Transthoracic versus Extrathoracic Esophagectomy: Mortality, Morbidity, and Long-term Survival

Shahian, David M.; Neptune, Wilford B.; Ellis, F. Henry; Watkins, Elton

doi:10.1016/s0003-4975(10)62762-2

Cited by 117 publications

(23 citation statements)

References 61 publications

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“…The rate is equal to that of the mediastinal lower periesophageal nodes, which are the closest lymph nodes to the lesion. In our series, the 5-year survival rate of 33.6% for the patients with positive nodes certainly indicates the positive effect of our lymph node dissection on prognosis, because the rate is not at all inferior to any surgical result reported in the literature, even when investigators included those patients without lymph node metastasis [8,13,14]. Thirteen patients (16.5%) had one positive node, and the significantly better prognosis of those patients with no or one positive node again indicates the positive effect of lymph node dissection on prognosis.…”

Section: Discussionsupporting

confidence: 62%

Lymph node metastasis in thoracic esophageal carcinoma

Kato

Tachimori

Iizuka

et al. 1991

Journal of Surgical Oncology

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Seventy-nine patients with thoracic esophageal carcinoma underwent transthoracic esophagectomy with neck, mediastinal, and abdominal lymphadenectomy. The operative mortality rate was 3.8%. Fifty-seven patients (72.2%) had metastasis in the lymph nodes. Though three patients with carcinoma classified as pTis had no positive nodes, nine (50.0%) of the patients with a pT1 carcinoma had positive nodes. The 5-year survival rate for 57 patients with positive nodes was 33.6%. Twenty-nine patients (36.7%) had positive nodes in the neck; 47 (59.5% ), in the mediastinum; and 33 (41.8%), in the abdomen. Their 5-year survival rates were 30.0%, 24.4%, and 38.4%, respectively. The differences between these rates were not statistically significant. These results indicate that the neck lymph nodes should be regarded as part of the regional lymph nodes and that esophagectomy with wide lymph node dissection improves the long-term survival of patients with thoracic esophageal carcinoma.

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Section: Discussionsupporting

confidence: 62%

Lymph node metastasis in thoracic esophageal carcinoma

Kato

Tachimori

Iizuka

et al. 1991

Journal of Surgical Oncology

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“…In a series of 304 EWT collected by Perrachia and Bardini, the pulmonary complications were as follows: tracheobronchial tear (1.5%), pleural effusion (17.8%), and operative mortality rate 10.3% [I1]. Shahian et al have reported a respiratory morbidity rate higher (although nonsignificantly) after EWT than after open esophagectomy [13]. The technique of endoscopic dissection as described by Kipfm~ller et al seems to be much safer than EWT [4]: their blood loss was five times less, they had no pneumothorax (vs 71%), and the vagus nerves were preserved, avoiding recurrent laryngeal nerve palsy observed in 17% of the patients after EWT [7].…”

Section: Discussionmentioning

confidence: 99%

“…Esophagectomy without thoracotomy (EWT) has been suggested as a way to reduce this morbidity [10]. However, this theorical advantage has not been demonstrated [13], and the procedure may be complicated by mediastinal hemorrage, tracheal tear, and recurrent laryngeal nerve injury [7,9]. In addition, this "blind" dissection cannot remove the periesophageal tissue and the mediastinal nodes.…”

Section: Abstract: Esophagus -Esophagectomy -Vagotomy -Esophageal Mymentioning

confidence: 99%

Thoracoscopic dissection of the esophagus: an experimental study

et al. 1992

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In order to reduce the respiratory morbidity of thoracotomy in esophageal surgery, several methods have been used, such as blunt dissection and endoscopic dissection through mediastinoscopy. It seems that the latter reduces drastically the morbidity but does not allow full visualization of the esophageal wall, a disadvantage in some circumstances. We describe a thoracoscopic dissection of the esophagus which gives a large and magnified view of the pleural cavity, of the mediastinum, and of the esophagus.

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“…In prospective but nonrandomized studies, Hortsmann et al [34] and Shalian et al [35] have failed to show that transthoracic esophagectomy with systemic two-field lymphadenectomy results in longer survival (Table II). Only one random-assignment study with a limited number of patients has been performed comparing transhiatal and transthoracic esophagectomy, both without any form of extended lymph node dissection.…”

Section: Esophageal Cancermentioning

confidence: 99%

“…In this study, Goldminc et al [36] found that overall survival in either node-negative or node-positive patients was not significantly different (Table II). However, transhiatal esophagectomy is not viewed as a procedure that is easier or safer than transthoracic esophagectomy, but rather as an alternative in the surgical armamentarium [35]. Transthoracic esophagectomy is preferred unless there are significant contraindications [33,37].…”

Section: Esophageal Cancermentioning

confidence: 99%