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The Annals of Thoracic Surgery, Vol 56, 838-844, Copyright © 1993 by The Society of Thoracic Surgeons
WT Vigneswaran, VF Trastek, PC Pairolero, C Deschamps, RC Daly and MS Allen
One hundred thirty-one patients (107 men and 24 women) underwent
transhiatal esophagectomy for carcinoma of the esophagus. Median age was
65.3 years (range, 30 to 89 years). Signs and symptoms were present in 130
patients, which included dysphagia in 96 (73.3%) and weight loss (median,
7.7 kg) in 52 (39.7%). The cancer involved the gastroesophageal junction in
94 patients, the lower half of the intrathoracic esophagus in 25, the upper
half in 10, and multiple sites in 2. An adenocarcinoma was present in 101
patients (77.1%), squamous cell carcinoma in 29 (22.1%), and adenosquamous
cell in 1 (0.8%). The cancer was classified as stage 0 in 4 patients, stage
I in 16, stage IIA in 26, stage IIB in 18, stage III in 65, and stage IV in
1. The stomach was used to replace the esophagus in all patients. Operative
mortality was 2.3%. Anastomotic leak developed in 32 patients; 6 leaks were
not clinically significant, 12 healed with drainage alone, and 14 required
further surgical intervention. Follow-up ranged from 1 month to 6.7 years
(median, 1.4 years). Currently, 42 patients are alive, 34 without evidence
of recurrence. Overall 5-year survival was 20.8% and varied according to
stage. Five-year survival was 47.5% for patients with stage I disease
compared with 37.7% for patients in stage II and only 5.8% 4-year survival
for patients in stage III. Cell type also influenced survival. Five-year
survival for patients with adenocarcinoma was 27.1% compared with zero for
patients with squamous cell carcinoma (p < 0.03).(ABSTRACT TRUNCATED AT
250 WORDS)
ARTICLES
Transhiatal esophagectomy for carcinoma of the esophagus
Section of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota.
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