[Adenocarcinoma of the esophagus: prognostic comparison between transthoracic esophageal resection with expanded 2-field lymph node dissection and trans-hiatal esophageal dissection with abdominal lymph node excision].

A retrospective analysis should compare the two operative approaches, transhiatal or transthoracic resection in patients suffering from adenocarcinoma of the esophagus. Between 1985 and 2002 123 cases were presented with adenocarcinoma of the esophagus, treated in 65% by transhiatal resection including abdominal lymph node dissection and in 35% by the transthoracic approach with standardized extended mediastinal and abdominal lymph node dissection. Hospital mortality was 14% (6/43) after transthoracic resection and 3.8% (3/80) after transhiatal resection (ns). Die number of removed and examined abdominal lymph nodes following transhiatal resection was 14.1 (mean) versus 12.3 (mean) after transthoracic resection (ns). Die number of removed and examined mediastinal lymph nodes by transhiatal resection was 6.3 (mean) versus 19.7(mean) after transthoracic resection (p < 0.001). The median survival after transthoracic approach was 19 months versus 20 months after transhiatal approach (ns). Median survival of curatively resected patients (R0) were in both operative procedures similar (21 months). A more differentiated analysis referred to the UICC stages also demonstrated no differences in the survival between transthoracic and transhiatal resection. With respect to less mortality and less morbidity after transhiatal resection and because of the not detectable prognostic advantage of the transthoracic resection we suggest the transhiatal approach as the treatment of choice in patients with adenocarcinoma of the esophagus.