Schlottmann F, et al. - Authors performed a comparison of postoperative outcomes between transhiatal esophagectomy (THE) and transthoracic esophagectomy (TTE) and identified risk factors for morbidity. In this study, THE and TTE were similar regarding the incidence of anastomotic leak and 30-day mortality. The impact of gender, race, and patients’ comorbidities on postoperative complications was comparable across both types of esophagectomy.

Methods

• Authors performed a retrospective analysis using the American College of Surgeons National Surgical Quality Improvement Program database.
• They included adult patients who underwent THE or TTE between 2005 and 2014.
• Comparison of postoperative morbidity, length of stay, and 30-day mortality was performed.
• Using multivariable logistic regression they determined risk factors for complications; they used likelihood ratio tests to assess whether the effect of each risk factor was different across THE and TTE.

Results

• The study included 4053 patients; 2362 (58.3%) underwent TTE and 1691 (41.7%) underwent THE.
• Incidences of postoperative pneumonia and bleeding requiring transfusion were higher with TTE.
• THE seemed associated with higher incidences of superficial wound infection, deep wound infection, urinary tract infection, and sepsis.
• Findings revealed no marked differences in occurrence of anastomotic leak (THE 7.6% vs. TTE 9.4%, p = 0.35) or 30-day mortality (THE 2.3% vs. TTE 2.5%, p = 0.63).
• Postoperative complications seemed to have an independent association with female gender, black race, hypertension, diabetes, chronic obstructive pulmonary disease, partially or fully dependent functional status, and an ASA score ≥ 3.
• Authors realized that the impact of the risk factors on morbidity was similar across both procedures.