title: Outcomes after transhiatal esophagectomies in an eastern-European low-volume center.
abstract: BACKGROUND
  The present study proposes to analyze the results obtained after transhiatal esophagectomies (THE), from the perspective of an Eastern European surgical center with low esophageal resection volume (LV).
  
  
  OBJECTIVE
  Our analysis, which to the authors' knowledge is the first of its kind in Romania, has the purpose of comparing our results with those obtained in higher or similar volume centers, in order to derive conclusions regarding the quality of therapeutic management for patients diagnosed with esophageal cancer in Romania.
  
  
  METHODS
  Retrospective observational study.
  
  
  METHODS
  In total, 70 patients were included, in whom THE was performed during the period 1997-2013 by six senior surgeons. The majority of our patients had esophageal cancers (n=66; 94.3%); we also performed 4 THE procedures for benign conditions (n=3; 4.27%) and esophageal perforation (n=1; 1.42%).
  
  
  RESULTS
  The majority of cancer-group patients had T3/N+ tumors. The nodal involvement in the T2, T3 and T4 categories was 9.9%, 21.6% and 35.1%, respectively. Complications were identified in 45 patients (68.2%), with the majority being represented by pulmonary complications (16 patients; 24.3%) and cervical leaks (15 cases; 22.7%). In-hospital mortality was 9.09%. We found a one-year overall survival rate of 58.7% (95%CI: 51.7-65.7%), 27.2% at 2 years (95%CI: 21.2-36.2%) and 10.5% at 3 years (95%CI: 6.5-14.5%). The median survival rate was estimated to be 16 months.
  
  
  CONCLUSIONS
  Morbidity and in-hospital mortality after THE was performed in low-volume centers, despite being significantly higher than reported in HV centers, could be kept at reasonable rates. In our opinion, the measures which have the potential to raise the standard of care for patients diagnosed with esophageal cancer in Romania are represented by the standardization of therapeutic and diagnostic protocols for esophageal cancer and the centralization of these major oncologic interventions in surgical excellence centers.
authors.affiliation: Second Department of General Surgery, Emergency Mureş County Hospital, University of Medicine and Pharmacy, Târgu Mureş, Romania.
authors.forename: Radu
authors.initials: R
authors.lastname: Neagoe
authors.affiliation: Department of Epidemiology, University of Medicine and Pharmacy, Târgu Mureş, Romania.
authors.forename: Septimu
authors.initials: S
authors.lastname: Voidazan
authors.affiliation: Department of ENT Surgery, Emergency Mureş County Hospital, University of Medicine and Pharmacy, Târgu Mureş, Romania.
authors.forename: Mihaly
authors.initials: M
authors.lastname: Szocs
authors.affiliation: Second Department of General Surgery, Emergency Mureş County Hospital, University of Medicine and Pharmacy, Târgu Mureş, Romania.
authors.forename: Daniela Tatiana
authors.initials: DT
authors.lastname: Sala
authors.affiliation: Second Department of General Surgery, Emergency Mureş County Hospital, University of Medicine and Pharmacy, Târgu Mureş, Romania.
authors.forename: Serban
authors.initials: S
authors.lastname: Bancu
authors.affiliation: Department of ENT Surgery, Emergency Mureş County Hospital, University of Medicine and Pharmacy, Târgu Mureş, Romania.
authors.forename: Gheorghe
authors.initials: G
authors.lastname: Mulhfay
keywords: Low-volume center; morbidity; survival transhiatal esophagectomy