Transhiatal esophagectomy in the management of perforated esophageal cancer.

Instrumental perforation of esophageal malignancy is best managed by immediate esophagectomy. Transthoracic esophagectomy has been the technique most described in the management of patients with this injury. A recent series reported the successful use of transhiatal esophagectomy with primary cervical esophagogastrostomy in four patients with perforated esophageal cancers. We have also used this technique to treat a patient with instrumental perforation of a distal esophageal cancer. This case is presented to add to the published experience using transhiatal esophagectomy in the management of perforated esophageal malignancy. The merits of transhiatal esophagectomy warrant consideration of this approach as a useful alternative to transthoracic resection in the management of selected patients with perforated esophageal cancer.