Early Results of Laparoscopic Trans-Hiatal Esophagectomy versus Three-Field Thoracoscopic Esophagectomy in the Treatment of Esophageal Cancer

Abstract

Background: Esophageal cancer is an aggressive malignancy, often diagnosed at advanced stages, with high mortality rates. The main surgical approaches for its treatment include transthoracic and trans-hiatal esophagectomy, both of which can be performed using minimally invasive techniques. The choice of the most appropriate approach depends on anatomical, oncological, and clinical factors and remains a topic of debate in the literature, particularly regarding early morbidity and mortality outcomes. Aim: To compare the immediate outcomes of the transthoracic and trans-hiatal video-endoscopic approaches in the surgical treatment of esophageal cancer, with emphasis on early mortality and postoperative complications. Methods : This is a retrospective study based on the analysis of medical records of 90 patients who underwent video-assisted or thoracoscopic esophagectomy between October 2007 and March 2025. Demographic, clinical, surgical, histological, and postoperative data were collected and evaluated, and statistical comparisons were made between the transthoracic group (n = 35) and the trans-hiatal group (n = 55). Results : The transthoracic approach was associated with significantly higher thirty-day mortality, with a four-fold increase in risk compared with the trans-hiatal approach (p = 0.003). Other complications such as anastomotic leakage, pneumonia, sepsis, and chylothorax occurred in both groups without significant differences. Logistic regression revealed a higher risk of major complications in the transthoracic group (OR = 2.54; p = 0.036). This group also had a higher prevalence of squamous cell tumors in the mid-esophagus and greater exposure to neoadjuvant chemo-radiotherapy. Conclusion: Although both techniques are feasible, the trans-hiatal approach was associated with lower mortality and reduced rates of major complications, suggesting it may be safer for patients with tumors located in the lower third of the esophagus and less loco-regional involvement. The choice of surgical approach should be individualized, taking into account anatomical and oncological aspects.