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The Annals of Thoracic Surgery, Vol 54, 686-689, Copyright © 1992 by The Society of Thoracic Surgeons
TM Daniel, KJ Fleischer, TL Flanagan, CG Tribble and IL Kron
One hundred one consecutive patients underwent an esophagectomy with
gastric interposition for benign and malignant processes from January 1982
through July 1990. Seventy-seven underwent transhiatal esophagectomy and
24, transthoracic esophagectomy. Multivariate analysis was performed
comparing the hospitalization experience of the two groups. There was no
significant difference found between the mean intraoperative blood loss for
transhiatal esophagectomy (770 +/- 105 mL) and that of transthoracic
esophagectomy (700 +/- 175 mL). There was a significant difference between
operative time, with transhiatal esophagectomy averaging 5.4 hours and
transthoracic esophagectomy averaging 7.3 hours. Postoperative stay was not
significantly different although there was a wide range of values for the
transthoracic esophagectomy group. An 8% operative mortality was
experienced by both groups. There were a significant number of minor
anastomotic leaks at the cervical anastomotic level for the transhiatal
esophagectomy group, but all responded to nonoperative management. The
highest morbidity and mortality were seen in the subgroup of transhiatal
esophagectomies done for laryngocervical malignancies. The lowest morbidity
and mortality were seen in the subgroup of 12 patients who underwent
transhiatal esophagectomy for nonmalignant esophageal conditions.
Transhiatal esophagectomy appears to be a safe alternative for early
intrathoracic esophageal malignancies at any level, for bulky distal
esophageal lesions, and for benign conditions requiring total
esophagectomy.
ARTICLES
Transhiatal esophagectomy: a safe alternative for selected patients
Department of Surgery, University of Virginia Health Sciences Center, Charlottesville 22908.
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