Transcervical Endoscopic Esophageal Mobilization: An Approach to Transhiatal Esophagectomy

Background

Transcervical endoscopic esophageal mobilization (TEEM) is an approach to transhiatal esophagectomy that aims to minimize blood loss and decrease the operative time commonly associated with traditional transhiatal technique.

Methods

A retrospective chart review was conducted on patients who underwent TEEM esophagectomy between 2009 and 2020. Baseline characteristics, perioperative outcomes, and postoperative complications were recorded. To report survival, a Kaplan-Meier survival plot was developed using SAS software (SAS Institute).

Results

A total of 241 patients underwent TEEM esophagectomy. The mean operative time was 185.1 ± 59.3 minutes, blood loss was 251.4 ± 212.3 mL, the number lymph nodes dissected was 13.6 ± 6.2, and the length of stay was 11.9 ± 8.5 days. In the postoperative setting, 68 (28.2%) patients experienced hoarseness, 62 (25.7%) had postoperative atrial fibrillation, 30 (12.4%) had an anastomotic leak, and 12 (4.6%) experienced chylothorax. The overall 30- and 90-day mortality rates were 2.1% (5 of 241) and 4.6% (11 of 241), respectively. The median overall survival was 2.36 years, with 60% 3-year survival and 40% 5-year survival.

Conclusions

TEEM esophagectomy is a safe approach with acceptable postoperative morbidity and mortality and shorter operative times compared with historical norms.