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

<p>Abstract</p> <p>Background</p> <p>The 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.</p> <p>Methods</p&g...

Full description

Bibliographic Details
Main Authors: Kneist Werner, Messow Claudia M, Heckhoff Sina, Gockel Ines, Junginger Theodor
Format: Article
Language:English
Published: BMC 2005-06-01
Series:World Journal of Surgical Oncology
Online Access:http://www.wjso.com/content/3/1/40
id doaj-3696b88e726448e39e83c2f32513b20a
record_format Article
spelling doaj-3696b88e726448e39e83c2f32513b20a2020-11-24T23:17:49ZengBMCWorld Journal of Surgical Oncology1477-78192005-06-01314010.1186/1477-7819-3-40Transhiatal and transthoracic resection in adenocarcinoma of the esophagus: Does the operative approach have an influence on the long-term prognosis?Kneist WernerMessow Claudia MHeckhoff SinaGockel InesJunginger Theodor<p>Abstract</p> <p>Background</p> <p>The 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.</p> <p>Methods</p> <p>Between 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.</p> <p>Results</p> <p>The 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).</p> <p>Conclusion</p> <p>The 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.</p> http://www.wjso.com/content/3/1/40
collection DOAJ
language English
format Article
sources DOAJ
author Kneist Werner
Messow Claudia M
Heckhoff Sina
Gockel Ines
Junginger Theodor
spellingShingle Kneist Werner
Messow Claudia M
Heckhoff Sina
Gockel Ines
Junginger Theodor
Transhiatal and transthoracic resection in adenocarcinoma of the esophagus: Does the operative approach have an influence on the long-term prognosis?
World Journal of Surgical Oncology
author_facet Kneist Werner
Messow Claudia M
Heckhoff Sina
Gockel Ines
Junginger Theodor
author_sort Kneist Werner
title Transhiatal and transthoracic resection in adenocarcinoma of the esophagus: Does the operative approach have an influence on the long-term prognosis?
title_short Transhiatal and transthoracic resection in adenocarcinoma of the esophagus: Does the operative approach have an influence on the long-term prognosis?
title_full Transhiatal and transthoracic resection in adenocarcinoma of the esophagus: Does the operative approach have an influence on the long-term prognosis?
title_fullStr Transhiatal and transthoracic resection in adenocarcinoma of the esophagus: Does the operative approach have an influence on the long-term prognosis?
title_full_unstemmed Transhiatal and transthoracic resection in adenocarcinoma of the esophagus: Does the operative approach have an influence on the long-term prognosis?
title_sort transhiatal and transthoracic resection in adenocarcinoma of the esophagus: does the operative approach have an influence on the long-term prognosis?
publisher BMC
series World Journal of Surgical Oncology
issn 1477-7819
publishDate 2005-06-01
description <p>Abstract</p> <p>Background</p> <p>The 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.</p> <p>Methods</p> <p>Between 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.</p> <p>Results</p> <p>The 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).</p> <p>Conclusion</p> <p>The 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.</p>
url http://www.wjso.com/content/3/1/40
work_keys_str_mv AT kneistwerner transhiatalandtransthoracicresectioninadenocarcinomaoftheesophagusdoestheoperativeapproachhaveaninfluenceonthelongtermprognosis
AT messowclaudiam transhiatalandtransthoracicresectioninadenocarcinomaoftheesophagusdoestheoperativeapproachhaveaninfluenceonthelongtermprognosis
AT heckhoffsina transhiatalandtransthoracicresectioninadenocarcinomaoftheesophagusdoestheoperativeapproachhaveaninfluenceonthelongtermprognosis
AT gockelines transhiatalandtransthoracicresectioninadenocarcinomaoftheesophagusdoestheoperativeapproachhaveaninfluenceonthelongtermprognosis
AT jungingertheodor transhiatalandtransthoracicresectioninadenocarcinomaoftheesophagusdoestheoperativeapproachhaveaninfluenceonthelongtermprognosis
_version_ 1725583168358055936