Transhiatal esophagectomy in a high volume institution
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Transhiatal esophagectomy in a high volume institution Andrew R Davies, Matthew J Forshaw, Aadil A Khan, Alia S Noorani, Vanash M Patel, Dirk C Strauss and Robert C Mason* Address: Department of general surgery, St Thomas' hospital, Guy's and St Thomas', NHS foundation trust, Lambeth Palace Road, London, SE1 7EH, UK Email: Andrew R Davies - [email protected]; Matthew J Forshaw - [email protected]; Aadil A Khan - [email protected]; Alia S Noorani - [email protected]; Vanash M Patel - [email protected]; Dirk C Strauss - [email protected]; Robert C Mason* - [email protected] * Corresponding author
Published: 20 August 2008 World Journal of Surgical Oncology 2008, 6:88
doi:10.1186/1477-7819-6-88
Received: 28 April 2008 Accepted: 20 August 2008
This article is available from: http://www.wjso.com/content/6/1/88 © 2008 Davies et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract Background: The optimal operative approach for carcinoma at the lower esophagus and esophagogastric junction remains controversial. The aim of this study was to assess a single unit experience of transhiatal esophagectomy in an era when the use of systemic oncological therapies has increased dramatically. Study Design: Between January 2000 and November 2006, 215 consecutive patients (182 males, 33 females, median age = 65 years) underwent transhiatal esophagectomy; invasive malignancy was detected preoperatively in 188 patients. 90 patients (42%) received neoadjuvant chemotherapy. Prospective data was obtained for these patients and cross-referenced with cancer registry survival data. Results: There were 2 in-hospital deaths (0.9%). Major complications included: respiratory complications in 65 patients (30%), cardiovascular complications in 31 patients (14%) and clinically apparent anastomotic leak in 12 patients (6%). Median length of hospital stay was 14 days. The radicality of resection was inversely related to T stage: an R0 resection was achieved in 98–100% of T0/1 tumors and only 14% of T4 tumors. With a median follow up of 26 months, one and five year survival rates were estimated at 81% and 48% respectively. Conclusion: Transhiatal esophagectomy is an effective operative approach for tumors of the infracarinal esophagus and the esophagogastric junction. It is associated with low mortality and morbidity and a five survival rate of nearly 50% when combined with neoadjuvant chemotherapy.
Introduction During the last thirty years, there has been a marked increase in the incidence of adenocarcinoma close to the esophagogastric junction whilst the incidence of squamous cell carcinoma of the esophagus has remained relatively unchanged [1]. Surgical resection of tumors in the esophagus and esophagogastric junction h
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