The Annals of Thoracic Surgery, Vol 40, 343-348, Copyright © 1985 by The Society of Thoracic Surgeons
Transhiatal (blunt) esophagectomy for malignant and benign esophageal disease: clinical experience and technique
JR Stewart, MG Sarr, KW Sharp, G Efron, J Juanteguy and TR Gadacz
"Blunt" transhiatal esophagectomy was performed in 23 selected patients.
Nineteen had squamous carcinoma of the esophagus (upper third, 1; middle
third, 12; distal third, 6), and 2 had adenocarcinoma of the distal
esophagus. The other 2 patients had severe lye strictures. Resection with
reconstruction was performed in one stage. Esophagogastric continuity was
restored using the stomach in the posterior mediastinal position in 20
patients and in the substernal position in 2. The colon in the posterior
mediastinal position was used in 1 patient with a lye stricture. Transmural
tumor extension or cervical or celiac nodal metastases or both were present
in 18 of 21 patients with carcinoma. There was 1 hospital death due to
pericardial tamponade. Morbidity included a transient cervical anastomotic
leak in 3 patients, one temporary and three permanent unilateral recurrent
laryngeal nerve palsies, one intraoperative splenic injury, and severe
hemorrhage requiring sternotomy for control in 1 patient. Pulmonary
complications occurred in 4 patients: aspiration pneumonia (1) and moderate
atelectasis (3). Three patients have died (11, 12, and 17 months
postoperatively) in the group with cancer, with follow-up time of 3 to 30
months (mean, 15 months). Transhiatal blunt esophagectomy is a safe and
effective procedure in many patients with either esophageal cancer or
extensive, benign esophageal strictures.
