EN-BLOC RESECTION FOR CANCER OF THE GASTRIC CARDIA WITHOUT THORACOTOMY

Thirty-five consecutive patients underwent en bloc resection of cardia cancer without thoracotomy. All tumors were adenocarcinoma. The opera tive procedure involved wide resection of the peri-hiatal diaphragm, d issection of the upper abdominal and lower mediastinal lymph nodes, an d resection of the stomach including a portion of the lower thoracic e sophagus without thoracotomy. The resection area of the diaphragm incl uded not only the crural muscle as in other methods, but also the diap hragmatic tissue surrounding the esophageal hiatus. Through the enlarg ed hiatus, dissection of the mediastinum was possible up to the carina from the abdominal cavity. The mediastinal node stations were affecte d in 25% of patients whose tumor invaded to the serosa. Hypotension wi th or without atrial arrythmias and pleural tears occurred during surg ery in 20 patients (57%) and in 18 patients (51%), respectively. Posto peratively, hypoxia requiring reintubation developed in 7 patients (19 %), pleural effusions needed tube drainage in 16 patients (46%), atele ctasis in 5 patients (14%), and anastomotic leaks in 3 patients (9%). They were all successfully treated. The cumulative 5-year survival rat e for 21 patients with stages I (2 patients), II (9), and III (10) dis eases was 62%, whereas none of the patients with stage IV disease live d for more than 2 years after surgery. Because thoracotomy is avoided, the procedure is better tolerated by debilitated patients. We believe this technique is a reasonable and safe alternative to the left thora cotomy approach for resection of cancer of the gastric cardia. (C) 199 3 Wiley-Liss, Inc.