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. 1993 Jul;218(1):97–104. doi: 10.1097/00000658-199307000-00015

Endodissection of the thoracic esophagus. Technique and clinical results in transhiatal esophagectomy.

R Bumm 1, A H Hölscher 1, H Feussner 1, M Tachibana 1, H Bartels 1, J R Siewert 1
PMCID: PMC1242906  PMID: 8328835

Abstract

OBJECTIVE: Transhiatal esophagectomy (THE), mostly performed in patients with adenocarcinoma of the esophagus, bears the risk of damage to mediastinal structures because the physician's vision is poor during esophageal dissection. The authors report a new endoscopic technique, which enables microsurgical dissection of the esophagus under visual control, that can be performed simultaneously to the abdominal approach. The clinical results in unselected patients with malignant esophageal disease were compared with those of patients undergoing conventional THE. METHODS: Thirty unselected patients (24 men and 6 women; median age, 60 years; age range, 35 to 80 years), mostly with adenocarcinoma of the esophagus, underwent endodissection between April 1991 and July 1992. Thirty patients, who underwent conventional THE between January 1986 and December 1990, were selected using a matched pair algorithm. RESULT: Three significant intraoperative complications were recorded during endodissection (one case of mediastinal bleeding; one case of postoperative bleeding; and one case of a lesion of the right main bronchus), and all were managed without further patient morbidity. The mortality rate (30 days) was 6.6% in the endodissection group (vs. 9.9% THE; not significant [NS]). The frequency of postoperative severe pulmonary complications was 13.3% in the endodissection group (vs. 30% in THE; p < 0.05). The rate of recurrent nerve palsy was only 6.6% in the endodissection group (vs. 13.3% in THE; NS). CONCLUSIONS: Endodissection is especially helpful during esophageal dissection at or above the trachea. It allows identification of mediastinal structures and controlled biopsy of mediastinal lymph nodes. This study showed that endodissection eliminates the "blind angle" during conventional THE, prevents recurrent nerve damage, and reduces pulmonary distress during transhiatal esophagectomy.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Barbier P. A., Becker C. D., Wagner H. E. Esophageal carcinoma: patient selection for transhiatal esophagectomy. A prospective analysis of 50 consecutive cases. World J Surg. 1988 Apr;12(2):263–269. doi: 10.1007/BF01658071. [DOI] [PubMed] [Google Scholar]
  2. Buess G., Becker H. D., Mentges B., Teichmann R., Lenz G. Die endoskopisch-mikrochirurgische Dissektion der Speiseröhre. II. Erste klinische Erfahrungen mit Darstellung der Operationstechnik. Chirurg. 1990 Apr;61(4):308–311. [PubMed] [Google Scholar]
  3. Finley R. J., Grace M., Duff J. H. Esophagogastrectomy without thoracotomy for carcinoma of the cardia and lower part of the esophagus. Surg Gynecol Obstet. 1985 Jan;160(1):49–56. [PubMed] [Google Scholar]
  4. Finley R. J., Grace M., Duff J. H. Esophagogastrectomy without thoracotomy for carcinoma of the cardia and lower part of the esophagus. Surg Gynecol Obstet. 1985 Jan;160(1):49–56. [PubMed] [Google Scholar]
  5. Finley R. J., Inculet R. I. The results of esophagogastrectomy without thoracotomy for adenocarcinoma of the esophagogastric junction. Ann Surg. 1989 Oct;210(4):535–543. doi: 10.1097/00000658-198910000-00014. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Hankins J. R., Attar S., Coughlin T. R., Jr, Miller J. E., Hebel J. R., Suter C. M., McLaughlin J. S. Carcinoma of the esophagus: a comparison of the results of transhiatal versus transthoracic resection. Ann Thorac Surg. 1989 May;47(5):700–705. doi: 10.1016/0003-4975(89)90121-5. [DOI] [PubMed] [Google Scholar]
  7. Larrieu H., Millat B., Gayral F. Oesophagectomies transhiatales. Chirurgie. 1985;111(9):835–836. [PubMed] [Google Scholar]
  8. Orringer M. B. Transhiatal esophagectomy without thoracotomy for carcinoma of the thoracic esophagus. Ann Surg. 1984 Sep;200(3):282–288. doi: 10.1097/00000658-198409000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Siewert J. R. Esophageal cancer from the German point of view. Jpn J Surg. 1989 Jan;19(1):11–20. doi: 10.1007/BF02471561. [DOI] [PubMed] [Google Scholar]
  10. Siewert J. R., Hölscher A. H., Horvath O. P. Transmediastinale Oesophagektomie. Langenbecks Arch Chir. 1986;367(3):203–213. doi: 10.1007/BF01258939. [DOI] [PubMed] [Google Scholar]
  11. Siewert J. R., Hölscher A. H., Horvath O. P. Transmediastinale Oesophagektomie. Langenbecks Arch Chir. 1986;367(3):203–213. doi: 10.1007/BF01258939. [DOI] [PubMed] [Google Scholar]
  12. Siewert J. R., Hölscher A. H., Roder J., Bartels H. En-bloc Resektion der Speiseröhre beim Oesophaguscarcinom. Langenbecks Arch Chir. 1988;373(6):367–376. doi: 10.1007/BF01272555. [DOI] [PubMed] [Google Scholar]
  13. Skinner D. B. En bloc resection for neoplasms of the esophagus and cardia. J Thorac Cardiovasc Surg. 1983 Jan;85(1):59–71. [PubMed] [Google Scholar]
  14. Steiger Z., Wilson R. F. Comparison of the results of esophagectomy with and without a thoracotomy. Surg Gynecol Obstet. 1981 Nov;153(5):653–656. [PubMed] [Google Scholar]
  15. Ulrich B., Kasperk R., Grabitz K., Kremer K. Die Oesophagusresektion ohne Thoracotomie beim Carcinom. Erfahrungsbericht über 100 Fälle. Chirurg. 1985 Apr;56(4):251–260. [PubMed] [Google Scholar]

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