Transhiatal esophagectomy for carcinoma of the esophagus and cardia. Experience with 160 cases
G. A. Gelfand, R. J. Finley, B. Nelems, R. Inculet, K. G. Evans and G. Fradet
Department of Surgery, University of British Columbia, Vancouver.
We reviewed our experience from 1979 to 1990 with 160 cases of transhiatal
esophagectomy for carcinoma of the lower esophagus and cardia to evaluate
trends in patient selection, management, and outcome. Patients treated in
the past 6 years (n = 110) and those treated before 1985 (n = 50) were
similar in terms of age and sex distribution, medical history, and weight
loss. The majority of tumors seen were adenocarcinoma, with patients in the
latter group having significantly lower stages. Significant decreases in
anesthetic time, units of blood transfusions, chest tube insertions, length
of postoperative ventilation, incidence of postoperative pneumonia, and
length of hospital stay were seen during the past 6 years. Wound infections
increased significantly during the same period. The decrease in the 30-day
mortality rate from 6% to 0.9% was not significant. Survival rates did not
differ between groups, with overall rates of 62%, 40%, and 21% at 1, 2, and
5 years, respectively.
