Open transthoracic or transhiatal esophagectomy versus minimally invasive esophagectomy in terms of morbidity, mortality and survival I. Braghetto, A. Csendes, G. Cardemil, P. Burdiles, O. Korn, H. Valladares Department of Surgery, University Hospital, Faculty of Medicine, University of Chile, Santos Dumont 999, Santiago, Chile Abstract Background: Surgical treatment of esophageal cancer is associated with a high rate of morbidity and mortality even in specialized centers. Minimally invasive surgery has been proposed to decrease these complications. Methods: The authors present their results regarding postoperative complications and the survival rate at 3 years, comparing the classic open procedures (trans- thoracic or transhiatal esophagectomy) with minimally invasive surgery. Surgical procedures were performed according to procedures published elsewhere. Results: The study enrolled 166 patients who underwent surgery between 1990 and 2003. Open transthoracic surgery was performed for 60 patients. In this group of patients, postoperative mortality was observed in 11% of the cases. Major, minor, and late complications were observed in 61.6% of the patients, and the 3-year sur- vival rate was 30% for this group. Open transhiatal surgery was performed for 59 patients. The morbidity, mortality, and 3-year rate were almost the same as for the transthoracic surgery group. For the 47 patients submitted to minimally invasive procedures (thoraco- scopic and laparoscopic), the complications and mor- tality rates were significantly reduced (38.2% and 6.4%, respectively). For the patients submitted to minimally invasive surgery, the 3-year survival rate was 45.4%. It is important to clarify that the patients submitted to minimally invasive surgery manifested early stages of the diseases, and that this the reason why the morbimor- tality and survival rates were better. Conclusions: The transthoracic and transhiatal open approaches have similar early and late results. Mini- mally invasive surgery is an option for patients with esophageal carcinoma, with reported results similar to those for open surgery. This approach is indicated mainly for selected patients with early stages of the disease. Key words: Esophageal carcinoma — Esophagectomy — Laparoscopy — Minimally invasive surgery — Thoracoscopy Open transthoracic esophagectomy (Ivor LewisÕs or AkijamaÕs procedure) is associated with significant morbidity (60–80%) and an operative mortality rate of 5% to 10% [9, 11, 12, 25]. To diminish these compli- cations, transhiatal esophagectomy with cervical eso- phagogastroanastomosis (OrringerÕs procedure) has been suggested. The results from comparisons of the transthoracic and transhiatal approaches have been controversial. Some reports have argued that the transhiatal approach has a lower rate of pulmonary complications and lower mortality than the transtho- racic approach, whereas other prospective reports have demonstrated similar postoperative results and similar 5-year survival rates. According to the re- ported results, the transthoracic approach has been more advisable for tumors located in the supracarineal esophagus, and transhiatal approach is the procedure of choice for tumors located at the distal esophagus [6, 12, 16, 19, 20]. More recently, video-assisted and thoracoscopic/ laparoscopic procedures have offered an advantageous alternative because of less operative trauma than expe- rienced with thoracotomy or manual blind or blunt transhiatal esophagectomy. Several reports have pre- sented very promising results concerning surgical per- formance, early complications, postoperative mortality, and long-term follow-up results [7, 13, 14, 17, 18, 23]. In 1993, we presented our video-assisted transhiatal technique during the 4th World Congress of the Inter- national Gastrosurgical Club [1–3]. Others have pre- sented the technique and the results for minimally Presented as a ‘‘free paper’’ during the 9th World Congress of Endo- scopic Surgery, Cancun, Mexico, 4–7 February, 2004 Correspondence to: I. Braghetto