{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T06:59:16Z","timestamp":1778655556594,"version":"3.51.4"},"reference-count":46,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2022,6,20]],"date-time":"2022-06-20T00:00:00Z","timestamp":1655683200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,12,31]]},"abstract":"<jats:title>Summary<\/jats:title>\n               <jats:p>Transthoracic esophagectomy (TTE) for esophageal cancer facilitates mediastinal dissection; however, it has a significant impact on cardiopulmonary status. High-risk patients may therefore be better candidates for transhiatal esophagectomy (THE) in order to prevent serious complications. This study addressed short-term outcome following TTE and THE in patients that are considered to have a higher risk of surgery-related morbidity. This population-based study included patients who underwent a curative esophagectomy between 2011 and 2018, registered in the Dutch Upper GI Cancer Audit. The Charlson comorbidity index was used to assign patients to a low-risk (score\u2009\u2264\u20091) and high-risk group (score\u2009\u2265\u20092). Propensity score matching was applied to produce comparable groups between high-risk patients receiving TTE and THE. Primary endpoint was mortality (in-hospital\/30-day mortality), secondary endpoints included morbidity and oncological outcomes. Additionally, a matched subgroup analysis was performed, including only cervical reconstructions. Of 5,438 patients, 945 and 431 high-risk patients underwent TTE and THE, respectively. After propensity score matching, mortality (6.3 vs 3.3%, P\u2009=\u20090.050), overall morbidity, Clavien-Dindo\u2009\u2265\u20093 complications, pulmonary complications, cardiac complications and re-interventions were significantly more observed after TTE compared to THE. A significantly higher mortality after TTE with a cervical reconstruction was found compared to THE (7.0 vs. 2.2%, P\u2009=\u20090.020). Patients with a high Charlson comorbidity index predispose for a complicated postoperative course after esophagectomy, this was more outspoken after TTE compared to THE. In daily practice, these outcomes should be balanced with the lower lymph node yield, but comparable positive node count and radicality after THE.<\/jats:p>","DOI":"10.1093\/dote\/doac028","type":"journal-article","created":{"date-parts":[[2022,6,20]],"date-time":"2022-06-20T22:05:37Z","timestamp":1655762737000},"source":"Crossref","is-referenced-by-count":3,"title":["Short-term outcome for high-risk patients after esophagectomy"],"prefix":"10.1093","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4605-4058","authenticated-orcid":false,"given":"Victor D","family":"Plat","sequence":"first","affiliation":[{"name":"Department of Gastrointestinal Surgery, Amsterdam UMC, VU University Medical Center , Amsterdam , The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wessel T","family":"Stam","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery, Amsterdam UMC, VU University Medical Center , Amsterdam , The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Boukje T","family":"Bootsma","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery, Amsterdam UMC, VU University Medical Center , Amsterdam , The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer","family":"Straatman","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery, Amsterdam UMC, VU University Medical Center , Amsterdam , The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Klausch","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Amsterdam UMC, VU University Medical Center , Amsterdam , The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David J","family":"Heineman","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery, Amsterdam UMC, VU University Medical Center , Amsterdam , The Netherlands"},{"name":"Department of Cardiothoracic Surgery, Amsterdam UMC, VU University Medical Center , Amsterdam , The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Donald L","family":"van der Peet","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery, Amsterdam UMC, VU University Medical Center , Amsterdam , The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Freek","family":"Daams","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery, Amsterdam UMC, VU University Medical Center , Amsterdam , The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"Dutch Upper GI Cancer Audit Group","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2022,6,21]]},"reference":[{"key":"2023010614045474100_ref1","doi-asserted-by":"crossref","first-page":"2074","DOI":"10.1056\/NEJMoa1112088","article-title":"Preoperative chemoradiotherapy for esophageal or junctional cancer","volume":"366","author":"Hagen","year":"2012","journal-title":"N Engl J Med"},{"key":"2023010614045474100_ref2","doi-asserted-by":"crossref","first-page":"1662","DOI":"10.1056\/NEJMoa022343","article-title":"Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus","volume":"347","author":"Hulscher","year":"2002","journal-title":"New