Transhiatal esophagectomy.

Thirty-six patients underwent resection of the thoracic esophagus without a thoracotomy for the management of cancer of the cervical esophagus (2 patients), middle third and lower third of the esophagus (4 patients and 23 patients, respectively), and the gastroesophageal junction (17 patients). In addition to a total esophagectomy, two patients required a laryngectomy and seven patients had a total gastrectomy. Intraoperative bleeding occurred in three patients. Postoperative complications included subphrenic abscess (Candida) (2 patients), diaphragmatic hernia (1 patient), and salivary fistula (11 patients). Three patients died in the postoperative period from necrosis of interposed colon, pneumonia, and liver failure due to liver metastasis. The average blood loss was 1,300 ml, the duration of surgical procedure was 5.3 hours, and the hospital stay was 21 days. The survival rates at 1, 2, and 3 years were 80 percent, 50 percent, and 33 percent, respectively. Transhiatal esophagectomy can be considered a sound alternative to transthoracic esophagectomy in the management of tumors involving the cervical and lower esophagus. Small lesions of the middle third should also be considered for this procedure, however, bulky lesions of the upper esophagus are better removed by thoracotomy.