Transhiatal and transthoracic resection in adenocarcinoma of the esophagus: Does the operative approach have an influence on the long-term prognosisReportar como inadecuado

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World Journal of Surgical Oncology

, 3:40

First Online: 24 June 2005Received: 01 January 2005Accepted: 24 June 2005


BackgroundThe goal of the present analysis was to investigate the long-term prognosis for adenocarcinoma of the esophagus treated with either the transhiatal TH or the transthoracic TT operative approach.

MethodsBetween September 1985 and March 2004, esophageal resection due to carcinoma was performed on a total of 424 patients. This manuscript takes into account the 150 patients suffering from adenocarcinoma of the esophagus in whom a transhiatal resection of the esophagus was performed. In the event of transmural tumor growth and a justifiable risk of surgery, the transthoracic resection was selected. An extended mediastinal lymph node dissection, however, was only carried out in the course of the transthoracic approach.

ResultsThe transthoracic resection of the esophagus demonstrated a higher rate of general complications p = 0.011 as well as a higher mortality rate p = 0.011. The mediastinal dissection of the lymph nodes, however, revealed no prognostic influence. Considering all of the 150 patients with adenocarcinoma, as well as only those patients who had undergone curative resections R0, the transhiatal approach was seen to demonstrate a better five-year survival rate of 32.1% versus 35.1%, with a median survival time of 24 versus 28 months, as compared with those who had undergone a transthoracic approach with a five-year survival rate of 13.6% all patients versus 17.7% R0 resection with a median survival time of 16 versus 17 months p < 0.05.

ConclusionThe prognosis in patients with adenocarcinoma of the esophagus is influenced by the depth of the tumor pT and the pM-category, as shown in the multivariate analysis. The present analysis did not demonstrate a relevant difference in survival for patients with N0 and N1 stages undergoing transhiatal or transthoracic esophagectomy. It is questionable, if a more extensive mediastinal lymph node dissection, in addition to the clearance of abdominal lymph nodes, offers prognostic advantages in adenocarcinoma of the esophagus. However, the morbidity and mortality associated with the transthoracic approach is higher.

Electronic supplementary materialThe online version of this article doi:10.1186-1477-7819-3-40 contains supplementary material, which is available to authorized users.

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Autor: Ines Gockel - Sina Heckhoff - Claudia M Messow - Werner Kneist - Theodor Junginger


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