Transhiatal and transthoracic esophagectomy for adenocarcinoma of the esophagus
M. R. Moon, W. J. Schulte, G. B. Haasler and R. E. Condon
Department of Surgery, Medical College of Wisconsin, Milwaukee 53226.
Adenocarcinoma of the esophagus is no longer rare and is treated by
resection. To determine whether the approach used for resection influences
outcome, we studied 88 patients who underwent resection; 14 had stage I or
II disease, 74 had stage III, and 40 had stage IV. One third of those with
Barrett's esophagus were noted on screening endoscopy to have potentially
curable disease; the others were diagnosed with stage III or IV disease.
Transhiatal esophagectomy was performed in 63 patients; 24 patients
underwent transthoracic esophagectomy. We found no difference in survival
or morbidity between transhiatal and transthoracic esophagectomy. Overall
5-year survival for stage I and II disease was 86%. For stage III and IV
disease, 5-year survival was 14.5%. Aggressive surveillance of Barrett's
esophagus facilitates the discovery of early disease. Esophagectomy for
adenocarcinoma can result in cure of early cancers and improved palliation
of more advanced disease.
