title: How much length of the distal esophagus is removed by transhiatal approach for squamous cell carcinoma and Barrett's adenocarcinoma in Japanese patients?
abstract: OBJECTIVE
  The removed length of the esophagus by transhiatal distal esophagectomy (THDE) for patients with squamous cell carcinoma (SCC) and Barrett's adenocarcinoma (BAC) in the distal/abdominal esophagus was investigated.
  
  
  METHODS
  Twenty six patients with carcinoma mainly located in the distal/ abdominal esophagus were treated by THDE: SCC (Group-S, n=17) and BAC (Group-A, n=9). The length of the mobilized esophagus (D1) and that of the removed esophagus (D2) were measured. After surgery, we measured the distance between the stapled line of the esophagogastrostomy and the diaphragmatic hiatus (D3). The ratio of D3 to the distance between the bronchial bifurcation and the hiatus (D3-ratio) was calculated.
  
  
  RESULTS
  The mean D1, D2 and D3 were 91.2mm, 65.2mm and 63.2mm, respectively. There were no differences among D1, D2 and D3 between Group-S and Group-A. The mean D3-ratio was 51.9%, and there was no difference between Group-S and Group-A. No postoperative mortality was observed, although postoperative complications were observed in 2 patients (7.7%). After THDE, no local recurrence was observed, node recurrence in 4 (15.4%) and distant metastasis in 7 (26.9%). Five-year survival rate after THDE was 70.1%. Seven patients (26.9%) complained of heartburn and only one of Group-S frequently felt heartburn. In endoscopic findings, most of the patients with heartburn were classified as Grade M.
  
  
  CONCLUSIONS
  Approximately 65mm of the distal esophagus and approximately 50% of the distance between the bronchial bifurcation and the hiatus was safely removed by THDE for SCC and BAC of the distal/abdominal esophagus, in spite of limited cases.
authors.affiliation: Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan. nkoide@shinshu-u.ac.jp
authors.forename: Naohiko
authors.initials: N
authors.lastname: Koide
authors.forename: Akira
authors.initials: A
authors.lastname: Suzuki
authors.forename: Masato
authors.initials: M
authors.lastname: Kitazawa
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Saito
authors.forename: Shinichi
authors.initials: S
authors.lastname: Miyagawa
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D001471:Barrett Esophagus / Q000473:pathology / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis