Several case series have demonstrated that laparoscopic transhiatal esophagectomy (LTHE) is associated with favorable perioperative outcomes compared to historical data for open transhiatal esophagectomy (OTHE). Contemporaneous evaluation of open and laparoscopic THE is rare, limiting meaningful comparison of techniques.
All patients who underwent OTHE (n = 32) and LTHE (n = 41) during the introduction of the latter procedure at our institution (1/2012–4/2014) were identified, and patient charts were retrospectively reviewed.
Indications for operation included 69 patients with esophageal malignancy (adenocarcinoma: 64; squamous cell carcinoma: 4; melanoma: 1) and 4 patients with benign disease. There were no significant differences in clinicopathologic variables between OTHE and LTHE cohorts, except for an increased rate of cardiovascular disease in the LTHE cohort (p = 0.04). There was no significant difference in median operative time or operative complications, yet LTHE was associated with a lower incidence of intraoperative blood transfusion (p < 0.01). There were no 30-day mortalities. LTHE was associated with a reduced time to reach 24-h tube feeding goals (p = 0.02), shorter length of hospital stay (p = 0.01), and 6 % reduced median direct cost (p = 0.04). There were no significant differences in rates of major perioperative morbidities. Patients were followed for a median of 11.0 months during which there were no significant differences between cohorts in disease-free survival or overall survival.
When compared to OTHE, LTHE improves surgical outcomes and decreases hospital costs; short-term oncologic outcomes are similar. LTHE is preferable to OTHE in patients requiring transhiatal esophagectomy.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Siegel RL, Miller KD, Jemal A (2015) Cancer statistics, 2015. CA Cancer J Clin 65(1):5–29
Boshier PR, Anderson O, Hanna GB (2011) Transthoracic versus transhiatal esophagectomy for the treatment of esophagogastric cancer: a meta-analysis. Ann Surg 254(6):894–906
Hulscher JBF, Tijssen JGP, Obertop H, van Lanschot JJB (2001) Transthoracic versus transhiatal resection for carcinoma of the esophagus: a meta-analysis. Ann Thorac Surg 72(1):306–313
Orringer MB, Marshall B, Chang AC, Lee J, Pickens A, Lau CL (2007) Two thousand transhiatal esophagectomies: changing trends, lessons learned. Ann Surg 246(3):363–372
Hulscher JB, van Sandick JW, de Boer AG, Wijnhoven BP, Tijssen JG, Fockens P, Stalmeier PF, ten Kate FJ, van Dekken H, Obertop H, Tilanus HW, van Lanschot JJ (2002) Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med 347(21):1662–1669
Hamouda AH, Forshaw MJ, Tsigritis K, Jones GE, Noorani AS, Rohatgi A, Botha AJ (2010) Perioperative outcomes after transition from conventional to minimally invasive Ivor-Lewis esophagectomy in a specialized center. Surg Endosc 24(4):865–869
Noble F, Kelly JJ, Bailey IS, Byrne JP, Underwood TJ (2013) A prospective comparison of totally minimally invasive versus open Ivor Lewis esophagectomy. Dis Esophagus 26(3):263–271
Kinjo Y, Kurita N, Nakamura F, Okabe H, Tanaka E, Kataoka Y, Itami A, Sakai Y, Fukuhara S (2012) Effectiveness of combined thoracoscopic–laparoscopic esophagectomy: comparison of postoperative complications and midterm oncological outcomes in patients with esophageal cancer. Surg Endosc 26(2):381–390
Bailey L, Khan O, Willows E, Somers S, Mercer S, Toh S (2013) Open and laparoscopically assisted oesophagectomy: a prospective comparative study. Eur J Cardiothorac Surg 43(2):268–273
Yamasaki M, Miyata H, Fujiwara Y, Takiguchi S, Nakajima K, Kurokawa Y, Mori M, Doki Y (2011) Minimally invasive esophagectomy for esophageal cancer: comparative analysis of open and hand-assisted laparoscopic abdominal lymphadenectomy with gastric conduit reconstruction. J Surg Oncol 104(6):623–628
Watanabe M, Baba Y, Nagai Y, Baba H (2013) Minimally invasive esophagectomy for esophageal cancer: an updated review. Surg Today 43(3):237–244
Bernabe KQ, Bolton JS, Richardson WS (2005) Laparoscopic hand-assisted versus open transhiatal esophagectomy: a case-control study. Surg Endosc 19(3):334–337
Maas KW, Biere SSAY, Scheepers JJG, Gisbertz SS, van der Peet DL, Cuesta MA (2012) Laparoscopic versus open transhiatal esophagectomy for distal and junction cancer. Rev Esp Enferm Dig 104(4):197–202
Cash JC, Zehetner J, Hedayati B, Bildzukewicz NA, Katkhouda N, Mason RJ, Lipham JC (2014) Outcomes following laparoscopic transhiatal esophagectomy for esophageal cancer. Surg Endosc 28(2):492–499
Edge S, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A (eds) (2010) American joint comittee on cancer: American joint committee on cancer staging manual, 7th edn. Springer, NY, NY
