Transhiatal approach to total gastrectomy for adenocarcinoma of the gastric cardia

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.