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. 2021 Mar 22;33(4):e1567.
doi: 10.1590/0102-672020200004e1567. eCollection 2021.

TRANSHIATAL ESOPHAGECTOMY IN SQUAMOUS CELL CARCINOMA OF THE ESOPHAGUS: WHAT ARE THE BEST INDICATIONS?

[Article in English, Portuguese]
Felipe Monge Vieira  1 , Marcio Fernandes Chedid  1   2 , Richard Ricachenevsky Gurski  1   2 , Carlos Cauduro Schirmer  2 , Leandro Totti Cavazzola  1   3 , Ricardo Vitiello Schramm  1 , André Ricardo Pereira Rosa  2 , Cleber Dario Pinto Kruel  1   2
Affiliations

TRANSHIATAL ESOPHAGECTOMY IN SQUAMOUS CELL CARCINOMA OF THE ESOPHAGUS: WHAT ARE THE BEST INDICATIONS?

[Article in English, Portuguese]
Felipe Monge Vieira et al. Arq Bras Cir Dig. .

Abstract
in English, Portuguese

Background: Overall survival in patients who underwent transhiatal esophagectomy submitted or not to neoadjuvant therapy. 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.

Racional:: O sul do Brasil tem uma das maiores incidências de carcinoma epidermoide do esôfago no mundo. A esofagectomia transtorácica permite linfadenectomia abdominal e torácica mais completa do que a transhiatal. No entanto, esta está associado à menor morbidade.

Objetivo:: Analisar os desfechos e fatores prognósticos do câncer epidermoide do esôfago que foram tratados com procedimento transhiatal.

Métodos:: Foram incluídos todos os pacientes selecionados para abordagem transhiatal como tratamento potencialmente curativo correlacionando sobrevida geral, tempo operatório, análise de linfonodos e uso de terapia neoadjuvante.

Resultados:: Foram avaliados 96 pacientes. A sobrevida geral em cinco anos foi de 41,2%. A análise multivariada mostrou que o tempo operatório e a presença de linfonodos positivos foram associados a pior resultado, enquanto a terapia neoadjuvante contribuiu para melhor resultado. O grupo de linfonodos negativos teve taxa de sobrevivência em cinco anos de 50,2%.

Conclusão:: A esofagectomia transhiatal pode ser empregada com segurança em pacientes que apresentem desnutrição com grau que permita o procedimento, nos com distúrbios respiratórios associados e nos idosos. Proporciona sobrevida em longo prazo considerável, especialmente na ausência de metástases para linfonodos locais. O uso mais amplo da terapia neoadjuvante tem o potencial de aumentar ainda mais a sobrevida em longo prazo.

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Conflict of interest statement

Conflict of interest: none

Figures

None
Overall survival in patients who underwent transhiatal esophagectomy submitted or not to neoadjuvant therapy
None
Sobrevida global em pacientes submetidos à esofagectomia transhiatal discriminados por realização de neoadjuvância
FIGURE 1
FIGURE 1. A) Overall survival; B) survival excluding short-term death; C) overall survival in patients submitted or not to neoadjuvant therapy; D) upperfront esophagectomy survival according positive and negative lymph-nodes; E) survival according to TNM stage; F) survival in patients submitted or not to neoadjuvant therapy excluding short-term death.
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