Source: Arthroscopy  |  Posted 5 years ago

By John Otrompke

CHICAGO, IL -- October 12, 2006 -- A study presented here at the American College of Surgeons (ACS) 92[^]nd[] Clinical Congress contributed to resolving an issue hotly debated in the surgical literature.

Two commonly-used methods of performing surgery for esophageal cancer may be equally safe and efficacious when performed at centers of excellence. However, the transhiatal esophagectomy (THE) method may offer a safer approach than transthoracic esophagectomy (TTE) when performed at institutions doing less than 10 such procedures per year.

The study followed 17,395 patients from the Nationwide In-patient Sample database between 1999 and 2003. The study included 11,914 patients who underwent THE and 5,481 patients who underwent TTE.

Overall mortality following the procedures was 8.8%, while overall morbidity -- which included conditions such as mediastinitis, or a leak from the site of surgery into the chest cavity -- was 50.7%.

Inpatient mortality following THE was 8.91%, compared with 8.47% following TTE.

"Esophageal resection has been associated with a high mortality and morbidity rate," said Rafe Connors, MD, general surgery resident, University of Utah School of Medicine, Salt Lake City, Utah, who presented the study on October 10[^]th[].

"Some have made the argument that we should do an anastomosis in the neck so that it isn't prone to leaking, or that it leaks to the skin," Dr. Connors said. About 80% of cases in which the procedure is done are esophageal cancer cases, he noted.

Nonetheless, the large study indicated that both procedures are equally safe, when performed in relatively high-volume centers, defined as centers handling 10 or more such cases per year over the past 10 years, Dr. Connors said.

Another question addressed by the study was whether the esophageal resection procedures were safer when performed in high-volume hospitals.

Results show that centers which saw fewer than 10 cases per year had a mortality rate of 10.6%, compared with 5.8% at higher-volume centers, according to the abstract. Additionally, low volume centers discharged patients to home more often, with TTE patients more likely to be discharged to home than THE patients.

[Presentation title: The Debate Between Transhiatal and Transthoracic Esophagectomy: A Five-Year Prospective Cohort of 17,395 Patients.]