NEW YORK (Reuters Health) – Five-year survival rates are not significantly different for patients with esophagogastric cancer whether they undergo transthoracic or transhiatal esophagectomy, according to the findings of a meta-analysis reported in the Annals of Surgery online July 21.

However, Dr. George B. Hanna and colleagues saw significant heterogeneity among the studies, so “The finding of equivalent survival should therefore be viewed with caution.”

Esophagectomy is the main treatment for potentially curable esophageal cancer, say the authors, who are based at St. Mary’s Hospital, Imperial College London, UK. While the transthoracic approach allows more thorough dissection of the tumor and adjacent lymphatics, morbidity and mortality are often considerable, they explain. On the other hand, a transhiatal approach is less traumatic but the quality of the resection may be compromised.

The current meta-analysis aimed to clarify these issues by incorporating findings from recent studies. The team identified 52 studies involving 5905 patients – 3389 undergoing transthoracic operations and 2516 transhiatal procedures.

The results indicated that transthoracic surgery took longer than transhiatal operations by 85 minutes, and lengths of stay were longer by 3.9 days.

“The transthoracic group had significantly more respiratory complications, wound infections, and early postoperative mortality,” the researchers report, “whereas anastomotic leak, anastomotic stricture, and recurrent laryngeal nerve palsy rate was significantly higher in the transhiatal group.”

The primary endpoint, 5-year survival, was not significantly different in the two groups, at 26.6% with the transthoracic approach and 25.8% with the transhiatal strategy (odds ratio 1.03, p=0.84), Dr. Hanna and colleagues found.

“However, lymphadenectomy and reported surgical quality was suboptimal in both groups and the transthoracic group had significantly more advanced cancer,” they caution. “Only through adequate surgical quality and standards of reporting may the true benefit of these operations be determined.”

Reference:
Transthoracic Versus Transhiatal Esophagectomy for the Treatment of Esophagogastric Cancer: A Meta-Analysis
Ann Surg 2011