Transthoracic versus transhiatal esophagectomy – influence on patient survival

Łochowski, Mariusz; Łochowska, Barbara; Kozak, Józef

doi:10.5114/pg.2016.64609

Cited by 5 publications

(9 citation statements)

References 12 publications

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“… 35 , 36 , 37 , 38 With the transhiatal approach, we obtained a mean proximal resection margin of 42.4 mm, which is similar to margins obtained by other authors with the thoraco-abdominal approach. 32 , 35 , 36 , 37 , 38 Duan reported a 38 mm margin with right thoracoabdominal approach in their patients’ population, which corresponds to the results obtained in our study. 32 Studies have demonstrated that in patients with type S II and S III only in a dismal number of patients the tumor invaded more than 25 mm beyond the proximal margin.…”

Section: Discussionsupporting

confidence: 87%

“… 13 , 33 Many studies also confirmed that the overall 5-year survival did not depend on the surgical approach as long as R0 resection could be obtained. 13 , 33 , 35 , 37 , 39 The patients in our cohort had a 5-year OS of 33.4%. The independent predictors for long-term survival were T and N stage, multivisceral resection and microscopic free surgical margins.…”

Section: Discussionmentioning

confidence: 72%

“…The overall 5-year survivals for S II and S III patients were reported to be from 16% to 58%. 6 , 7 , 8 , 9 , 13 , 33 , 35 , 39 Although the Eastern authors consistently reported 5-year survival rates above 40%, most of Western authors report survivals over 30%. 13 , 33 Many studies also confirmed that the overall 5-year survival did not depend on the surgical approach as long as R0 resection could be obtained.…”

Section: Discussionmentioning

confidence: 99%

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Outcomes of the surgical treatment for adenocarcinoma of the cardia – single institution experience

Potrč

Ivanecz

Krebs

et al. 2017

Radiology and Oncology

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BackgroundAdenocarcinomas at the cardia are biologically aggressive tumors with poor long-term survival following curative resection. For resectable adenocarcinoma of the cardia, mostly esophagus extended total gastrectomy or esophagus extended proximal gastric resection is performed; however, the surgical approach, transhiatal or transthoracic, is still under discussion. Postoperative morbidity, mortality and long-term survival were analyzed to evaluate the potential differences in clinically relevant outcomes.Patients and methodsOf altogether 844 gastrectomies performed between January 2000 and December 2016, 166 were done for the adenocarcinoma of the gastric cardia, which we analyzed with using the Cox proportional hazards model.Results136 were esophagus extended total gastrectomy and 125 esophagus extended proximal gastric resection. A D2 lymphadenectomy was performed in 88.2%, splenectomy in 47.2%, and multivisceral resections in 12.4% of patients. R0 resection rate was 95.7%. The mean proximal resection margin on the esophagus was 42.45 mm. It was less than 21 mm in 9 patients. Overall morbidity regarding Clavien-Dindo classification (> 1) was altogether 28.6%. 15.5% were noted as surgical and 21.1% as medical complications. The 30-day mortality was 2.2%. The 5-year survival for R0 resections was 33.4%. Multivisceral resection, depth of tumor infiltration, nodal stage, and curability of the resection were identified as independent prognostic factors.ConclusionsTranshiatal approach for resection of adenocarcinoma of the cardia is a safe procedure for patients with Siewert II and III regarding the postoperative morbidity and mortality; moreover, long-term survival is comparable to transthoracic approach. The complications associated with thoracoabdominal approach can therefore be avoided with no impact on the rate of local recurrence.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Outcomes of the surgical treatment for adenocarcinoma of the cardia – single institution experience

Potrč

Ivanecz

Krebs

et al. 2017

Radiology and Oncology

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“…28 A recent study has shown that patients who underwent transthoracic esophagectomy had significantly more lymph nodes removed than those who underwent transhiatal esophagectomy. 16 However, some other studies showed no difference between the two groups. 20,26,29-30 Concordantly, we found no significant difference between the two groups regarding the mean number of dissected lymph nodes.…”

Section: Discussionmentioning

confidence: 93%

“…Most of previous studies found no significant difference between the two groups regarding postoperative deaths and patients’ survival. 15-16,21 However, a meta-analysis in 2014 showed that transhiatal esophagectomy led to lower 30-day postoperative mortality rates. 20…”

Section: Discussionmentioning

confidence: 99%

Transhiatal versus Left Transthoracic Esophagectomy for Gastroesophageal Junction Cancer; The Impact of Surgical Approach on Postoperative Complications

Mir

Lashkari

Ghalehtaki

et al. 2019

Middle East J Dig Dis

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BACKGROUND Esophagectomy is the mainstay of treatment for esophageal cancer. Although different surgical approaches have been described, choosing the most appropriate technique is still on debate. We compared the complications of transhiatal esophagectomy (THE) versus left transthoracic esophagectomy (LTE) among a group of Iranian patients with gastroesophageal junction cancer. METHODS This was a retrospective study between 2011 and 2013 on 40 patients with gastroesophageal cancer. 23 patients underwent THE and the others underwent LTE. 30-day postoperative mortality, complications, duration of hospital stay, and number of dissected lymph nodes were studied. RESULTS 37.5% of the patients had squamous cell carcinoma. No mortality was seen. Totally, 10 patients suffered from complications. Cardiac and pulmonary complications occurred in eight and six patients, respectively. No patients suffered from vocal cord injuries and anastomotic leakage. The mean duration of postoperative hospital stay was 11.82 ± 3.8 days, and the mean number of dissected lymph nodes was 8.2 ± 3.9. No significant difference was seen between the two groups (p > 0.05). CONCLUSION Choosing between the approaches for resection of gastroesophageal cancer may not impact the complications and mortality rates. We propose that LTE approach could be used safely in comparison with THE, and that selecting between THE and LTE may be based on the surgeon’s preference and experience.

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A Comparative Study between the Postoperative Complications of Stripping Esophagectomy and Classic (Orringer's Technique) Esophagectomy

2022

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Recent studies have suggested that morbidity and mortality rate of transhiatal esophagectomy is comparable to that of thoracotomy, calling the need for the modifications in the surgical procedures. Our methodology includes stripping of esophagus by nasogastric tube to reduce the manipulation of thoracic cavity and associated complications. We also present the comparison between the stripping and classic (Orringer's technique) esophagectomy.Patients presenting esophageal carcinoma from 2015 to 2017 were the target of this study. Patients undergoing esophagectomy were randomized to have classic or stripping esophagectomy. Operating time, manipulation time, blood losses during the surgery, duration of hospitalization, volume intake, hypotension time, arrhythmia, and transfusion were the recorded parameters. Complications, such as anastomotic leak, cardiac effects, and morbidity, were also studied. Seventy patients were referred for transhiatal esophagectomy for esophageal carcinoma at the Al Zahra Hospital. Mean ages of patients in the stripping and Orringer group were 64.00 ± 10.57 and 57.42 ± 12.20 years, respectively. Manipulation time, operating time, blood loss during the surgery, and transfusion were statistically significant variables between the two groups. Although volume intake and duration of hospitalization were not significantly different parameters, however, betterment in the outcomes was evident. Substantial decrease in overall complications via stripping method was obtained, hence can be suggested as an effective alternative, to remove the need of thoracotomy, for transhiatal esophagectomy.

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Transthoracic versus transhiatal esophagectomy – influence on patient survival

Cited by 5 publications

References 12 publications

Outcomes of the surgical treatment for adenocarcinoma of the cardia – single institution experience

Outcomes of the surgical treatment for adenocarcinoma of the cardia – single institution experience

Transhiatal versus Left Transthoracic Esophagectomy for Gastroesophageal Junction Cancer; The Impact of Surgical Approach on Postoperative Complications

A Comparative Study between the Postoperative Complications of Stripping Esophagectomy and Classic (Orringer's Technique) Esophagectomy

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