Extended Transthoracic Resection Compared with Limited Transhiatal Resection for Adenocarcinoma of the Esophagus

• Published in: The New England journal of medicine Vol. 347; no. 21; pp. 1662 - 1669
• Main Authors: Hulscher, Jan B.F, van Sandick, Johanna W, de Boer, Angela G.E.M, Wijnhoven, Bas P.L, Tijssen, Jan G.P, Fockens, Paul, Stalmeier, Peep F.M, ten Kate, Fiebo J.W, van Dekken, Herman, Obertop, Huug, Tilanus, Hugo W, van Lanschot, J. Jan B
• Format: Journal Article
• Language: English
• Published: Boston, MA Massachusetts Medical Society 21-11-2002
• Subjects: Adenocarcinoma - mortality; Adenocarcinoma - surgery; Adult; Aged; Biological and medical sciences; Cancer; Comparative analysis; Cost-Benefit Analysis; Disease-Free Survival; Esophageal Neoplasms - mortality; Esophageal Neoplasms - surgery; Esophagectomy - economics; Esophagectomy - methods; Esophagus; Female; Follow-Up Studies; Health Care Costs; Humans; Male; Medical procedures; Medical sciences; Middle Aged; Neoplasm Recurrence, Local - epidemiology; Quality-Adjusted Life Years; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Survival Analysis; Throat; Adenocarcinoma; Human; Statistical analysis; Esophageal disease; Malignant tumor; Survival; Esophagus; Quality of life; Health economy; Surgery; Digestive diseases; Technique; Comparative study; Cost efficiency analysis
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMoa022343

This study compared extended transthoracic resection with limited transhiatal resection for adenocarcinoma of the esophagus or gastric cardia. The five-year survival rates in the two groups were not significantly different, but a nonsignificant trend in overall survival favored transthoracic resection in later years.
In this study of resection for adenocarcinoma, a trend in survival favored transthoracic resection.
Long-term survival after surgery with curative intent for adenocarcinoma of the distal esophagus and gastric cardia is only 20 percent.
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Surgery is generally considered to offer the best chance for cure, but opinions differ on how to improve survival by surgery. One strategy aims at decreasing early postoperative risk by the use of limited cervicoabdominal (transhiatal) esophagectomy without formal lymphadenectomy. Another is intended to improve long-term survival by performing a combined cervicothoracoabdominal resection, with wide excision of the tumor and peritumoral tissues and extended lymph-node dissection in the posterior mediastinum and the upper abdomen (transthoracic esophagectomy with extended en . . .