BEYOND THE SCALPEL - TRANSHIATAL ESOPHAGECTOMY COMPARED WITH TRANSTHORACIC RESECTION AND SYSTEMATIC LYMPHADENECTOMY FOR THE TREATMENT OF ESOPHAGEAL CANCER

Objective: To compare the results of transhiatal oesophagectomy with those of transthoracic resection with systematic two field en bloc lymhadenectomy in the treatment of carcinoma of the oesophagus. Design: Prospective open (non-random) study. Setting: University hospital, Germany. Subjects: 87 patients with carcinoma of the oesophagus of whom 46 underwent transhiatal, and 41 transthoracic resection. Main outcome measures: Morbidity and short and long term mortality. Results: The type of operation was chosen on clinical grounds, and the groups were comparable except for site and type of tumour, and nodal stage. The hospital mortality was 7/46 (15%) in the transhiatal group and 4/41 (10%) in the transthoracic group. The most common complication was anastomotic leak (23/46, 50%, compared with 10/41, 24%, p = 0.014), followed by major pulmonary complications (16/46, 35%, compared with 12/41, 29%), and cardiac complications (12/46, 26% compared with 11/41, 27%). Median survival was 350 days in the transhiatal group and 378 days in the transthoracic group. The percentage survival after one, two, and three years in the two groups was 48 and 55, 26 and 18, and 21 and 17, respectively. There were no significant differences in short or long term mortality. Conclusion: We have been unable to show that the oncologically more radical procedure (transthoracic resection with systematic two field en bloc lymphadenectomy) results in longer survival, but we have shown that it can be done with similar morbidity and short term mortality. Because it is possible to stage the disease exactly with a transthoracic resection, and because published reports from other centres have hinted at improved prognosis after it, we shall continue to do the operation for suitable patients.