Transthoracic versus transhiatal esophagectomy

A prospective study of 945 patients

Jeffrey Rentz, David Bull, David Harpole, Stephen Bailey, Leigh A Neumayer, Theodore Pappas, Barbara Krasnicka, William Henderson, Jennifer Daley, Shukri Khuri, Walter Ehrman, Douglas Wood, Rentz, Thomas Rice

Research output: Contribution to journalArticle

128 Citations (Scopus)

Abstract

Objective: Debate continues as to whether transhiatal esophagectomy results in lower morbidity and mortality than transthoracic esophagectomy. Most data addressing this issue are derived from single-institution studies. To investigate this question from a nationwide multicenter perspective, we used the Veterans Administration National Surgical Quality Improvement Program to prospectively analyze risk factors for morbidity and mortality in patients undergoing transthoracic esophagectomy or transhiatal esophagectomy from 1991 to 2000. Methods: Univariate and multivariate analyses were performed on 945 patients (mean age, 63 ± 10 years). There were 562 transthoracic esophagectomies and 383 transhiatal esophagectomies in 105 hospitals, with complete 30-day outcomes recorded. Results: There were no differences in recorded preoperative variables between the groups that might bias any comparisons. Overall mortality was 10.0% (56/562) for transthoracic esophagectomy and 9.9% (38/383) for transhiatal esophagectomy (P = .983). Morbidity occurred in 47% (266/562) of patients after transthoracic esophagectomy and in 49% (188/383) of patients after transhiatal esophagectomy (P = .596). Risk factors for mortality common to both groups included a serum albumin value of less than 3.5 g/dL, age greater than 65 years, and blood transfusion of greater than 4 units (P < .05). When comparing transthoracic esophagectomy with transhiatal esophagectomy, there was no difference in the incidence of respiratory failure, renal failure, bleeding, infection, sepsis, anastomotic complications, or mediastinitis. Wound dehiscence occurred in 5% (18/383) of patients undergoing transhiatal esophagectomy and only 2% (12/562) of patients undergoing transthoracic esophagectomy (P = .036). Conclusions: These data demonstrate no significant differences in preoperative variables and postoperative mortality or morbidity between transthoracic esophagectomy and transhiatal esophagectomy on the basis of a 10-year, prospective, multi-institutional, nationwide study.

Original languageEnglish (US)
Pages (from-to)1114-1120
Number of pages7
JournalJournal of Thoracic and Cardiovascular Surgery
Volume125
Issue number5
DOIs
StatePublished - May 1 2003
Externally publishedYes

Fingerprint

Esophagectomy
Prospective Studies
Mortality
Morbidity
Mediastinitis
United States Department of Veterans Affairs
Quality Improvement
Serum Albumin
Blood Transfusion

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Transthoracic versus transhiatal esophagectomy : A prospective study of 945 patients. / Rentz, Jeffrey; Bull, David; Harpole, David; Bailey, Stephen; Neumayer, Leigh A; Pappas, Theodore; Krasnicka, Barbara; Henderson, William; Daley, Jennifer; Khuri, Shukri; Ehrman, Walter; Wood, Douglas; Rentz; Rice, Thomas.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 125, No. 5, 01.05.2003, p. 1114-1120.

Research output: Contribution to journalArticle

Rentz, J, Bull, D, Harpole, D, Bailey, S, Neumayer, LA, Pappas, T, Krasnicka, B, Henderson, W, Daley, J, Khuri, S, Ehrman, W, Wood, D, Rentz & Rice, T 2003, 'Transthoracic versus transhiatal esophagectomy: A prospective study of 945 patients', Journal of Thoracic and Cardiovascular Surgery, vol. 125, no. 5, pp. 1114-1120. https://doi.org/10.1067/mtc.2003.315
Rentz, Jeffrey ; Bull, David ; Harpole, David ; Bailey, Stephen ; Neumayer, Leigh A ; Pappas, Theodore ; Krasnicka, Barbara ; Henderson, William ; Daley, Jennifer ; Khuri, Shukri ; Ehrman, Walter ; Wood, Douglas ; Rentz ; Rice, Thomas. / Transthoracic versus transhiatal esophagectomy : A prospective study of 945 patients. In: Journal of Thoracic and Cardiovascular Surgery. 2003 ; Vol. 125, No. 5. pp. 1114-1120.
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abstract = "Objective: Debate continues as to whether transhiatal esophagectomy results in lower morbidity and mortality than transthoracic esophagectomy. Most data addressing this issue are derived from single-institution studies. To investigate this question from a nationwide multicenter perspective, we used the Veterans Administration National Surgical Quality Improvement Program to prospectively analyze risk factors for morbidity and mortality in patients undergoing transthoracic esophagectomy or transhiatal esophagectomy from 1991 to 2000. Methods: Univariate and multivariate analyses were performed on 945 patients (mean age, 63 ± 10 years). There were 562 transthoracic esophagectomies and 383 transhiatal esophagectomies in 105 hospitals, with complete 30-day outcomes recorded. Results: There were no differences in recorded preoperative variables between the groups that might bias any comparisons. Overall mortality was 10.0{\%} (56/562) for transthoracic esophagectomy and 9.9{\%} (38/383) for transhiatal esophagectomy (P = .983). Morbidity occurred in 47{\%} (266/562) of patients after transthoracic esophagectomy and in 49{\%} (188/383) of patients after transhiatal esophagectomy (P = .596). Risk factors for mortality common to both groups included a serum albumin value of less than 3.5 g/dL, age greater than 65 years, and blood transfusion of greater than 4 units (P < .05). When comparing transthoracic esophagectomy with transhiatal esophagectomy, there was no difference in the incidence of respiratory failure, renal failure, bleeding, infection, sepsis, anastomotic complications, or mediastinitis. Wound dehiscence occurred in 5{\%} (18/383) of patients undergoing transhiatal esophagectomy and only 2{\%} (12/562) of patients undergoing transthoracic esophagectomy (P = .036). Conclusions: These data demonstrate no significant differences in preoperative variables and postoperative mortality or morbidity between transthoracic esophagectomy and transhiatal esophagectomy on the basis of a 10-year, prospective, multi-institutional, nationwide study.",
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AU - Bull, David

AU - Harpole, David

AU - Bailey, Stephen

AU - Neumayer, Leigh A

AU - Pappas, Theodore

AU - Krasnicka, Barbara

AU - Henderson, William

AU - Daley, Jennifer

AU - Khuri, Shukri

AU - Ehrman, Walter

AU - Wood, Douglas

AU - Rentz,

AU - Rice, Thomas

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