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J Gastrointest Surg. 2017 Nov;21(11):1757-1763. doi: 10.1007/s11605-017-3572-1. Epub 2017 Sep 12.

Transhiatal vs. Transthoracic Esophagectomy: A NSQIP Analysis of Postoperative Outcomes and Risk Factors for Morbidity.

Author information

1
Department of Surgery and Center for Esophageal Diseases and Swallowing, University of North Carolina at Chapel Hill, 4030 Burnett Womack Building, 101 Manning Drive, CB 7081, Chapel Hill, NC, 27599-7081, USA. fschlottmann@hotmail.com.
2
Department of Surgery and Center for Esophageal Diseases and Swallowing, University of North Carolina at Chapel Hill, 4030 Burnett Womack Building, 101 Manning Drive, CB 7081, Chapel Hill, NC, 27599-7081, USA.
3
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
4
Department of Medicine and Surgery, University of North Carolina, Chapel Hill, NC, USA.

Abstract

BACKGROUND:

Both transhiatal esophagectomy (THE) and transthoracic esophagectomy (TTE) are accepted procedures for esophageal resection. We aimed to compare postoperative outcomes between these procedures and identify risk factors for morbidity.

METHODS:

A retrospective analysis was performed using the American College of Surgeons National Surgical Quality Improvement Program database. Adult patients who underwent THE or TTE between 2005 and 2014 were included. Postoperative morbidity, length of stay, and 30-day mortality were compared. Multivariable logistic regression was used to determine risk factors for complications, and likelihood ratio tests were used to assess whether the effect of each risk factor was different across THE and TTE.

RESULTS:

A total of 4053 patients were included, 2362 (58.3%) underwent TTE and 1691 (41.7%) underwent THE. TTE was associated with higher incidences of postoperative pneumonia and bleeding requiring transfusion. THE had higher incidences of superficial wound infection, deep wound infection, urinary tract infection, and sepsis. There were no significant differences in occurrence of anastomotic leak (THE 7.6% vs. TTE 9.4%, p = 0.35) or 30-day mortality (THE 2.3% vs. TTE 2.5%, p = 0.63). Female gender, black race, hypertension, diabetes, chronic obstructive pulmonary disease, partially or fully dependent functional status, and an ASA score ≥ 3 were independently associated with postoperative complications. The impact of the risk factors on morbidity was similar across both procedures.

CONCLUSIONS:

THE and TTE have similar incidence of anastomotic leak and 30-day mortality. The impact of gender, race, and patients' comorbidities on postoperative complications is similar across both types of esophagectomy.

KEYWORDS:

Outcomes; Transhiatal esophagectomy; Transthoracic esophagectomy

PMID:
28900830
DOI:
10.1007/s11605-017-3572-1
[Indexed for MEDLINE]

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