A decade of experience with transthoracic and transhiatal esophagectomy.
BACKGROUND
Morbidity and mortality remain significant for transthoracic (TT) and transhiatal (TH) esophagectomy. We report a case-specific approach employing either resection to minimize perioperative morbidity and mortality.


METHODS
All primary esophageal resections performed for benign and malignant esophageal disease were reviewed over a 10-year period. The operative approach was tailored to the location and extent of disease and the physiologic reserve of the patient.


RESULTS
In all, 115 patients underwent esophagectomy for benign (25) and malignant (90) disease. Fifty-six TT and 59 TH resections were performed. Four emergent TT cases did not have reconstruction. There was 1 hospital mortality. Perioperative transfusion was avoided in 65 patients. Respiratory complications occurred in 15. Three patients had a cervical anastomotic leak requiring open wound drainage. No association between resection type and complication was evident.


CONCLUSIONS
The judicious use of both TT and TH esophagectomy resulted in an operative mortality of less than 1%, reduced operative blood loss, and a relatively low rate of perioperative complications.
Bousamra
Michael
M
Department of Surgery, Division of Thoracic and Cardiovascular Surgery, University of Louisville School of Medicine, 201 Abraham Flexner Way, #1200, Louisville, KY 40202, USA. Bousamra@louisville.edu
Haasler
George B
GB
Parviz
Maryam
M
D000368:Aged; D016009:Chi-Square Distribution; D003964:Diaphragm; D004935:Esophageal Diseases / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000601:surgery; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D016019:Survival Analysis; D013909:Thorax; D016896:Treatment Outcome