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Transhiatal vs. Three- Hole Esophagectomy: Does Technique Change Survival?
Shirali T. Patel*, Susannah M. Cheek, Houssam Osman, Dhiresh R. Jeyarajah
Surgery, Methodist Dallas Medical Center, Dallas, TX
Background: Surgical treatment for esophageal cancer remains one of the fundamental treatments. Multiple surgical approaches have been described for esophagectomy and can be grouped under two categories: either transhiatal or transthoracic. Controversy exists whether more extensive resection provides better surgical outcomes. This study aims to describe the experience at a non-university tertiary care center (NUTCC) and to evaluate outcomes comparing Transhiatal vs. Three-Hole esophagectomy (Modified McKeown).
Methods: A retrospective chart analysis of 123 patients from 2006 to 2012 comparing Transhiatal vs. Three-Hole esophagectomy (open and minimally invasive surgery) was performed. Operative time, estimated blood loss (EBL), lymph node (LN) harvest, margin status, ICU stay, respiratory failure, anastomotic leak, and survival analysis were compared. Statistical analysis was performed using 2 sample t test, Wilcoxon- Mann-Whitney test, and Fisher exact test.
Results: Analysis for both Laparoscopic and Open approaches for Three-Hole vs. Transhiatal esophagectomies. (See Table 1)
Log-rank test comparing the two groups showed a significant difference in increased survival for the Transhiatal group (p= 0.04).
Conclusion: This analysis of comparing Transhiatal with Three- Hole esophagectomy demonstrated a significant difference in operative time and LN harvest. Moreover, there was a significant increase in survival in the Transhiatal group favoring outcomes based on surgical approach. The question remains does increased nodal harvest translate to increased survival in the Transhiatal group. Analysis for both Laparoscopic and Open approaches for Three-Hole vs. Transhiatal esophagectomies | Transhiatal N=73 | 3-Hole N=50 | P-Value | | Operative time (hrs) | 2.83 | 4.35 | <0.0001 | | EBL (mls) | 300(75-3000) | 300(100-700) | 0.63 | | LN Harvest | 12(0-34) | 8(1-26) | 0.0004 | | LN positive | 0 | 0 | 0.1688 | | Margin Status positive | 15(20.5%) | 7(14%) | 0.33 | | ICU stay (days) | 3(1-33) | 3(1-49) | 0.46 | | Anastomotic leak | 3(4.1%) | 0 | 0.27 | | Respiratory Failure | 11(15.07%) | 4(8%) | 0.24 |
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