Surgical management of esophageal cancer. A decade of change.

Abstract

To examine trends for use of transhiatal esophagectomy (THE) and to relate outcome variables to changes in use, controlling for preoperative risk. High operative morbidity and mortality rates are reported with conventional transthoracic esophagectomy (TTE). Transhiatal esophagectomy has been proposed as an alternative but is controversial. In this retrospective study divided into early and late time periods, outcome variables were subjected to univariate and multivariate analyses. Use of THE increased significantly in the late period (p < 0.0001). Patients who had THE had significantly higher American Society of Anesthesiologists (ASA) risk scores (p < 0.001). By the late period, 92% of patients with ASA III/IV scores were resected by THE. Postoperative morbidity decreased significantly and operative mortality decreased from 15% to 0% (p < 0.01) between the early and late time periods. By multivariate analysis, ASA > or = III and TTE were associated with adverse surgical outcome. Pathologic stage determined disease-free survival, which was 37% at 3 years for all survivors. Increased use of THE results in better operative outcome and does not adversely affect disease-free survival.