Transthoracic versus Transhiatal Esophagectomy: Comparative Study regarding Surgical Approach in Esophageal Cancer

TRANSTHORACIC VERSUS TRANSHIATAL ESOPHAGECTOMY: COMPARATIVE STUDY REGARDING SURGICAL APPROACH IN ESOPHAGEAL CANCER (Abstract): BACKGROUND: Surgical resection can offer the best curative treatment for oesophageal cancer but is associated with high postoperative morbidity rates. Most common surgical approaches are transthoracic (TT) and transhiatal (TH) techniques. Transhiatal approach has the advantage of reducing the pulmonary morbidity in patients with impaired pulmonary function. AIM: The aim of this study is to compare the TT and TH approach, in terms of preoperative assessment and short term outcomes. MATERIALS AND METHODS: We performed an observational study on a prospective collected database which included all the patients diagnosed with oesophageal cancer in which surgery was performed. A detailed assessment of comorbidities was performed using several scales: Charlson and age adjusted Charlson score, physiological score of POSSUM. Postoperative complications were graded according to the Dindo-Clavien classification. RESULTS: During a 9 years period surgery was performed in 50 cases, 33 by TT approach and 17 by TH approach respectively. The mean age was 58.7 ± 2.21 years old (95% CI 56.3-61.2). Patients in the TH group had a higher Charlson score (3 vs 2, P = 0.01), age adjusted Charlson score (5 vs 4, P = 0.03) and physiological score (17 vs 15, P = 0.04). TT techniques were mainly used for middle oesophageal cancers (69.7%) and TH for lower oesophageal tumors (82.4%). The overall operative morbidity was 60% with no difference between the two groups even for minor and major complications. Pulmonary complications occurred in 23 cases (46%), cardiac complications in 5 cases (10%), anastomotic leakage in 6 cases (12%) and recurrent nerve paralysis in 6 cases (12%). Multivariate analysis showed that age adjusted Charlson score (OR = 2.77; 95%CI 1.114-6.9236) and physiological score (OR = 1.7601; 95% CI 1.2067-2.5674) were predictors for complications. CONCLUSION: In our study mortality and morbidity showed no statistical difference in relation to the surgical approach. An accurate preoperative assessment and tailoring an adequate surgical approach can limit the percentage of postoperative complications.