Three-field transthoracic versus transhiatal esophagectomy in the management of carcinoma esophagus - A single-center experience with a review of literature

Background: The management of esophageal cancer continues to be riddled with controversies, even as more and more clinical trials are being conducted amid a remarkable change in histology and epidemiology. Significant variations exist in the surgical treatment of esophageal cancer, and there is no consensus on the best surgical approach or the extent of lymphadenectomy. Interestingly, extended esophagectomy (three-field lymphadenectomy) has not been compared with transhiatal esophagectomy in a head-to-head fashion. Methods: We did a retrospective comparison of 111 consecutive patients who underwent curative resection for carcinoma of the esophagus, via either a transthoracic esophagectomy with three-field dissection (3F TTE) or transhiatal esophagectomy ("THE") at a regional cancer center in South India over a period of 5 years from 2002 to 2006. The primary outcome measure was 5-year disease-free (DFS) and the overall survival (OS). An exhaustive analysis of the short-term outcomes was also made. Results: The 5-year overall survival and disease-free survival were 52 and 49 % in the 3F TTE group and 37 and 37 %, respectively, in the "THE" group, which were not statistically significant. The short and the long-term outcomes in both the groups compared favorably with the other published series. Conclusions: Our study possibly for the first time compares 3F TTE and "THE" in the management of resectable carcinoma of the esophagus. Although the survival outcomes of both the groups were not statistically different, 3F TTE did show a trend towards improved DFS and OS when compared to "THE" group. However, this being a retrospective study, the results of this analysis need to be verified in an adequately sized prospective randomized study. © 2013 Springer Science+Business Media.