For a lower end esophagus adenocarcinoma, a trans-hiatal oesophagostomy is planned. The approach would be in the following order:
|A||Abdomen and Neck|
|B||Chest and Abdomen and Neck|
|C||Abdomen and Chest and Neck|
|D||Chest and Neck|
a. The transhiatal resection requires two incisions: left neck and abdomen. The stomach and esophagus are mobilized through an upper midline abdominal incision, avoiding a thoracotomy. Mobilization of the esophagus is done blindly with manual manipulation through a widened hiatus
b. The stomach is tubularized and gently passed through the posterior mediastinum, and a cervical esophagogastric anastomosis is performed. Accessible lymph nodes in the neck, lower chest, and abdomen are removed, but there is no additional attempt to perform an extensive lymphadenectomy.
c. Advantages include a decreased anastomotic leak rate to 3% using the stapled technique,a less morbid cervical leak if a leak does occur, and a mortality rate of 4% that compares favorably against the higher rates seen with both the TTE and EBE. Reduced operative times, less blood loss, and fewer cardiorespiratory complications have all been reported with THE.
d. Disadvantages include a higher rate of postoperative strictures, injury to great vessels, and airway structures secondary to a blind transhiatal dissection, and an inability to perform a complete lymph node dissection.