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Evaluating Outcomes And Trends of Transthoracic and Transhiatal Esophagectomy:
A Decade Analysis of High Volume Centers

Mehraneh D Jafari*1, Wissam J Halabi*1, Nguyen Q Vinh*2, Brian R Smith*1, Michael J Stamos1, Ninh T Nguyen1
1University of California, Irvine, Orange, CA;2University of California, Irvine, Irvine, CA

OBJECTIVE:
Controversy exists regarding the optimal surgical management of esophageal cancer. This study examined the trends and outcomes of the transthoracic (TTE) vs. transhiatal (THE) esophagectomy.

METHODS:
Using Nationwide Inpatient Sample between 2001-2010, data for patients with esophageal cancer was analyzed. Yearly trends in the use of TTE vs THE were analyzed and multivariate logistic regression was used to compare outcomes while controlling for age, gender, comorbidities, procedure type and hospital volume. Outcomes were analyzed according to hospital volume (Low-volume (LVC) <10 cases per year and high-volume (HVC) >=10 cases per year).

RESULTS:
Among the 41,051 cases identified, 37.8% were performed in HVC. Between 2001 and 2010, there was a trend towards an increase number of esophagectomies performed per year (1,402 to 1,975). An improvement in mortality was observed over this period (8.34% vs. 4.23%). TTE was the predominate operation (75.5%). Compared to THE, TTE was associated with a lower hospital charge ($118K vs. 150K), a shorter length of stay (15 vs. 18), and lower in-hospital mortality (3.4% vs. 6.9%). On multivariate regression analysis with TTE as reference, THE was associated with a 2.6 increase odds of mortality (p<0.02), and 1.6 increase odds of serious morbidity (p<0.01). No significant difference in outcomes was detected in HVC compared to LVC.

CONCLUSION:
The number of esophagectomies performed for esophageal cancer is increasing over the past decade with an overall decrease in mortality. The predominate operation continues to be TTE which is associated with a decreased serious morbidity and mortality compared to THE.


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