Transhiatal oesophagectomy--its role for tumours of the middle third of the intrathoracic oesophagus.

All patients presenting to a regional unit with oesophageal carcinoma over a twelve month period are reviewed and the role of transhiatal oesophagectomy for tumours of the middle third of the intrathoracic oesophagus is evaluated. Of the 28 cases of oesophageal carcinoma, 22 (78%) were resected by blunt transhiatal oesophagectomy, the remaining six (22%) has various forms of palliative treatment. In the resected group post-operative morbidity was compared in patients with tumours of the middle third to those with lower and upper third tumours combined. There was one post-operative death in each group giving an overall operative mortality of 9%. Resection for carcinoma of the middle third (N = 7) resulted in a complication rate of 50% and a mean ICU stay of 19.5 days as opposed to a complication rate of 35% and a mean ICU stay of ten days (P = 0.050) for tumours of upper and lower third combined (N = 15). On the basis of these figures we question whether transhiatal oesophagectomy, despite its many advantages, can be applied safely to tumours of the middle third of the intrathoracic oesophagus.