38 Outcomes Following Transhiatal Oesophagectomy at a Single UK Centre: A Retrospective Review of 248 Operations Over 17 Years

Abstract Aim To evaluate perioperative outcomes, pathological findings, and long-term survival following transhiatal oesophagectomy (THO) for distal oesophageal tumours. Method: A retrospective review was conducted using a prospectively maintained database of all patients who underwent THO from 2007 to 2024. Data included demographics, comorbidities, pathological staging, complications, and survival. Kaplan-Meier and log-rank tests assessed survival. Results A total of 248 patients (median age 66; 81.9% male) underwent THO, with 85.1% receiving neoadjuvant chemotherapy. Cardiopulmonary exercise testing (CPET) was performed in 74.2%, with 30.3% classified high risk (anaerobic threshold <11 ml/kg/min). Complications occurred in 36.3%, including cardiac events (15.3%) and anastomotic leak (16.9%). Vocal cord neuropraxia was seen in 8.5%, with permanent injury in 1.6%. Unplanned ITU admission occurred in 12.5%, and in-hospital mortality was 0.4%. R0 resection was achieved in 75.8%. CRM involvement occurred in 23.8%. Median lymph node yield was 18. Advanced disease was common (47.6% pT3). Among adenocarcinoma patients treated with neoadjuvant therapy, median survival was 66.0 months (stage II), 27.0 (IIIB), and 21.0 (IVA); not reached for stage I or IIIA. Median overall survival was 94.0 months, increasing to 162.0 in R0 cases vs 28.0 with CRM involvement (p<0.0001). Conclusions Transhiatal oesophagectomy remains a viable and oncologically effective approach for selected patients with distal oesophageal cancer, demonstrating comparable survival with relatively low perioperative morbidity. Margin status and pathological stage were key predictors of survival. These findings support the use of THO beyond early-stage disease in appropriately chosen patients and reinforce the critical importance of achieving R0 resection to improve survival.