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Introduction: Despite improvement in surgical technique, morbidity and mortality is still significant after esophagectomy. Operative technique might be considered as an important factor in the outcomes of this operation. This study was intended to evaluate the perioperative outcomes of partial versus total esophagectomy for malignancy.
Methods: Using the Nationwide Inpatient Sample (NIS) database, clinical data of patients who underwent esophagectomy (partial or total) with the diagnosis of esophageal malignancy including carcinoma in situ from 2006-2008 were examined. Patient characteristics, comorbidities, perioperative complications, length of stay, hospital charges and in-hospital mortality were evaluated.
Results: A total of 5,851 patients underwent partial (65.60%) and total (34.30%) esophagectomy during this period. The mean age was similar between groups (partial: 63.3, total: 64.4 years; p=0.07) and the majority of patients were male (partial: 81.8%, total: 79.3%; p=0.02) and Caucasian (partial: 84.92%; total: 87.55%; p=0.02). Most of the comorbidities were similar between groups (hypertension, congestive heart failure, chronic lung disease, liver disease, renal failure, weight loss, anemia, smoking, peripheral vascular disorder and alcohol abuse). Outcome measures between groups are shown below.
Conclusion: The most frequent procedure for esophageal malignancy is partial esophagectomy. Compared to the total esophagectomy, partial esophagectomy was associated with lower morbidity and lower mortality and comparable hospital stay and hospital charges. Partial esophagectomy may improve morbidity and mortality in esophageal malignancy.





Perioperative outocomes of partial esophagectomy vs. total esophagectomy

Outcome measures	Partial esophagectomy	Total esophagectomy	P-value
Number	3838	2013
Acute respiratory failure (%)	23.2	32.4	<0.01
Pneumonia (%)	10.3	11.3	0.25
Empyema (%)	3.5	1.8	<0.01
Fistula (%)	1.9	1.6	0.47
Overall complication rate* (%)	43.0	50.7	<0.01
In-hospital mortality (%)	5.8	8.4	<0.01
Mean length of hospital stay (days)	16.9	18.1	0.20
Mean total hospital sharges (\0	146,542	161,962	0.12

*Patient who had at least one postoperative complication