistics & numerical data; Logistic Models; Male; Middle Aged; Original; Postoperative Complications; Proportional Hazards Models; Retrospective Studies; Stomach - transplantation; Survival Rate; Treatment Outcome
• ISSN: 0003-4932; 1528-1140
• DOI: 10.1097/SLA.0b013e31814697f2

"Rediscovered" in 1976, transhiatal esophagectomy (THE) has been applicable in most situations requiring esophageal resection and reconstruction. The objective of this study was to review the authors' 30-year experience with THE and changing trends in its use. Using the authors' prospective Esophagectomy Database, this single institution experience with THE was analyzed retrospectively. Two thousand and seven THEs were performed-1063 (previously reported) between 1976 and 1998 (group I) and 944 from 1998 to 2006 (group II), 24% for benign disease, 76%, cancer. THE was possible in 98%. Stomach was the esophageal substitute in 97%. Comparing outcomes between group I and group II, statistically significant differences (P < 0.001) were observed in hospital mortality (4% vs. 1%); adenocarcinoma histology (69% vs. 86%); use of neoadjuvant chemoradiation (28% vs. 52%); mean blood loss (677 vs. 368 mL); anastomotic leak (14% vs. 9%); and discharge within 10 days (52% vs. 78%). Major complications remain infrequent: wound infection/dehiscence, 3%, atelectasis/pneumonia, 2%, intrathoracic hemorrhage, recurrent laryngeal nerve paralysis, chylothorax, and tracheal laceration,