Transthoracic versus transhiatal esophagectomy: a prospective study of 945 patients.
OBJECTIVE
Debate continues as to whether transhiatal esophagectomy results in lower morbidity and mortality than transthoracic esophagectomy. Most data addressing this issue are derived from single-institution studies. To investigate this question from a nationwide multicenter perspective, we used the Veterans Administration National Surgical Quality Improvement Program to prospectively analyze risk factors for morbidity and mortality in patients undergoing transthoracic esophagectomy or transhiatal esophagectomy from 1991 to 2000.


METHODS
Univariate and multivariate analyses were performed on 945 patients (mean age, 63 +/- 10 years). There were 562 transthoracic esophagectomies and 383 transhiatal esophagectomies in 105 hospitals, with complete 30-day outcomes recorded.


RESULTS
There were no differences in recorded preoperative variables between the groups that might bias any comparisons. Overall mortality was 10.0% (56/562) for transthoracic esophagectomy and 9.9% (38/383) for transhiatal esophagectomy (P =.983). Morbidity occurred in 47% (266/562) of patients after transthoracic esophagectomy and in 49% (188/383) of patients after transhiatal esophagectomy (P =.596). Risk factors for mortality common to both groups included a serum albumin value of less than 3.5 g/dL, age greater than 65 years, and blood transfusion of greater than 4 units (P <.05). When comparing transthoracic esophagectomy with transhiatal esophagectomy, there was no difference in the incidence of respiratory failure, renal failure, bleeding, infection, sepsis, anastomotic complications, or mediastinitis. Wound dehiscence occurred in 5% (18/383) of patients undergoing transhiatal esophagectomy and only 2% (12/562) of patients undergoing transthoracic esophagectomy (P =.036).


CONCLUSIONS
These data demonstrate no significant differences in preoperative variables and postoperative mortality or morbidity between transthoracic esophagectomy and transhiatal esophagectomy on the basis of a 10-year, prospective, multi-institutional, nationwide study.
Rentz
Jeffrey
J
Veterans Affairs Medical Center/University of Utah Medical School, Salt Lake City, Utah 84132-2301, USA.
Bull
David
D
Harpole
David
D
Bailey
Stephen
S
Neumayer
Leigh
L
Pappas
Theodore
T
Krasnicka
Barbara
B
Henderson
William
W
Daley
Jennifer
J
Khuri
Shukri
S
D003128:Coma / Q000209:etiology; D004938:Esophageal Neoplasms / Q000401:mortality / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods* / Q000401:mortality; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D011014:Pneumonia / Q000209:etiology*; D011183:Postoperative Complications; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000209:etiology; D012307:Risk Factors; D012709:Serum Albumin; D016896:Treatment Outcome
D012709:Serum Albumin