ReviewTransthoracic versus transhiatal resection for carcinoma of the esophagus: a meta-analysis
Section snippets
Patients and methods
A literature search (MEDLINE) was performed, and all human studies published in the English-language literature between 1990 and 1999 comparing transthoracic esophagectomy with transhiatal esophagectomy for carcinoma of the thoracic esophagus or the gastroesophageal junction were identified, using the medical subject headings “esophageal neoplasms” and “surgery.” All titles and abstracts were scanned, and appropriate citations were reviewed. A manual search of the bibliographies of relevant
Results
Fifty articles were identified (Table 1)9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58. Twenty-four studies compared transthoracic with transhiatal resections 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32. There were six prospective comparative studies, three of which were randomized 9, 10, 11, 12,
Comment
There has been much debate about the optimal type of resection for esophageal cancer. Only three randomized trials have been published, including a total of only 138 patients (of a total of 7,527 patients in the articles reviewed, Table 1). The other studies are mostly retrospective, consecutive case studies that described the authors’ experience with one or several procedures, thereby reflecting the personal preference of the surgeon. The paucity of prospective comparative studies (six of 50,
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