England Journal of Medicine"},{"key":"2023010614045474100_ref3","doi-asserted-by":"crossref","DOI":"10.1245\/s10434-020-08760-8","article-title":"Transthoracic versus transhiatal esophagectomy for esophageal cancer: a nationwide propensity score-matched cohort analysis","author":"Mertens","year":"2021","journal-title":"Ann Surg Oncol"},{"key":"2023010614045474100_ref4","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1097\/SLA.0b013e318188c474","article-title":"The number of lymph nodes removed predicts survival in esophageal cancer: an international study on the impact of extent of surgical resection","volume":"248","author":"Peyre","year":"2008","journal-title":"Ann Surg"},{"key":"2023010614045474100_ref5","doi-asserted-by":"crossref","first-page":"992","DOI":"10.1097\/SLA.0b013e31815c4037","article-title":"Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the mid\/distal esophagus: five-year survival of a randomized clinical trial","volume":"246","author":"Omloo","year":"2007","journal-title":"Ann Surg"},{"key":"2023010614045474100_ref6","doi-asserted-by":"crossref","first-page":"1016","DOI":"10.1097\/SLA.0000000000000335","article-title":"What should be the gold standard for the surgical component in the treatment of locally advanced esophageal cancer: transthoracic versus transhiatal esophagectomy","volume":"260","author":"Kutup","year":"2014","journal-title":"Ann Surg"},{"key":"2023010614045474100_ref7","doi-asserted-by":"crossref","first-page":"1757","DOI":"10.1007\/s11605-017-3572-1","article-title":"Transhiatal vs. transthoracic esophagectomy: a NSQIP analysis of postoperative outcomes and risk factors for morbidity","volume":"21","author":"Schlottmann","year":"2017","journal-title":"J Gastrointest Surg"},{"key":"2023010614045474100_ref8","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1016\/j.athoracsur.2016.04.055","article-title":"Predictors of major morbidity or mortality after resection for esophageal cancer: a society of thoracic surgeons general thoracic surgery database risk adjustment model","volume":"102","author":"Raymond","year":"2016","journal-title":"Ann Thorac Surg"},{"key":"2023010614045474100_ref9","doi-asserted-by":"crossref","first-page":"1492","DOI":"10.1007\/s11605-010-1328-2","article-title":"Patient and peri-operative predictors of morbidity and mortality after esophagectomy: American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), 2005\u20132008","volume":"14","author":"Dhungel","year":"2010","journal-title":"J Gastrointest Surg"},{"key":"2023010614045474100_ref10","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: development and validation","volume":"40","author":"Charlson","year":"1987","journal-title":"J Chronic Dis"},{"key":"2023010614045474100_ref11","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.1002\/bjs.9854","article-title":"Impact of co-morbidity on mortality after oesophageal cancer surgery","volume":"102","author":"Backemar","year":"2015","journal-title":"Br J Surg"},{"key":"2023010614045474100_ref12","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1016\/j.athoracsur.2011.07.030","article-title":"Impact of the surgical technique on pulmonary morbidity after esophagectomy","volume":"93","author":"Bakhos","year":"2012","journal-title":"Ann Thorac Surg"},{"key":"2023010614045474100_ref13","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1001\/jamasurg.2013.2356","article-title":"Esophagectomies with thoracic incisions carry increased pulmonary morbidity","volume":"148","author":"Bhayani","year":"2013","journal-title":"JAMA Surg"},{"key":"2023010614045474100_ref14","doi-asserted-by":"crossref","first-page":"1170","DOI":"10.1016\/j.athoracsur.2004.02.034","article-title":"Reducing hospital morbidity and mortality following esophagectomy","volume":"78","author":"Atkins","year":"2004","journal-title":"Ann Thorac Surg"},{"key":"2023010614045474100_ref15","doi-asserted-by":"crossref","first-page":"1887","DOI":"10.1016\/S0140-6736(12)60516-9","article-title":"Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial","volume":"379","author":"Biere","year":"2012","journal-title":"Lancet (London, England)"},{"key":"2023010614045474100_ref16","article-title":"Reporting national outcomes after esophagectomy and gastrectomy according to the esophageal complications consensus group (ECCG)","author":"Werf","year":"2020","journal-title":"Ann Surg"},{"key":"2023010614045474100_ref17","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1136\/bmj.39335.541782.AD","article-title":"Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"335","author":"Elm","year":"2007","journal-title":"Br Med J (Clin Res Ed)"},{"key":"2023010614045474100_ref18","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1016\/S0022-5223(19)41012-X","article-title":"Esophagectomy without