Transhiatal versus transthoracic resection for oesophageal carcinoma in Yemen.

INTRODUCTION

Cancer of the oesophagus is a major problem in Yemen, where most of the patients present with advanced disease. Curative oesophageal resection for carcinoma may be carried out by either the transhiatal or transthoracic technique. The aims of this study were to compare the morbidity, mortality, short term outcome and long term survival of the two techniques in the treatment of oesophageal carcinoma.

METHODS

From March 1998 to July 2004,118 patients with cancer of the oesophagus were studied. The tumours in 84 patients were resected by transhiatal oesophagectomy (43) and transthoracic oesophagectomy (41).

RESULTS

The two groups were comparable in terms of age, sex, location of the tumours, risk factors and stage of the disease. There was no significant difference in the mean intensive care unit stay, blood transfusion and mean hospital stay. Anastomotic leak was higher in the transhiatal oesophagectomy group than transthoracic group (21 percent versus 12 percent, p-value is equal to 0.001). Recurrent laryngeal nerve lesion was present in 18.6 percent of the transhiatal group and absent in the transthoracic group. The overall hospital mortality was 8.3 percent with no significant difference between the two groups (transhiatal 9.3 percent versus transthoracic 7.3 percent, p-value is equal to 0.742).

CONCLUSION

Transhiatal oesophagectomy was associated with a higher incidence of anastomotic complications and recurrent laryngeal nerve lesions, but there was no significant difference in the mortality between the two groups.