Background: A thoracoabdominal approach has traditionally been described fo
r the resection of tumours of the gastric cardia. The aim of this study was
to evaluate a transhiatal approach for resection of cancers of the gastric
cardia.
Methods: Twenty consecutive patients undergoing transhiatal gastro-oesophag
ectomy for cancer of the gastric cardia were studied. Data were collected p
rospectively with regard to operating time, operative blood loss, intensive
care unit (ICU) stay, analgesia use, duration of hospital stay, and pathol
ogical details of resection margin clearance and lymph node yield. Results
were compared with those of the 20 preceding patients for whom the same pro
spective information had been recorded following resection via the standard
thoracoabdominal approach.
Results: The transhiatal approach required a shorter operating time (median
190 (range 105-255) versus 280 (225-330) min; P = 0.004). It resulted in l
ess blood loss (median 405 (180-2000) versus 1000 (420-3200) ml; P= 0.03) a
nd fewer days in the ICU (median 0 (0-31) versus 2 (1-8) days; P= 0.005) de
spite being performed in an older patient population (median 71 (43-78) ver
sus 63 (59-70) years; P = 0.016). There was no difference in either the lym
ph node harvest or length or involvement of upper resection margins.
Conclusion: The transhiatal approach to the resection of tumours at the gas
tric cardia is a valid and safe alternative to the standard thoracoabdomina
l technique. This technique avoids thoracotomy and its associated morbidity
and is accompanied by reduced blood loss, decreased operating time and a s
horter ICU stay.