Oesophagectomy without thoracotomy: first 250 patients.

OBJECTIVE

To evaluate morbidity, mortality and cure rate after transhiatal oesophagectomy for carcinoma of the oesophagus.

DESIGN

Prospective audit.

SETTING

University hospital, India.

SUBJECTS: From December 1986 to June 1993 a total of 250 consecutive patients underwent one stage transhiatal oesophagectomy with cervical oesophagogastrostomy for carcinoma of the oesophagus.

INTERVENTIONS: Transhiatal oesophagectomy.

MAIN OUTCOME MEASURES: Morbidity and mortality.

RESULTS

The mortality was 6% (14/250) and complications included recurrent laryngeal nerve palsy (n = 35, 14%), anastomotic leak (n = 38, 15%), respiratory failure (n = 8, 3%), anastomotic stenosis (n = 44, 18%) and anastomotic recurrence (n = 3, 1%). The actuarial survival at one year was 45% and at five years was 5%.

CONCLUSIONS

Transhiatal oesophagectomy is safe and well tolerated for the treatment of carcinoma of the oesophagus when done with care. Avoidance of thoracotomy, adequate longitudinal clearance, cervical anastomosis, and a short operating time are its main advantages.