thoracotomy","volume":"76","author":"Orringer","year":"1978","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2023010614045474100_ref19","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1002\/bjs.1800630403","article-title":"Total three-stage oesophagectomy for cancer of the oesophagus","volume":"63","author":"McKeown","year":"1976","journal-title":"Br J Surg"},{"key":"2023010614045474100_ref20","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1002\/bjs.18003413304","article-title":"The surgical treatment of carcinoma of the oesophagus; with special reference to a new operation for growths of the middle third","volume":"34","author":"Lewis","year":"1946","journal-title":"Br J Surg"},{"key":"2023010614045474100_ref21","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1016\/0895-4356(92)90133-8","article-title":"Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases","volume":"45","author":"Deyo","year":"1992","journal-title":"J Clin Epidemiol"},{"key":"2023010614045474100_ref22","doi-asserted-by":"crossref","first-page":"1577","DOI":"10.1245\/s10434-008-9867-4","article-title":"Postoperative mortality after esophagectomy for cancer: development of a preoperative risk prediction model","volume":"15","author":"Ra","year":"2008","journal-title":"Ann Surg Oncol"},{"key":"2023010614045474100_ref23","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1016\/j.surg.2018.04.026","article-title":"Timing of esophagectomy after neoadjuvant chemoradiation treatment in squamous cell carcinoma","volume":"164","author":"Franko","year":"2018","journal-title":"Surgery"},{"key":"2023010614045474100_ref24","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1016\/j.athoracsur.2011.02.089","article-title":"The effect of regionalization on outcome in esophagectomy: a Canadian national study","volume":"92","author":"Finley","year":"2011","journal-title":"Ann Thorac Surg"},{"key":"2023010614045474100_ref25","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1097\/01.sla.0000133083.54934.ae","article-title":"Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey","volume":"240","author":"Dindo","year":"2004","journal-title":"Ann Surg"},{"key":"2023010614045474100_ref26","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1164\/rccm.200405-644ST","article-title":"Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia","volume":"171","year":"2005","journal-title":"Am J Respir Crit Care Med"},{"key":"2023010614045474100_ref27","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1037\/a0014268","article-title":"Average causal effects from nonrandomized studies: a practical guide and simulated example","volume":"13","author":"Schafer","year":"2008","journal-title":"Psychol Methods"},{"key":"2023010614045474100_ref28","doi-asserted-by":"crossref","first-page":"1218","DOI":"10.1002\/pds.1674","article-title":"Assessing balance in measured baseline covariates when using many-to-one matching on the propensity-score","volume":"17","author":"Austin","year":"2008","journal-title":"Pharmacoepidemiol Drug Saf"},{"key":"2023010614045474100_ref29","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1097\/SLA.0000000000001098","article-title":"International consensus on standardization of data collection for complications associated with esophagectomy: esophagectomy complications consensus group (ECCG)","volume":"262","author":"Low","year":"2015","journal-title":"Ann Surg"},{"key":"2023010614045474100_ref30","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1097\/00000658-200111000-00001","article-title":"Should en bloc esophagectomy be the standard of care for esophageal carcinoma?","volume":"234","author":"Altorki","year":"2001","journal-title":"Ann Surg"},{"key":"2023010614045474100_ref31","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/j.ijsu.2017.03.052","article-title":"Meta-analysis of transhiatal esophagectomy in carcinoma of esophagogastric junction, does it have an advantage?","volume":"42","author":"Yan","year":"2017","journal-title":"Int J Surg (London, England)"},{"key":"2023010614045474100_ref32","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1002\/bjs.9764","article-title":"Ten-year follow-up results of a randomized clinical trial comparing left thoracoabdominal and abdominal transhiatal approaches to total gastrectomy for adenocarcinoma of the oesophagogastric junction or gastric cardia","volume":"102","author":"Kurokawa","year":"2015","journal-title":"Br J Surg"},{"key":"2023010614045474100_ref33","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1016\/j.athoracsur.2007.10.007","article-title":"Outcomes after transhiatal and transthoracic esophagectomy for cancer","volume":"85","author":"Chang","year":"2008","journal-title":"Ann Thorac Surg"},{"key":"2023010614045474100_ref34","doi-asserted-by":"crossref","first-page":"1114","DOI":"10.1067\/mtc.2003.315","article-title":"Transthoracic versus transhiatal esophagectomy: a prospective study of 945 