Horstmann O, Verreet P R, Becker H, Ohmann C, Röher H D
Department of General and Trauma Surgery, Heinrich-Heine-University, Düsseldorf, Germany.
Eur J Surg. 1995 Aug;161(8):557-67.
To compare the results of transhiatal oesophagectomy with those of transthoracic resection with systematic two field en bloc lymphadenectomy in the treatment of carcinoma of the oesophagus.
Prospective open (non-random) study.
University hospital, Germany.
87 patients with carcinoma of the oesophagus of whom 46 underwent transhiatal, and 41 transthoracic resection.
Morbidity and short and long term mortality.
The type of operation was chosen on clinical grounds, and the groups were comparable except for site and type of tumour, and nodal stage. The hospital mortality was 7/46 (15%) in the transhiatal group and 4/41 (10%) in the transthoracic group. The most common complication was anastomotic leak (23/46, 50%, compared with 10/41, 24%, p = 0.014), followed by major pulmonary complications (16/46, 35%, compared with 12/41, 29%), and cardiac complications (12/46, 26% compared with 11/41, 27%). Median survival was 350 days in the transhiatal group and 378 days in the transthoracic group. The percentage survival after one, two, and three years in the two groups was 48 and 55, 26 and 18, and 21 and 17, respectively. There were no significant differences in short or long term mortality.
We have been unable to show that the oncologically more radical procedure (transthoracic resection with systematic two field en bloc lymphadenectomy) results in longer survival, but we have shown that it can be done with similar morbidity and short term mortality. Because it is possible to stage the disease exactly with a transthoracic resection, and because published reports from other centres have hinted at improved prognosis after it, we shall continue to do the operation for suitable patients.
比较经裂孔食管切除术与经胸切除术加系统性二野整块淋巴结清扫术治疗食管癌的效果。
前瞻性开放性（非随机）研究。
德国大学医院。
87例食管癌患者，其中46例行经裂孔手术，41例行经胸切除术。
发病率及短期和长期死亡率。
手术方式根据临床情况选择，除肿瘤部位、类型及淋巴结分期外，两组具有可比性。经裂孔组医院死亡率为7/46（15%），经胸组为4/41（10%）。最常见的并发症是吻合口漏（23/46，50%，经胸组为10/41，24%，p = 0.014），其次是严重肺部并发症（16/46，35%，经胸组为12/41，29%）和心脏并发症（12/46，26%，经胸组为11/41，27%）。经裂孔组中位生存期为350天，经胸组为378天。两组1年、2年和3年生存率分别为48%和55%、26%和18%、21%和17%。短期和长期死亡率无显著差异。
我们未能证明肿瘤学上更彻底的手术（经胸切除术加系统性二野整块淋巴结清扫术）能带来更长的生存期，但我们已表明其发病率和短期死亡率与之相似。由于经胸切除术能够准确分期疾病，且其他中心的已发表报告暗示术后预后有所改善，我们将继续为合适的患者进行该手术。
