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Thoracoscopy-Assisted Esophagectomy vs Transhiatal Esophagectomy for Carcinoma Esophagus: a Prospective Comparison of Short-Term Outcomes

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Abstract

Introduction

Transhiatal esophagectomy (THE) was popularized to reduce the morbidity of esophagectomy. Thoracoscopy-assisted esophagectomy (TAE) offers esophageal dissection under magnified vision. This study compares the short-term morbidity and oncological outcome following TAE and THE for esophageal carcinoma.

Methodology

This is a prospective comparative (January 2017–May 2018) study between TAE and THE for >cT1bN1 esophageal carcinoma. After neoadjuvant chemoradiotherapy (NACRT), responders and patients with stable diseases were subjected to surgery. Thoracoscopy in esophagectomy was performed in prone position. Follow-up duration was at least 4 weeks post-discharge.

Results

Thirty-three patients of esophageal carcinoma undergoing TAE (n = 18) or THE (n = 15) were included. Common locations of tumor were lower third of esophagus (72.7%) and esophagogastric junction (18.2%). Majority (73.3%) had squamous cell carcinoma. Median interval between NACRT and surgery was 13 weeks. The mean operating time was significantly more with TAE than THE (292.5 vs 207.33 min, p = 0.005). R0 resection rate in TAE was 83.3% compared with 66.7% in THE. There was no difference in the lymph node yield. There was non-significant trend towards lower incidence of major pulmonary complication (66.7% vs 80.0%), cardiac complications (27.8% vs 46.7%), anastomotic leak (27.8% vs 46.7%), recurrent laryngeal nerve palsy (16.7% vs 20.0%), and overall major morbidity (Clavien-Dindo ≥ III) (44.4% vs 66.7%) in TAE than THE. The chyle leak was observed more in TAE (16.7%) than THE (6.7%).

Conclusions

TAE achieved higher R0 resection rate and better short-term morbidity than THE. Enrollment of small number of cases in the study precluded statistical significance.

Trial Registration

This study was registered in Clinical Trial Registry-India (CTRI registration no: CTRI/2018/05/013880) in 14-05-2018.

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Availability of Data and Material

Available on demand to corresponding author.

Code Availability

Microsoft Excel Sheet and SPSS 22.0

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Authors and Affiliations

  1. Department of Surgical Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India

    Kunal Bikram Deo, Harjeet Singh, Vikas Gupta, Ganga Ram Verma & Rajesh Gupta

  2. Department of Histopathology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India

    Ashim Das

  3. Department of Surgery, B P Koirala Institute of Health Sciences, Dharan, Nepal

    Kunal Bikram Deo

Authors
  1. Kunal Bikram Deo
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  2. Harjeet Singh
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  3. Vikas Gupta
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  4. Ashim Das
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  5. Ganga Ram Verma
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  6. Rajesh Gupta
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Contributions

Concept and protocol of study: (KBD, HS, VG, AD, GRV, RG), patient enrollment (KBD, HS, VG, GRV, RG), data of Surgical aspects and outcome (KBD, HS, VG, GRV, RG), pathological aspects and details (AD), data entry and analysis (KBD, GRV), manuscript preparation (KBD, GRV), manuscript finalization (KBD, HS, VG, GRV, RG), final approval of manuscript (GRV, RG).

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Correspondence to Rajesh Gupta.

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Deo, K.B., Singh, H., Gupta, V. et al. Thoracoscopy-Assisted Esophagectomy vs Transhiatal Esophagectomy for Carcinoma Esophagus: a Prospective Comparison of Short-Term Outcomes. J Gastrointest Canc 53, 333–340 (2022). https://doi.org/10.1007/s12029-021-00607-z

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  • DOI: https://doi.org/10.1007/s12029-021-00607-z

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