title: Laparoscopic transhiatal esophagectomy improves hospital outcomes and reduces cost: a single-institution analysis of laparoscopic-assisted and open techniques.
abstract: Several case series have demonstrated that laparoscopic transhiatal esophagectomy (LTHE) is associated with favorable perioperative outcomes compared to historical data for open transhiatal esophagectomy (OTHE). Contemporaneous evaluation of open and laparoscopic THE is rare, limiting meaningful comparison of techniques.
  
  
  
  All patients who underwent OTHE (n = 32) and LTHE (n = 41) during the introduction of the latter procedure at our institution (1/2012-4/2014) were identified, and patient charts were retrospectively reviewed.
  
  
  
  Indications for operation included 69 patients with esophageal malignancy (adenocarcinoma: 64; squamous cell carcinoma: 4; melanoma: 1) and 4 patients with benign disease. There were no significant differences in clinicopathologic variables between OTHE and LTHE cohorts, except for an increased rate of cardiovascular disease in the LTHE cohort (p = 0.04). There was no significant difference in median operative time or operative complications, yet LTHE was associated with a lower incidence of intraoperative blood transfusion (p < 0.01). There were no 30-day mortalities. LTHE was associated with a reduced time to reach 24-h tube feeding goals (p = 0.02), shorter length of hospital stay (p = 0.01), and 6 % reduced median direct cost (p = 0.04). There were no significant differences in rates of major perioperative morbidities. Patients were followed for a median of 11.0 months during which there were no significant differences between cohorts in disease-free survival or overall survival.
  
  
  
  When compared to OTHE, LTHE improves surgical outcomes and decreases hospital costs; short-term oncologic outcomes are similar. LTHE is preferable to OTHE in patients requiring transhiatal esophagectomy.
authors.affiliation: Department of Surgery, University of Pennsylvania, 3400 Spruce St., Philadelphia, PA, 19104, USA.
authors.forename: Brett L
authors.initials: BL
authors.lastname: Ecker
authors.affiliation: Department of Surgery, University of Pennsylvania, 3400 Spruce St., Philadelphia, PA, 19104, USA.
authors.forename: Goda E
authors.initials: GE
authors.lastname: Savulionyte
authors.affiliation: Department of Surgery, University of Pennsylvania, 3400 Spruce St., Philadelphia, PA, 19104, USA.
authors.forename: Jashodeep
authors.initials: J
authors.lastname: Datta
authors.affiliation: Department of Surgery, University of Pennsylvania, 3400 Spruce St., Philadelphia, PA, 19104, USA.
authors.forename: Kristoffel R
authors.initials: KR
authors.lastname: Dumon
authors.affiliation: Department of Surgery, University of Pennsylvania, 3400 Spruce St., Philadelphia, PA, 19104, USA.
authors.forename: John
authors.initials: J
authors.lastname: Kucharczuk
authors.affiliation: Department of Surgery, University of Pennsylvania, 3400 Spruce St., Philadelphia, PA, 19104, USA.
authors.forename: Noel N
authors.initials: NN
authors.lastname: Williams
authors.affiliation: Department of Surgery, University of Pennsylvania, 3400 Spruce St., Philadelphia, PA, 19104, USA. Daniel.Dempsey@uphs.upenn.edu.
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Dempsey
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery; D000368:Aged; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D004938:Esophageal Neoplasms / Q000601:surgery; D016629:Esophagectomy / Q000191:economics / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000191:economics; D007902:Length of Stay; D008297:Male; D008545:Melanoma / Q000601:surgery; D008875:Middle Aged; D012189:Retrospective Studies
keywords: Cost analysis; Laparoscopic-assisted esophagectomy; Laparoscopy; Minimally invasive surgery; Transhiatal esophagectomy