Abstract
On the basis of experimental studies showing that the excessive operative stressof thoracolaparotomyenhances tumor growth and metastasis, we chose transhiatal esophagectomy for all resectable carcinomas of thelower esophagus and carcinoma of the middle and upper thoracic esophagus in the early stage. The records of 33patients with carcinoma in the lower esophagus who received transhiatal esophagectomies were analyzed forcomplications, late results and sites of first recurrence. Pneumothorax occurred in 8 patients (24%), recurrent nerveparalysis in 4 (12%) and pneumonia in 3 (9%). Operative mortality within 30 days was 6% (2/33) dueto laceration ofthe azygos vein during the operation and mediastinitis. The survival rate for 31 patients (2 cases of operative deathwere excluded) was 24.8%. The sites of first recurrence in the 31 patients with carcinoma of the lower esophaguswere investigated. In 9 patients (29%) the site was parenchymatous organs, in4 patients (13%) it was lymph nodes (bifurcation, pulmonal hilar, posterior mediastinal and para-aortic lymph node, one each), in 2 patients (6%) recurrence wasdisseminated and in one patient the first recurrence was in the remnant esophagus.These resultsindicated that transhiatal esophagectomy causes minimal surgicalstress, and gives equivalent a survival rate tothat after thoracolaparotomy. Intensive multidisciplinary treatment using irradiation and immunochemotherapymay be required to improve the prognosis.
