Transhiatal oesophagectomy: a single unit study
DOI:
https://doi.org/10.18203/2349-2902.isj20201381Keywords:
Transhiatal oesophagectomy, Oesophageal cancer, Orringer's surgery, ComplicationsAbstract
Background: Oesophageal cancer is a common gastrointestinal malignancy in our country and transhiatal oesopahgectomy is popular choice of surgery for lower oesophageal cancers. This study aims at identifying the feasibility and effectiveness of this surgery in our setting.
Methods: This prospective study was performed in Department of Surgery, SDM College of Medical Sciences and Hospital, Dharwad, India. It included a total of 10 cases operated during the study period. Various pre-operative, intra-operative and post-operative parameters were observed and results tabulated.
Results: In our study dysphagia (90%) was the most common presenting complaint and tobacco, either smoked (40%) or chewed (40%) formed a common risk factor. Lower oesophageal growths (80%) were more common than mid oesophageal (20%). The preferred incision was midline (80%) and average duration of surgery was 351min and average blood loss was estimated to be 521 ml. There was one mortality and a R0 resection in 90% of the cases with 10% positive for local lymphnodal malignant spread.
Conclusions: Our statistics are not very different to the studies compared, and we believe they will only improve. We propose transhiatal oesophagectomy to be a practical and affective tool in a surgeon’s armamentarium, which certainly can be a formidable treatment modality in sub-carinal oesophageal cancer.
References
Ferlay JSI, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, et al. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11. Lyon, France: International Agency for Research on Cancer; 2013.
Arnold M, Soerjomataram I, Ferlay J, Forman D. Global incidence of oesophageal cancer by histological subtype in 2012. Gut. 2015;64:381-7.
Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin. 2016;66:115-32.
Brown LM, Devesa SS, Chow WH. Incidence of adenocarcinoma of the esophagus among white Americans by sex, stage, and age. J Natl Cancer Inst 2008;100:1184-7.
Abnet CC, Arnold M, Wei WQ. Epidemiology of Esophageal Squamous Cell Carcinoma. Gastroenterology. 2018;154(2):360-73.
Orringer MB, Marshall B, Iannettoni MD. Transhiatal esophagectomy: Clinical experience and refinements. Ann Surg. 1999;230:392-400.
Van Sandick JW, van Lanschot JJ, ten Kate FJ, Tijssen JG, Obertop H. Indicators of prognosis after transhiatal esophageal resection without thoracotomy for cancer. J Am Coll Surg. 2002;194:28-36.
Engel LS, Chow WH, Vaughan TL, Gammon MD, Risch HA, Stanford JL, et al. Population attributable risks of esophageal and gastric cancers. J Natl Cancer Inst. 2003; 95:1404-13.
Wang JB, Fan JH, Liang H. Attributable causes of esophageal cancer incidence and mortality in China. PLoS One. 2012; 7:e42281.
Blot WJ, Li JY. Some considerations in the design of a nutrition intervention trial in Linxian, People's Republic of China. Natl Cancer Inst Monogr. 1985;69:29-34.
Cancer IAfRo. Volume 100E: Personal Habits and Indoor Combustions. Volume International Agency for Research on Cancer; Lyon, France: 2012.
Jiao WJ, Wang TY, Gong M, Pan H, Liu YB, Liu ZH. Pulmonary complications in patients with chronic obstructive pulmonary disease following transthoracic esophagectomy. World J Gastroenterol. 2006;12(16):2505-9.
Hulscher JB, Tijssen JG, Obertop H, van Lanschot JJ: Transthoracic versus transhiatal resection for carcinoma of the esophagus: A meta-analysis. Ann Thorac Surg. 2001;72:306-13.
Lerut T, Nafteux P, Moons J, Coosemans W, Decker G, De Leyn P. Three-Field Lymphadenectomy for Carcinoma of the Esophagus and Gastroesophageal Junction in 174 R0 Resections: Impact on Staging, Disease-Free Survival, and Outcome: A Plea for Adaptation of TNM Classification in Upper-Half Esophageal Carcinoma. Ann Surg 2004;240(6):962-74.
Goldminc M, Maddern G, Le Prise E, Meunier B, Campion JP, Launois B. Oesophagectomy by a transhiatal approach or thoracotomy: a prospective randomized trial. Br J Surg. 1993;80:367-70.
Chu KM, Law SY, Fok M, Wong J. A prospective randomized comparison of transhiatal and transthoracic resection for lower-third esophageal carcinoma. Am J Surg 1997;174:320-4.
Jacobi CA, Zieren HU, Müller JM, Pichlmaier H. Surgical therapy of esophageal carcinoma: the influence of surgical approach and esophageal resection on cardiopulmonary function. Eur J Cardiothorac Surg. 1997;11:32-7.
Hulscher JB, van Sandick JW, de Boer AG, Wijnhoven BP, Tijssen JG, Fockens P. Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med 2002;347:1662-9.