A TRANSDIAPHRAGMATIC RETROPERITONEAL APPROACH FOR LOWER ESOPHAGEAL AND GASTROESOPHAGEAL JUNCTION CARCINOMAS

Radical surgery and a regional lymphadenectomy still appear to be the treatment of choice for lower esophageal and gastroesophageal carcinom as. However, in some instances, difficulties can be encountered both i n assessing the resectability of tumors extending toward retroperitone al structures and in performing a lymphadenectomy of the preaortic are a extending between the hiatus and celiac axis, For these reasons, we developed a specific transdiaphragmatic retroperitoneal approach, Afte r thoraco-phreno-laparotomy, and exploration of both the thorax and th e abdomen to rule out any metastatized disease, an extraperitoneal, po sterior phrenotomy is performed from the aortic hiatus and extending a nteriorly for 5 cm, This creates an access to the retroperitoneal spac e and, by incising the arcuate ligament, a wide exposure of the aorta can be obtained at this level, In this way a more complete visualizati on of the transdiaphragmatic preaortic area and an easier and safer di ssection of the preaortic lymphoid tissue is possible.