Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2007 Sep;246(3):363-72; discussion 372-4.
doi: 10.1097/SLA.0b013e31814697f2.

Two thousand transhiatal esophagectomies: changing trends, lessons learned

Mark B Orringer  1 , Becky Marshall, Andrew C Chang, Julia Lee, Allan Pickens, Christine L Lau
Affiliations

Two thousand transhiatal esophagectomies: changing trends, lessons learned

Mark B Orringer et al. Ann Surg. 2007 Sep.

Abstract

Objective: "Rediscovered" in 1976, transhiatal esophagectomy (THE) has been applicable in most situations requiring esophageal resection and reconstruction. The objective of this study was to review the authors' 30-year experience with THE and changing trends in its use.

Methods: Using the authors' prospective Esophagectomy Database, this single institution experience with THE was analyzed retrospectively.

Results: Two thousand and seven THEs were performed-1063 (previously reported) between 1976 and 1998 (group I) and 944 from 1998 to 2006 (group II), 24% for benign disease, 76%, cancer. THE was possible in 98%. Stomach was the esophageal substitute in 97%. Comparing outcomes between group I and group II, statistically significant differences (P < 0.001) were observed in hospital mortality (4% vs. 1%); adenocarcinoma histology (69% vs. 86%); use of neoadjuvant chemoradiation (28% vs. 52%); mean blood loss (677 vs. 368 mL); anastomotic leak (14% vs. 9%); and discharge within 10 days (52% vs. 78%). Major complications remain infrequent: wound infection/dehiscence, 3%, atelectasis/pneumonia, 2%, intrathoracic hemorrhage, recurrent laryngeal nerve paralysis, chylothorax, and tracheal laceration, <1% each. Late functional results have been good or excellent in 73%. Aggressive preoperative conditioning, avoiding the ICU, improved pain management, and early ambulation reduce length of stay, with 50% in group II discharged within 1 week.

Conclusion: THE refinements have reduced the historic morbidity and mortality of esophageal resection. This largest reported THE experience reinforces the value of consistent technique and a clinical pathway in managing these high acuity esophageal patients.

PubMed Disclaimer

Figures

None
FIGURE 1. Kaplan-Meier actuarial survival curve of 1482 patients undergoing transhiatal esophagectomy for carcinoma of the intrathoracic esophagus and cardia.
None
FIGURE 2. Site-dependent Kaplan-Meier survival curves in patients undergoing transhiatal esophagectomy for carcinoma of the intrathoracic esophagus and cardia. Differences in survival were statistically significant (P < 0.0001).
None
FIGURE 3. Kaplan-Meier survival curves in 583 patients who received chemotherapy and radiation therapy before THE. One hundred and twenty-five (21%) were “complete responders” (T0N0 tumors) whose survival was considerably better than those with residual carcinoma in the resected specimen. Differences in survival were statistically significant (P < 0.0001).
None
FIGURE 4. Stage-dependent Kaplan-Meier actuarial survival curves in patients undergoing transhiatal esophagectomy for carcinoma of the intrathoracic esophagus and cardia.
None
FIGURE 5. Histology-dependent Kaplan-Meier survival curves in patients undergoing transhiatal esophagectomy for carcinoma of the intrathoracic esophagus and cardia. Differences in survival were statistically significant (P < 0.0001).
See this image and copyright information in PMC

References

    1. Orringer MB, Sloan H. Esophagectomy without thoracotomy. J Thorac Cardiovasc Surg. 1978;76:643–654. - PubMed
    1. Denk W. Zur Radikaloperation des Osophaguskarfzentralbl. Chirurg. 1913;40:1065–1068.
    1. Turner GG. Excision of thoracic esophagus for carcinoma with construction of extrathoracic gullet. Lancet. 1933;2:1315–1316.
    1. Ong GB, Lee TC. Pharyngogastric anastomosis after oesophagopharyngectomy for carcinoma of the hypopharynx and cervical oesophagus. Br J Surg. 1960;48:193–200. - PubMed
    1. LeQuesne LP, Ranger D. Pharyngogastrectomy with immediate pharyngogastric anastomosis. Br J Surg. 1966;53:105–109. - PubMed

MeSH terms