title: [Esophageal cancer: surgical strategies].
abstract: BACKGROUND
  Oesophagectomy for cancer is associated to a significant morbidity and mortality. The superiority of transthoracic vs transhiatal is still a matter of controversy. The aim of this paper is to discuss the results of a series of patients submitted to either a transthoracic or a transhiatal according to the anatomic location regarding the carina.
  
  
  METHODS
  Retrospective analysis of 52 consecutive patients, with oesophageal carcinoma, 7 female and 45 males, median age 64 [46-85] years. Location: cervical - 1; above carina - 22; below or at carina level - 19; cardia type I -10. 19 adenocarcinoma, 32 squamous cells, 1 lymphoma. Twenty patients (40%) - neo-adjuvant therapy. Thoracoabdominal approach - 3, cervico-thoracoabdominal - 20, transhiatal - 27, exploratory thoracotomy - 2. Gastric pull-up 49 (cervical anastomosis - 46; thoracic - 3); cervical oesofagocoloplasty -1.
  
  
  RESULTS
  Pathologic staging: complete remission - 8; Ib - 3; IIa - 9; IIb - 4; IIa - 11; IIIb -2; IIIc - 10; IV - 1; non-stageable - 3. Major complications: 37%. Resectability: 96% (50/52). Mortality: 4th week - 6%; in-hospital - 14%. Median survival 18 months [3-80]. Survival Curves (Kaplan-Meier): 2 years - 47%; 5 years - 19% (transthoracic vs transhiatal p > 0.05).
  
  
  CONCLUSIONS
  Selection of surgical approach based on the anatomic location of the tumour regarding the carina was safe, the resectability was high and similar when a transthoracic or a transhiatal was planed and carry-on.
  
  
  CONCLUSIONS
  In this series of oesophageal cancer patients, in advanced pathologic condition (52% p Stages III/IV) the overall survival was similar for transthoracic and transhiatal. Neo-adjuvant treatments definitively contributed to enhance resectability.
authors.affiliation: Clínica Universitária de Cirurgia I. Faculdade de Medicina. Universidade de Lisboa. Hospital de Santa Maria. Centro Hospitalar Lisboa Norte. Lisboa. Portugal.
authors.forename: Paulo
authors.initials: P
authors.lastname: Costa
authors.affiliation: Clínica Universitária de Cirurgia I. Faculdade de Medicina. Universidade de Lisboa. Hospital de Santa Maria. Centro Hospitalar Lisboa Norte. Lisboa. Portugal.
authors.forename: Rui
authors.initials: R
authors.lastname: Esteves
authors.affiliation: Clínica Universitária de Cirurgia I. Faculdade de Medicina. Universidade de Lisboa. Hospital de Santa Maria. Centro Hospitalar Lisboa Norte. Lisboa. Portugal.
authors.forename: Patrícia
authors.initials: P
authors.lastname: Lages
authors.affiliation: Clínica Universitária de Cirurgia I. Faculdade de Medicina. Universidade de Lisboa. Hospital de Santa Maria. Centro Hospitalar Lisboa Norte. Lisboa. Portugal.
authors.forename: Filipa
authors.initials: F
authors.lastname: Ferreira
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies