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 19 January 2018

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News

Extended transthoracic versus limited transhiatal resection for esophageal adenocarcinoma

Transhiatal esophagectomy is associated with lower morbidity than transthoracic esophagectomy in surgery for esophageal cancer, find a research team from the Netherlands.

News image

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Controversy exists about the best surgical treatment for esophageal carcinoma.

In a study in the latest issue of the New England Journal of Medicine, researchers assigned patients with either adenocarcinoma of the mid-to-distal esophagus, or the gastric cardia involving the distal esophagus, to 2 surgical treatments.

A total of 106 patients were assigned to undergo transhiatal esophagectomy, and 114 to undergo transthoracic esophagectomy with extended en bloc lymphadenectomy.

Disease-free survival was 27% for transhiatal-esophagectomy group, versus 39% for transthoracic-esophagectomy group.
New England Journal of Medicine

The research team considered the principal end points to be overall survival and disease-free survival.

Additionally, they determined early morbidity and mortality, the number of quality-adjusted life-years gained, and cost effectiveness.

The team found that the demographic characteristics and characteristics of the tumor were similar in the 2 groups.

They determined perioperative morbidity to be higher after transthoracic esophagectomy, but found no significant difference in in-hospital mortality.

After a median follow-up of 4.7 years, 142 patients had died. 70% following transhiatal resection and 60% following transthoracic resection.

Although the difference in survival was not significant, the team identified a trend toward a survival benefit with the extended approach at 5 years.

Disease-free survival was 27% in the transhiatal-esophagectomy group, compared with 39% in the transthoracic-esophagectomy group, whereas overall survival was 29% versus 39%.

Dr Jan Hulscher's team concluded, "Transhiatal esophagectomy was associated with lower morbidity than transthoracic esophagectomy with extended en bloc lymphadenectomy".

"Although median overall, disease-free, and quality-adjusted survival did not differ statistically between the groups, there was a trend toward improved long-term survival at 5 years with the extended transthoracic approach".

N Engl J Med 2002; 347: 1662-9
22 November 2002

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