37 Widening the Scope: Transhiatal Oesophagectomy Beyond Early-Stage Disease

Abstract Aim To compare outcomes of transhiatal oesophagectomy (THO) and transthoracic oesophagectomy (TTO) in patients with ypT3 distal oesophageal tumours. Method A retrospective review was conducted using a prospectively maintained database at a single UK regional centre. Between 2007 and 2024, 270 patients with ypT3 tumours underwent either TTO (n=156) or THO (n=114). Surgical approach was determined via MDT discussion. A hybrid TTO technique was introduced during this period and used in 47 cases. Results Baseline demographics and cardiopulmonary fitness were comparable between groups. Postoperative pulmonary complications (53.2% vs 29.8%; p<0.01) and anastomotic leaks (24.4% vs 12.3%; p=0.013) were significantly more frequent in the TTO group. Vocal cord neuropraxia was more common following THO (10.5% vs 1.3%; p<0.001), although most cases resolved. No significant differences were observed in unplanned ITU admissions (20.5% vs 14%) or in-hospital mortality (3.2% vs 0.9%). R0 resection rates (TTO: 53.2%, THO: 57.9%; p=0.52) and CRM involvement (TTO: 44.9%, THO: 41.2%; p=0.64) were similar. Median lymph node yield was 19 in both groups. Median overall survival was 30.0 months (TTO) vs 32.0 months (THO) (p=0.59). Conclusions With the selection criteria used in our centre, patients with ypT3 tumours experience lower postoperative morbidity when managed with transhiatal oesophagectomy compared to transthoracic oesophagectomy, without compromise in overall survival. The higher-than-expected anastomotic leak rate observed in the TTO group may be partly attributable to the learning curve associated with the adoption of a hybrid approach.