Transhiatal Esophagectomy in Squamous Cell Carcinoma of the Esophagus: What Are the Best Indications?

Abstract

Background: Southern Brazil has one of the highest incidences of esophageal squamous cell carcinoma in the world. Transthoracic esophagectomy allows more complete abdominal and thoracic lymphadenectomy than transhiatal. However, this one is associated with less morbidity. Aim: To analyze the outcomes and prognostic factors of squamous esophageal cancer treated with transhiatal procedure. Methods: All patients selected for transhiatal approach were included as a potentially curative treatment and overall survival, operative time, lymph node analysis and use of neoadjuvant therapy were analyzed. Results: A total of 96 patients were evaluated. The overall 5-year survival was 41.2%. Multivariate analysis showed that operative time and presence of positive lymph nodes were both associated with a worse outcome, while neoadjuvant therapy was associated with better outcome. The negative lymph-node group had a 5-year survival rate of 50.2%. Conclusion: Transhiatal esophagectomy can be safely used in patients with malnutrition degree that allows the procedure, in those with associated respiratory disorders and in the elderly. It provides considerable long-term survival, especially in the absence of metastases to local lymph nodes. The wider use of neoadjuvant therapy has the potential to further increase long-term survival.

Cervical Esophagogastric Anastomosis Fistula Following Esophagectomy: A Problem With No Solution?

“…Thus, in recent years, we observed an improvement in surgical results with acceptable rates of complications 10 . However, when evaluating the surgical results, transthoracic esophagectomy shows more extensive lymphadenectomy related to a more significant number of resected lymph nodes.…”

The Esophageal, Gastric, and Colorectal Tumors and the Esophagogastroduodenoscopies and Colonoscopies by the Brazilian Unified Health System: What Is the Importance?

“…The incidence and statistics of malignant tumors of the esophagus, stomach, and colorectal in the Brazilian population are high and significant 1 , 15 , 29 . The most frequent malignant esophageal tumors are squamous cell carcinomas, followed by adenocarcinomas, which affect the esophagogastric junction.…”

“…The cost-effectiveness for detecting malignant esophagogastric junction and gastric tumors in the United States, in a high-risk population, using EGDs, was considered advantageous, in relation to the cost of surgical and oncological treatment of these tumors when diagnosed in advanced phase 26 , 29 .…”

“…Patients looking for medical help present these tumors in an advanced form; so it is important to implement specific health actions to provide orientations to the population, encouraging the early search for Medical Services and requesting these endoscopic examinations, for the diagnosis the tumors in early stages. The diagnosis of these tumors in early and non-advanced stages allows greater chances of surgical and oncological treatments, making possible better disease control and increased survival and quality of life 1 , 14 , 29 .…”

“…In Brazil, as in North America, Europe, and some countries in Asia, esophagus, stomach, and colorectal malignant tumors are among the most frequent cancer in the population, in both sexes, becoming a public health problem, since they involve health services, hospital, and outpatient clinics, of medium and high complexity 1 , 4 , 12 , 29 .…”