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Transthoracic versus transhiatal resection for esophageal adenocarcinoma of the lower esophagus: A value‐based comparison
Author(s) -
Khullar Onkar V.,
Jiang Renjian,
Force Seth D.,
Pickens Allan,
Sancheti Manu S.,
Ward Kevin,
Gillespie Theresa,
Fernandez Felix G.
Publication year - 2015
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.24024
Subject(s) - medicine , esophagectomy , propensity score matching , confounding , surveillance, epidemiology, and end results , esophagus , proportional hazards model , barrett's esophagus , adenocarcinoma , hazard ratio , surgery , cohort , esophageal adenocarcinoma , retrospective cohort study , esophageal cancer , epidemiology , population , cancer registry , cancer , confidence interval , environmental health
Background and Objective Our objective was to compare clinical outcomes, costs, and resource use based on operative approach, transthoracic (TT) or transhiatal (TH), for resection of esophageal cancer. Methods This cohort analysis utilized the Surveillance, Epidemiology, and End Results—Medicare linked data from 2002 to 2009. Only adenocarcinomas of the lower esophagus were examined to minimize confounding. Medicare data was used to determine episode of care costs and resource use. Propensity score matching was used to control for identified confounders. Kaplan–Meier method and Cox‐proportional hazard modeling were used to compare long‐term survival. Results 537 TT and 405 TH resections were identified. TT and TH esophagectomy had similar complication rates (46.7% vs. 50.8%), operative mortality (7.9% vs 7.1%), and 90 days readmission rates (30.5% vs. 32.5%). However, TH was associated with shorter length of stay (11.5 vs. 13.0 days, P = 0.006) and nearly $1,000 lower cost of initial hospitalization ( P = 0.03). No difference in 5‐year survival was identified (33.5% vs. 36%, P = 0.75). Conclusions TH esophagectomy was associated with lower costs and shorter length of stay in an elderly Medicare population, with similar clinical outcomes to TT. The TH approach to esophagectomy for distal esophageal adenocarcinoma may, therefore, provide greater value (quality/cost). J. Surg. Oncol. 2015; 112:517–523 . © 2015 Wiley Periodicals, Inc.