Clinical Results of Transhiatal Esophagectomy for Carcinoma of the Lower Esophagus

Toshihiro Hirai, Yoshinori Yamashita, Hidenori Mukaida, Takashi Iwata, Shuuji Saeki, Akihiro Yoshimoto, Tetsuya Toge

Department of Surgery, Research Institute for Nuclear Medicine and Biology, Hiroshima University

On the basis of experimental studies showing that the excessive operative stress of thoracolaparotomy enhances tumor growth and metastasis, we chose transhiatal esophagectomy for all resectable carcinomas of the lower esophagus and carcinoma of the middle and upper thoracic esophagus in the early stage. The records of 33 patients with carcinoma in the lower esophagus who received transhiatal esophagectomies were analyzed for complications, late results and sites of first recurrence. Pneumothorax occurred in 8 patients (24%), recurrent nerve paralysis in 4 (12%) and pneumonia in 3 (9%). Operative mortality within 30 days was 6% (2/33) due to laceration of the azygos vein during the operation and mediastinitis. The survival rate for 31 patients (2 cases of operative death were excluded) was 24.8%. The sites of first recurrence in the 31 patients with carcinoma of the lower esophagus were investigated. In 9 patients (29%) the site was parenchymatous organs, in 4 patients (13%) it was lymph nodes (bifurcation, pulmonal hilar, posterior mediastinal and para-aortic lymph node, one each), in 2 patients (6%) recurrence was disseminated and in one patient the first recurrence was in the remnant esophagus. These results indicated that transhiatal esophagectomy causes minimal surgical stress, and gives equivalent a survival rate to that after thoracolaparotomy. Intensive multidisciplinary treatment using irradiation and immunochemotherapy may be required to improve the prognosis.

Key words
esophageal cancer, transhiatal esophagectomy, postoperative complications, late results

Reprint requests
Toshihiro Hirai Department of Surgery, Research Institute for Nuclear Medicine and Biology, Hiroshima University
1-2-3 Kasumi, Minami-ku, Hiroshima, 734 JAPAN

Accepted
October 7, 1992

To read the PDF file you will need Abobe Reader installed on your computer.