Introduction The optimal operative approach to resectable cancers of the oesophagus and oesophago-gastric junction is contentious. Both transhiatal (THO) and 2-stage (2-ST) resections are routinely practised in our unit, largely according to individual surgeon preference.
Methods A prospectively collected database containing 550 consecutive resections was available for analysis. All other variables (Investigation, MDT decision making and ITU input) were consistent within the unit.
Results Between 2000 and 2010, 267 patients underwent THO and 283 had 2-ST oesophagectomy. Demographics showed equal characteristics between the groups with a median age of 65 years old and a predominantly male population. Adenocarcinomas made up 79% of resections. 330 (60%) patients underwent neo-adjuvant chemotherapy. 58% were pre-operatively staged as having stage 3 disease. In-hospital mortality was 1.1% (THO) vs 1.5% (2-ST). Hospital stay was similar between the two groups (median 14 days vs 15 days). Median survival on Kaplan–Meier analysis was 49 months for THO vs 34 months for 2-ST (p<0.0005). Further analysis of the 2-ST procedures showed median survival of 40 months, 29 months and 23 months for laparoscopic assisted, left thoraco-abdominal and ivor-lewis resections respectively.
Conclusion Only one randomised trial has ever compared the two operative approaches, demonstrating no survival advantage for more radical 2-Stage surgery. Quality of life data may support transhiatal resections. Our data suggests that transhiatal resections carry a low post-operative mortality with good long term survival rates that are at least comparable to 2-Stage procedures. Transhiatal oesophagectomy is a viable alternative in the treatment of oesophageal cancer.
Competing interests None declared.
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