A comparison of transhiatal and transthoracic resection for carcinoma of the thoracic esophagus.

Among 210 patients who underwent resection for carcinoma of the middle and lower thirds of the thoracic esophagus, 38 were selected for a transhiatal nonthoracotomy approach. Compared with the 172 resections through a transthoracic route, there was no difference in age, sex, location, and differentiation of tumor. In the transhiatal group, excessive bleeding and tumor perforation as a result of blunt dissection each occurred in seven patients (18 percent). Recurrent nerve injury was noted in five patients (13 percent), but tracheal damage and chylothorax were avoided. The incidences of operative mortality and postoperative complications were similar in both groups. Survival by life-table analysis showed the transhiatal approach to be inferior to the transthoracic one. This nonrandomized study did not answer the question as to whether respiratory complications were lessened but did show a significant number of intraoperative complications when the transhiatal approach was used. The results indicated that survival was better when resection was performed through the chest.