patients","volume":"125","author":"Rentz","year":"2003","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2023010614045474100_ref35","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1016\/j.jamcollsurg.2007.07.001","article-title":"Comparing outcomes after transthoracic and transhiatal esophagectomy: a 5-year prospective cohort of 17,395 patients","volume":"205","author":"Connors","year":"2007","journal-title":"J Am Coll Surg"},{"key":"2023010614045474100_ref36","first-page":"1009","article-title":"Short-term outcomes after esophagectomy at 164 American College of Surgeons National Surgical Quality Improvement Program hospitals: effect of operative approach and hospital-level variation","volume":"147","author":"Merkow","year":"2012","journal-title":"Arch Surg (Chicago, IL: 1960)"},{"key":"2023010614045474100_ref37","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1002\/bjs.9456","article-title":"Surgical resection strategy and the influence of radicality on outcomes in oesophageal cancer","volume":"101","author":"Davies","year":"2014","journal-title":"Br J Surg"},{"key":"2023010614045474100_ref38","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1002\/jso.23637","article-title":"Transhiatal versus transthoracic esophagectomy for esophageal cancer: a 2005\u20132011 NSQIP comparison of modern multicenter results","volume":"110","author":"Papenfuss","year":"2014","journal-title":"J Surg Oncol"},{"key":"2023010614045474100_ref39","doi-asserted-by":"crossref","first-page":"894","DOI":"10.1097\/SLA.0b013e3182263781","article-title":"Transthoracic versus transhiatal esophagectomy for the treatment of esophagogastric cancer: a meta-analysis","volume":"254","author":"Boshier","year":"2011","journal-title":"Ann Surg"},{"key":"2023010614045474100_ref40","doi-asserted-by":"crossref","first-page":"10183","DOI":"10.3748\/wjg.v20.i29.10183","article-title":"Transthoracic vs transhiatal surgery for cancer of the esophagogastric junction: a meta-analysis","volume":"20","author":"Wei","year":"2014","journal-title":"World J Gastroenterol"},{"key":"2023010614045474100_ref41","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1016\/j.jtcvs.2008.11.042","article-title":"Predictors of major morbidity and mortality after esophagectomy for esophageal cancer: a society of thoracic surgeons general thoracic surgery database risk adjustment model","volume":"137","author":"Wright","year":"2009","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2023010614045474100_ref42","doi-asserted-by":"crossref","first-page":"1245","DOI":"10.1016\/0895-4356(94)90129-5","article-title":"Validation of a combined comorbidity index","volume":"47","author":"Charlson","year":"1994","journal-title":"J Clin Epidemiol"},{"key":"2023010614045474100_ref43","doi-asserted-by":"crossref","first-page":"1240","DOI":"10.1016\/j.athoracsur.2013.05.051","article-title":"Assessment of morbidity and mortality after esophagectomy using a modified frailty index","volume":"96","author":"Hodari","year":"2013","journal-title":"Ann Thorac Surg"},{"key":"2023010614045474100_ref44","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1097\/SLA.0000000000002469","article-title":"Learning curve and associated morbidity of minimally invasive esophagectomy: a retrospective multicenter study","volume":"269","author":"Workum","year":"2019","journal-title":"Ann Surg"},{"key":"2023010614045474100_ref45","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1097\/SLA.0000000000002611","article-title":"Benchmarking complications associated with esophagectomy","volume":"269","author":"Low","year":"2019","journal-title":"Ann Surg"},{"key":"2023010614045474100_ref46","doi-asserted-by":"crossref","first-page":"814","DOI":"10.1097\/SLA.0000000000002445","article-title":"Defining benchmarks for transthoracic esophagectomy: a multicenter analysis of total minimally invasive esophagectomy in low risk patients","volume":"266","author":"Schmidt","year":"2017","journal-title":"Ann Surg"}],"container-title":["Diseases of the Esophagus"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/dote\/article-pdf\/36\/1\/doac028\/48468120\/doac028.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/dote\/article-pdf\/36\/1\/doac028\/48468120\/doac028.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,6]],"date-time":"2023-01-06T14:10:20Z","timestamp":1673014220000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/dote\/article\/doi\/10.1093\/dote\/doac028\/6611914"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,21]]},"references-count":46,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,6,21]]},"published-print":{"date-parts":[[2022,12,31]]}},"URL":"https:\/\/doi.org\/10.1093\/dote\/doac028","relation":{},"ISSN":["1120-8694","1442-2050"],"issn-type":[{"value":"1120-8694","type":"print"},{"value":"1442-2050","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,1]]},"published":{"date-parts":[[2022,6,21]]},"article-number":"doac028"}}