Transthoracic or transhiatal esophagectomy for cancer of the esophagus--does it matter?

Despite the ongoing controversy between proponents of TTE and THE, in the hands of experienced surgeons, both approaches provide excellent results for patients with carcinoma of the esophagus and EG junction. Ideally, surgeons dealing with esophageal carcinoma should be expert in both approaches and should select the best approach for the individual patient. The transhiatal approach appears to have a slightly lower operative mortality, and this advantage may be significant for the older, higher-risk surgical patient. Nevertheless, the transhiatal approach has a slightly higher risk of anastomotic complications and recurrent laryngeal nerve injury. Recent studies suggest, however, that the volume of experience of the surgeon is probably a more important factor in predicting operative mortality and complication rates than is the choice between TTE and THE. Cancer-related survival appears to be similar after the two procedures.