Transhiatal esophageal surgery for malignancy--a 7-year experience at a tertiary care hospital.

OBJECTIVE The aim of this study was to determine the outcomes of transhiatal esophagectomy for dysphagia for esophageal malignancy in terms of short and long-term morbidity and mortality and to determine the survival series. STUDY DESIGN Case series study. PLACE AND DURATION OF STUDY South and West Surgical Ward, Mayo Hospital, Lahore, from January 2001 to December 2007. METHODOLOGY All patients referred electively or admitted through OPD presenting with features of progressive dysphagia due to malignancy were included in the study. The patients were investigated for site of stricture and extent of growth into the surrounding structures. All underwent transhiatal esophagectomy and gastric tube or colon was used as the conduit to restore continuity. Patients with squamous cell variety were referred to oncology department for chemoradiotherapy postoperatively. Morbidity and in-hospital mortality were recorded. RESULTS A total of 42 patients were operated electively for malignant stricture esophagus through transhiatal approach. Site of lesion were 5 (11.9%) upper, 13 (31%) middle and 24 (58%) at lower end of esophagus. The TNM staging were stage I, IIa, IIb, III and IV in zero (0), 5 (11%), 10 (22%), 24 (57.8%) and 3 (7.1%) respectively. Mean operating time was 154 minutes and average blood loss of 371 ml. Postoperative complications included pneumothorax 16.7%, pulmonary complication (16.7%), anastomotic leakage (9.5%), wound infection (3.4%), recurrent laryngeal nerve injury (4.8%) and stricture formation (4.8%). Only 3 (7.1%) 30-day in-hospital mortality was recorded. CONCLUSION Transhiatal esophagectomy is the surgical treatment of choice for resection of carcinoma esophagus specifically at the lower and mid-esophageal levels. The frequency of complications is lower as compared to transthoracic approach and the early stage of presentation can lead to high 5-year survival ratios.