Transhiatal Esophagectomy for Treatment of Benign and Malignant Esophageal Disease

Abstract

Since our initial 1978 report, we have performed transhiatal esophagectomy (THE) in 1085 patients with intrathoracic esophageal disease: 285 (26%) benign lesions and 800 (74%) malignant lesions (4.5% upper, 22% middle, and 73.5% lower third/cardia). THE was possible in 97% of patients in whom it was attempted; reconstruction was performed at the same operation in all but six patients. The esophageal substitute was positioned in the original esophageal bed in 98%, stomach being used in 782 patients (96%) and colon in those with a prior gastric resection. Hospital mortality was 4%, with three deaths due to uncontrollable intraoperative hemorrhage. Major complications included anastomotic leak (13%), atelectasis/pneumonia prolonging hospitalization (2%), recurrent laryngeal nerve paralysis, chylothorax, and tracheal laceration (< 1% each). There were five reoperations for mediastinal bleeding within 24 hours of THE. Intraoperative blood loss averaged 689 ml. Altogether, 78% of the patients had no postoperative complications. Actuarial survival of the cancer patients mirrors that reported after transthoracic esophagectomy. Late functional results are good or excellent in 80%. Approximately 50% have required one or more anastomotic dilatations. With intensive preadmission pulmonary and physical conditioning, use of a side-to-side staple technique (which has reduced the cervical esophagogastric anastomotic leak rate to less than 3%), and postoperative epidural anesthesia, the need for an intensive care unit stay has been eliminated and the length of hospital stay was reduced to 7 days. We concluded that THE can be achieved in most patients requiring esophageal resection for benign and malignant disease and with greater safety and less morbidity than the traditional transthoracic approaches.

Video-assisted esophagectomy for esophageal cancer

“…TTE with extensive lymph node dissection is applied as an extensive operation for the esophageal cancer which is mainly located within higher to middle thoracic esophagus. THE is mainly applied for the lower and abdominal esophagus 40 . Although the literature which compares TTE and THE with randomized study did not prove the statistically significant difference in long term survival of these two operations for thoracic esophageal cancer [41][42][43][44] , meta-analysis of these two procedures concluded that although TTE has a higher early morbidity in pulmonary dysfunction and mortality rate 13 , there was a trend regarding the improvement of the long term survival.…”

Mucosectomia esofágica no tratamento do megaesôfago avançado: análise de 60 casos

“…[1][2][3][4][5][6][7][8][9][10][11][12] A vantagem desta via de acesso é a de evitar o comprometimento da dinâmica pulmonar. Entretanto, pode haver a abertura da pleura e, como conseqüência, o desenvolvimento de hemo ou hidropneumotórax, acarretando maior morbidade pós-operatória.…”

Colonic Esophageal Reconstruction by Substernal Approach for Caustic Stricture: What is the Impact of the Enlargement of the Thoracic Inlet on Cervical Anastomotic Complications?

“…The incidence of anastomotic leakage was higher than that of oesophageal reconstruction through the posterior mediastinum [9,10]. This incidence varied from 19 to 70% [11][12][13][14]. It has been reported that nearly 50% of cervical anastomotic leaks result from anastomotic strictures and the subsequent need for chronic dilatations, which negate the merits of an operation intended to restore comfortable swallowing [15].…”