Preoperative computed tomography for transhiatal esophagectomy.
We report the results of a retrospective evaluation of preoperative chest computed tomography (CT) in 50 consecutive patients with esophageal carcinoma confirmed surgically. Forty patients underwent transhiatal esophagectomy without thoracotomy. In ten cases, blunt dissection of the esophageal carcinoma was impossible because of involvement of an adjacent organ. Transhiatal esophagectomy carries lower morbidity and mortality rates than the standard thoracotomy procedure, although long-term survival is considered to be the same with either method. The overall sensitivity of CT in detecting involvement of an adjacent organ, thus contraindicating the transhiatal procedure, was 90%, with an overall specificity of 92%. The positive predictive value was 75%, and the negative predictive value 89%. The negative predictive value of CT for tracheobronchial invasion, the main surgical risk in the transhiatal procedure, was 90%. A negative preoperative CT appears to be a reliable indicator for patients undergoing transhiatal esophagectomy.
Legmann
P
P
Department of Radiology, Centre Hospitalier Universitaire Bichat, Paris, France.
Marmuse
J P
JP
Rjob
S
S
Benacerraf
R
R
D000230:Adenocarcinoma / Q000000981:diagnostic imaging; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D000075202:Contraindications; D004938:Esophageal Neoplasms / Q000601:surgery; D016629:Esophagectomy / Q000379:methods* / Q000401:mortality; D004947:Esophagus / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011300:Preoperative Care; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013908:Thoracotomy; D014057:Tomography, X-Ray Computed