Outcome of Transhiatal Esophagectomy Done for Advanced Oesophageal Cancer

Background: This study was aimed at assessing a single unit experience of Transhiatal Oesophagectomy (THE) done for advanced esophageal cancer and the possible contributing factors for adverse outcomes.
Methods: A Retrospective hospital based longitudinal case series analysis was undertaken at Tikur Anbessa Specialized Central Referral Hospital, Addis Ababa, Ethiopia. All patients admitted for esophageal cancer and operated with transhiatal oesophagectomy over a period of six years from November 2006 to November 2011. The outcome measures studied included the demographic characters, duration and severity of symptoms, relevant investigations, stage and site of the tumor, hospital stay, mortality, morbidity, and variables associated with adverse out comes.
Results: A total of 156 patients were operated for possible THE, of them 139 (89.1%) were found suitable for the planned procedure. Male to female ratio was 1:1.72 and mean age of presentation was 54.9 ± 11.8. Majority of patients seek medical advice late in the course of the illness. At the time of surgery, One hundred twenty seven (91.4%) of them were either stage three or above. Tumor was localized in the upper (1.4%) middle (23%) lower (62.2%) and GEJ (13%). Majority were squamous cell carcinoma (82%) . Patients presented after an average of 5.54 ± 3.05 months of symptom onset. The mean duration of surgery was 152.98 ± 37.3 minutes and the mean estimated amount of intra-operative blood loss was 733.38± 380.5 ml. The average hospital stay after surgery was 11.58 ± 7.4 days and the hospital mortality was 18.7%. The major risk factors for mortality were sepsis, anastomotic leak and respiratory conditions. All the 113(81.3%) operative survivors were discharged from the hospital after they resumed normal swallowing.
Conclusion: With Transhiatal Oesophagectomy, it is possible to achieve lasting relief from dysphagia if done in appropriately selected patients even for advanced esophageal cancer with acceptable mortality and morbidity.