A COMPARISON OF TRANSTHORACIC AND TRANSHIATAL RESECTION FOR THORACIC ESOPHAGEAL CANCER - OBSERVATIONS OF 30 YEARS

The transthoracic and transhiatal resection techniques are compared using the 30-year experience of Oulu University Central Hospital. During the period 1960-1982 we favoured resections trough a transthoracic route, while during the period 1983-1989 a transhiatal route was preferred. This change, and the more enthusiastic attitude adopted towards resection, has lead to an increase in resectability from 23 % (46/203) to 62 % (43/69) (P < 0.0001). The difference between radical resections, 50 % (23/46) and 37 % (16/43) has remained non-significant. Morbidity was higher after transthoracic than transhiatal resections, 57 % (26/46) versus 42 % (18/43), whereas mortality was nearly the same, 11 % (5/46) and 9 % (4/43). Postoperative pulmonary complications occurred in 28 % (13/46) after transthoracic resection and in 14 % (6/43) after transhiatal resection. No significant difference was detected in the development of late anastomotic strictures, 33 % (15/46) and 30 % (13/43), respectively. We conclude that transhiatal resection is as safe as transthoracic resection and seems to allow more resections to be carried out without any increase in mortality or morbidity, but long-term survival remains poor.