Transthoracic versus transhiatal esophagectomy for esophageal carcinoma: experience from a single tertiary care institution.

Background: There is a lot of controversy about the best surgical treatment for esophageal carcinoma.
Methods: In this retrospective study, 382 patients with carcinoma of the mid-to-distal esophagus underwent transthoracic or transhiatal esophagectomy. Early morbidity and mortality were compared. Principal endpoints were disease-free survival (DFS) and overall survival (OS).
Results: A total of 177 patients underwent transthoracic esophagectomy, and 205 patients underwent transhiatal esophagectomy. Demographic characteristics and characteristics of the tumor were similar in the two groups. Perioperative and postoperative morbidity was higher after transhiatal esophagectomy. In-hospital mortality was also higher after transhiatal esophagectomy. The median follow-up was 4.3 years. Estimated 3-year DFS rates were 44.63 and 31.21%, whereas the 3-year OS rates were 57.06 and 41.46% for the transthoracic and transhiatal groups, respectively (statistically significant). Also, the estimated 5-year DFS rates were 26.55 and 21.46%, whereas the 5-year OS rates were 32.76 and 30.24% for the transthoracic and transhiatal groups, respectively (statistically not significant).
Conclusions: Transhiatal esophagectomy was associated with higher perioperative and postoperative morbidity and in-hospital mortality than transthoracic esophagectomy. The DFS and OS were higher in the transthoracic group and were statistically significant at 3 years but statistically insignificant at 5 years.