Review
Transthoracic versus transhiatal resection for carcinoma of the esophagus: a meta-analysis

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Abstract

There is much controversy about the surgical approach to esophageal carcinoma: should an extensive resection be done to optimize long-term survival or should the extent of the operation be limited to obtain lower perioperative morbidity and mortality rates? We systematically reviewed the English-language literature published during the past decade, with emphasis on the differences between transthoracic and transhiatal resections regarding early morbidity, in-hospital mortality rates, and 3- and 5-year survival. Although transthoracic resections had significantly higher early (pulmonary) morbidity and mortality rates, 5-year survival was approximately 20% after both transthoracic and transhiatal resections.

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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