title: Transhiatal versus transthoracic esophagectomy for esophageal cancer: a 2005-2011 NSQIP comparison of modern multicenter results.
abstract: BACKGROUND
  The surgical approach to esophageal cancer continues to be controversial. A transthoracic approach is often advocated for better oncologic staging and improved survival. A transhiatal approach is often preferred due to a perceived decreased operative morbidity and mortality.
  
  
  METHODS
  Using the American College of Surgeons-National Surgical Quality Improvement Project (ACS-NSQIP) participant-use file, patients were identified who underwent either a transhiatal or transthoracic esophagectomy for cancer at participating hospitals from 2005 to 2011. Demographic, clinical, intra-operative variables, and 30-day morbidity and mortality were collected.
  
  
  RESULTS
  Of the 1,428 patients that had esophagectomy, 750 (52.5%) had a transhiatal (TH) resection and 678 (47.5%) had a transthoracic (TT) resection. The transhiatal group was older (66 vs. 63 years, P = 0.003) with a lower ASA class (2.84 vs. 2.91, P = 0.025). Operative time was greater in the TT group (364 vs. 298 min, P < 0.001). There was no significant difference in 30 day overall mortality (TH = 2.9%, TT = 4.7%, P = 0.095) however a trend favored the TH group. Serious morbidity remains clinically significant in both groups (TH = 39.6%, TT = 43.5%, P = 0.146). The TH group had a significantly higher superficial wound infection rate (11.6% vs. 6.2%, P < 0.001) while the TT group required more perioperative blood transfusions (12.5% vs. 8.9%, P = 0.032) and returns to operating room (14.5% vs. 10.9%, P = 0.046).
  
  
  CONCLUSIONS
  Serious morbidity continues to be high for both types of esophagectomy. There needs to be continued efforts to diminish these complications.
authors.affiliation: Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, New York.
authors.forename: Wesley A
authors.initials: WA
authors.lastname: Papenfuss
authors.forename: Moshim
authors.initials: M
authors.lastname: Kukar
authors.forename: Kristopher
authors.initials: K
authors.lastname: Attwood
authors.forename: Venkata R
authors.initials: VR
authors.lastname: Kakarla
authors.forename: Soni
authors.initials: S
authors.lastname: Chousleb
authors.forename: Steven N
authors.initials: SN
authors.lastname: Hochwald
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Nurkin
mesh_terms: D017677:Age Distribution; D000368:Aged; D001803:Blood Transfusion / Q000706:statistics & numerical data; D019992:Databases as Topic; D004938:Esophageal Neoplasms / Q000401:mortality / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D015999:Multivariate Analysis; D061646:Operative Time; D012086:Reoperation / Q000706:statistics & numerical data; D013530:Surgical Wound Infection / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000453:epidemiology
keywords: Ivor-Lewis; NSQIP; esophagectomy; transhiatal