Transhiatale oesofagusresectie zonder thoracotomie vanwege carcinoom: complicaties, ziekenhuissterfte en prognose bij 115 patiënten

To evaluate the short-term and long-term clinical outcome of transhiatal oesophagectomy without thoracotomy for cancer.

Design

Retrospective.

Methods

In the period January 1993-August 1996, 115 patients underwent a transhiatal oesophagectomy with curative intent for adenocarcinoma or squamous cell carcinoma of the middle or distal oesophagus or oesophagogastric junction. There were 87 men and 28 women with a median age of 65 years (range: 37-83). Median duration of postoperative follow-up was 27 months (range: 1-74) for all patients, and 45 months (range: 30-74) for those alive at final follow-up.

Results

No emergency thoracotomies were necessary. In-hospital mortality was 3.5 (4 patients). Vocal cord dysfunction (24) and pulmonary complications (23) were the most frequent early postoperative complications. Clinical leakage of the cervical anastomosis occurred in 8 patients (7). Forty per cent developed a benign anastomotic stricture which was treated by (repeated) endoscopic dilatation. A microscopically radical resection was achieved in 73 of the patients. Overall survival was 45 at 3 years.

Conclusion

Transhiatal oesophagectomy without thoracotomy can be considered a safe procedure for resectable cancer of the midoesophagus, the distal oesophagus or the oesophagogastric junction. Long-term oncological treatment results were in line with the data reported for oesophageal resections via a transthoracic approach.