title: [Transhiatal versus transthoracic esophagectomy: experience of the Brazilian National Cancer Institute].
abstract: OBJECTIVE
  Analyses of morbidity, mortality and overall survival after transhiatal (TH) or transthoracic (TT) esophagectomy.
  
  
  METHODS
  Retrospective non randomized study of 68 patients with esophagus neoplasia operated in the Brazilian National Cancer Institute between 1997 and 2005. We divided in two groups: Group 1--TH (33 patients); and Group 2--TT (35 patients).
  
  
  RESULTS
  The mean age was 40.7 years old (25-74 years old), being 73.5% male. Middle third tumors predominated in Group 2 (48.6% vs. 21.2%, p = 0,02). The mean of dissected lymph nodes was biggest in Group 2 (21.6 vs. 17.8 lymph nodes, p = 0.04), however without difference in number of metastatic lymph nodes (4.1 vs. 3.9 linfonodos, p = 0.85). The mean of operative time was higher in Group 2 (410 vs. 270 minutes, p = 0.001). Also the mean of length of stay was higher in Group 2 (19 vs. 14 days, p = 0.001). The operative morbidity was 50%, without statistical difference between the groups (42.4% vs. 57.1%, p = 0,23). Esophageal leakage occurred in 13.2% of cases, also without statistical difference (9.1% vs. 17.1%, p = 0.23). The mortality was 5.8% (04 patients), without statistical difference (1.4% vs. 4.4%, p = 0,83).
  
  
  CONCLUSIONS
  In our study, the morbidity and mortality showed no statistical difference in relation to the access performed, although higher operative time and length of stay were observed in TT access. The 3 and 5-years overall survival also were biggest in TT access, probably due to the biggest frequency of patients on initial stages between the submitted to the TT access.
authors.affiliation: Seção de Cirurgia Abdomino-Pélvica do Instituto Nacional de Câncer (INCA), Ministério da Saúde do Brasil, Rio de Janeiro.
authors.forename: Emerson Luis Gama
authors.initials: EL
authors.lastname: Prisco
authors.forename: Carlos Eduardo
authors.initials: CE
authors.lastname: Pinto
authors.forename: Aldo Vieira
authors.initials: AV
authors.lastname: Barros
authors.forename: Jadson Murilo Silva
authors.initials: JM
authors.lastname: Reis
authors.forename: Herbert Ives Barretto
authors.initials: HI
authors.lastname: de Almeida
authors.forename: Eduardo Linhares Riello
authors.initials: EL
authors.lastname: de Mello
mesh_terms: D000047:Academies and Institutes; D000328:Adult; D000368:Aged; D001938:Brazil; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D015996:Survival Rate; D013909:Thorax