Esophageal carcinoma: Patient selection for transhiatal esophagectomy. A prospective analysis of 50 consecutive cases

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Abstract
Fifty patients underwent transhiatal esophagectomy (THE) without thoracotomy with gastric interposition for esophageal carcinoma. Resection was considered curative in 15 patients with stage I or II, and palliative in 35 patients classified as stage III or IV. Postoperative morbidity was 42%. The frequency of complications was significantly higher following palliative surgery than after curative surgery. The mortality rate was 2%. On the basis of the clinical, diagnostic, surgical, and histologic data for all patients, criteria for patient selection are defined. Patients with tumors of the pretreatment T3 category and those with systemic metastases were excluded from the study. Differentiation between the pretreatment T1 and T2 categories was without importance in determining the suitability for THE.In advanced tumors of the upper thoracic esophagus, involvement of the tracheobronchial system may preclude complete removal of the tumor. Sharp dissection, which is often required in these cases, increases the risk of THE. Because such involvement can be recognized accurately on computed tomographic (CT) examination of the mediastinum, tumors of the upper thoracic esophagus should only be treated by THE if there are no signs of involvement of the tracheobronchial system on preoperative CT.Respiratory impairment rarely constitutes a contraindication, and THE is well tolerated even by geriatric patients. THE is a safe procedure for both curative and palliative resection of esophageal carcinoma provided that candidates for this operation are selected properly.