Transhiatal esophagectomy for benign and malignant conditions

Background: Experience with transhiatal esophagectomy (THE) for both benign and malignant diseases of the esophagus as practiced over an 18-year period is presented. Methods: Between 1982 and 2000, 411 consecutive patients underwent THE for both benign (n = 44) and malignant (n = 367) diseases of esophagus. Surviving patients were followed up for a mean of 30.4 months. Results: The overall operative mortality was 11% which had reduced to 6% for the last 111 patients. Operative mortality in the benign group was less than 5%. Respiratory complications were the most frequent cause of morbidity and mortality. Nonfatal anastomotic leaks occurred in 14%. The overall actuarial survival rates at 2, 5, and 10 years for carcinoma patients were 54%, 38%, and 18% respectively. The 2- and 5-year actuarial survival rates for postcricoid cancers were 83% and 64%, respectively. Conclusions: Transhiatal esophagectomy is safe and effective, and its results including long-term outcome are comparable with most published series.