Surgical outcomes of patients with superficial esophageal cancer—a comparison between trans-thoracic esophagectomy and trans-hiatal esophagectomy

Abstract

Purpose : We inspected the feasibility of minimally invasive surgery for superficial esophageal cancer, the trans-hiatal approach without thoracotomy.
Matearial : We examined the surgical outcomes of 33 superficial esophageal cancer whose cancer had invaded the submucosal layer and who underwent resection in our hospital between April 2003 and April 2009.
Method : The patients who had tumor invasion of within the sm1 and no metastasis to the upper and middle mediastinum lymph nodes were operated on by the trans-hiatal esophagectomy (THE). The other patients were underwent ordinary trans-thoracic esophagectomy (TTE). After the operations, we recommended adjuvant chemoradiation therapy for all patients whose tumor were histropathologically proved to involve the sm2 layer as well as the vessels and/or lymphatic duct.
Result : Of our 33 cases, nine were diagnosed as pM1 or pM2. Two were diagnosed as pM3, one of which had lymph node metastasis. Eleven cases were diagnosed as pSM1, four as pSM2, and seven as pSM3 ; and lymph node metastasis was observed in 4 pSM1 cases (36%), 2 pSM2 cases (50%) and 5 pSM3 cases (71.4%).
The five-year survival rate in all cases was 89.6%. The five-year survival rate by operating method was 100% in THE cases or 80.9% in TTE cases. The rates by tumor depth of invasion was 100% in pM1-2 cases, 92.3% in pM3-SM1 cases and 78.8% in pSM2-3 cases.
Conclusion : It is concluded that the surgical outcome of THE in accordance with our indication criteria is equal to that of TTE for superficial esophageal cancer.