title: A prospective comparison of transthoracic and transhiatal resection for esophageal carcinoma in Asians.
abstract: OBJECTIVE
  Transthoracic and transhiatal esophagectomy are two common procedures for esophageal cancer resection. Prospective studies comparing the two methods in Asian people are few. In addition, the data comparing their effects on the quality of life are lacking.
  
  
  METHODS
  A prospective randomized study was conducted from January 2003. Patients of resectable esophageal cancer of comparable stage were allocated to undergo the transthoracic or transhiatal procedure in turn. They were all reconstructed with stomach interposition through the retrosternal route. Discharged patients were followed-up in the outpatient clinic. They were questioned on the topics of (i) severity of pain, (ii) ease of swallowing, (iii) satisfaction of daily activities, (iv) dependence on medications, (v) working ability, (vi) fatigue, (vii) appetite, (viii) sociality, (ix) happiness and (x) self respect, in the third, sixth and twelfth month. Also the demographic data, operative results and survival were recorded.
  
  
  RESULTS
  Up to December 2006, eighty-seven patients of stage II and III, including 71 patients of middle third lesions and 16 lower third lesions were enrolled. The operation time was significantly longer, and the leakage rate was higher in the transthoracic group (Student's t-test and Fischer's exact test, respectively). However, intraoperative blood loss and postoperative hospital stay were not significantly different (Student t-test). Also, the Kaplan-Meier survival curves of these two groups were not significantly different by log-rank test (p=0.286). The score on the quality of life of transhiatal patients was significantly higher than that of transthoracic patients in the third, sixth and twelfth month.
  
  
  CONCLUSIONS
  Transhiatal esophagectomy is a safe and fast procedure. The survival was similar to that of transthoracic approach. Its leakage rate was lower and quality of life was better.
authors.affiliation: Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. shhwch@kmu.edu.tw
authors.forename: Shah-Hwa
authors.initials: SH
authors.lastname: Chou
authors.forename: Hung-Yi
authors.initials: HY
authors.lastname: Chuang
authors.forename: Meei-Feng
authors.initials: MF
authors.lastname: Huang
authors.forename: Chia-Hua
authors.initials: CH
authors.lastname: Lee
authors.forename: Harvey Man-Pun
authors.initials: HM
authors.lastname: Yau
mesh_terms: D000328:Adult; D000368:Aged; D044466:Asian People; D002277:Carcinoma / Q000208:ethnology* / Q000401:mortality / Q000601:surgery*; D015331:Cohort Studies; D004938:Esophageal Neoplasms / Q000208:ethnology* / Q000401:mortality / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011788:Quality of Life; D020127:Recovery of Function; D015996:Survival Rate; D016896:Treatment Outcome