Sanders G, Borie F, Husson E, Blanc PM, Di Mauro G, Claus C, Millat B (2007) Minimally invasive transhiatal esophagectomy: lessons learned. Surg Endosc 21(7):1190–1193
Montenovo MI, Chambers K, Pellegrini CA, Oelschlager BK (2011) Outcomes of laparoscopic-assisted transhiatal esophagectomy for adenocarcinoma of the esophagus and esophago-gastric junction. Dis Esophagus 24(6):430–436
Kinoshita T, Gotohda N, Kato Y, Takahashi S, Konishi M, Okazumi S, Katoh R, Kinoshita T (2012) Laparoscopic transhiatal resection for Siewert type II adenocarcinoma of the esophagogastric junction: operative technique and initial results. Surg Laparosc Endosc Percutaneous Tech 22(4):199–203
Mamidanna R, Bottle A, Aylin P, Faiz O, Hanna GB (2012) Short-term outcomes following open versus minimally invasive esophagectomy for cancer in England: a population-based national study. Ann Surg 255(2):197–203
Omloo JM, Lagarde SM, Hulscher JB, Reitsma JB, Fockens P, van Dekken H, Ten Kate FJ, Obertop H, Tilanus HW, van Lanschot JJ (2007) Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the mid/distal esophagus: five-year survival of a randomized clinical trial. Ann Surg 246(6):992–1000
Barkun JS, Barkun AN, Sampalis JS, Fried G, Taylor B, Wexler MJ, Goresky CA, Meakins JL (1992) Randomised controlled trial of laparoscopic versus mini cholecystectomy. The McGill Gallstone Treatment Group. Lancet 340(8828):1116–1119
Keus F, de Jong JA, Gooszen HG, van Laarhoven CJ (2006) Laparoscopic versus open cholecystectomy for patients with symptomatic cholecystolithiasis. Cochrane Database Syst Rev 18(4):CD006231
Luján JA, Frutos MD, Hernández Q, Liron R, Cuenca JR, Valero G, Parrilla P (2004) Laparoscopic versus open gastric bypass in the treatment of morbid obesity: a randomized prospective study. Ann Surg 239(4):433–437
Broeders JA, Rijnhart-de Jong HG, Draaisma WA, Bredenoord AJ, Smout AJ, Gooszen HG (2009) Ten-year outcome of laparoscopic and conventional nissen fundoplication: randomized clinical trial. Ann Surg 250(5):698–706
Zeng YK, Yang ZL, Peng JS, Lin HS, Cai L (2012) Laparoscopic assisted versus open distal gastrectomy for early gastric cancer: evidence from randomized and nonrandomized clinical trials. Ann Surg 256:39–52
Strong VE, Devaud N, Allen PJ, Gonen M, Brennan MF, Coit D (2009) Laparoscopic versus open subtotal gastrectomy for adenocarcinoma: a case–control study. Ann Surg Oncol 16:1507–1513
Reza MM, Blasco JA, Andradas E, Cantero R, Mayol J (2006) Systematic review of laparoscopic versus open surgery for colorectal cancer. Br J Surg 93(8):921–928
Jacob BP, Salky B (2005) Laparoscopic colectomy for colon adenocarcinoma: an 11-year retrospective review with 5-year survival rates. Surg Endosc 19(5):643–649
Whitson BA, Groth SS, Duval SJ, Swanson SJ, Maddaus MA (2008) Surgery for early-stage non-small cell lung cancer: a systematic review of the video-assisted thoracoscopic surgery versus thoracotomy approaches to lobectomy. Ann Thorac Surg 86(6):2008–2016
Nagpal K, Ahmed K, Vats A, Yakoub D, James D, Ashrafian H, Darzi A, Moorthy K, Athanasiou T (2010) Is minimally invasive surgery beneficial in the management of esophageal cancer? A meta-analysis. Surg Endosc 24(7):1621–1629
Dantoc MM, Cox MR, Eslick GD (2012) Does minimally invasive esophagectomy (MIE) provide for comparable oncologic outcomes to open techniques? A systematic review. J Gastrointest Surg 16(3):486–494
Kang J, Yoon KJ, Min BS, Hur H, Baik SH, Kim NK, Lee KY (2013) The impact of robotic surgery for mid and low rectal cancer: a case-matched analysis of a 3-arm comparison—open, laparoscopic, and robotic surgery. Ann Surg 257(1):95–101
Parameswaran R, Veeramootoo D, Krishnadas R, Cooper M, Berrisford R, Wajed S (2009) Comparative experience of open and minimally invasive esophagogastric resection. World J Surg 33:1868–1875
Lee L, Sudarshan M, Li C, Latimer E, Fried GM, Mulder DS, Feldman LS, Ferri LE (2013) Cost-effectiveness of minimally invasive versus open esophagectomy for esophageal cancer. Ann Surg Oncol 20(12):3732–3739
Drs. Ecker, Datta, Dumon, Williams, Kucharczuk and Dempsey have no conflict of interest or financial ties to disclose. Ms. Savulionyte has no conflict of interest or financial ties to disclose.
Brett L. Ecker and Goda E. Savulionyte are co-first authors.
About this article
Cite this article
Ecker, B.L., Savulionyte, G.E., Datta, J. et al. Laparoscopic transhiatal esophagectomy improves hospital outcomes and reduces cost: a single-institution analysis of laparoscopic-assisted and open techniques. Surg Endosc 30, 2535–2542 (2016). https://doi.org/10.1007/s00464-015-4519-9
- Transhiatal esophagectomy
- Minimally invasive surgery
- Laparoscopic-assisted esophagectomy
- Cost analysis