LEFT THORACIC APPROACH FOR CANCER OF CARDIA - EARLY AND LATE RESULTS

Background. The surgical treatment of cancer of the cardia is controve rsial and results are often disappointing. Concern exists not only wit h regards to the surgical approach but also to the extent of the resec tion. The authors analyze their experience over a 20-year period adopt ing almost exclusively a ''limited'' esophagogastrectomy with a wide r egional lymphadenectomy through a left thoracotomy. The aim of the stu dy is to determine if this approach actually plays a role in the treat ment of this tumor. Methods. 148 patients were evaluated for cardial c ancer. Of these 22 (14.8%) were not resectable and 6 (4%) received oth er types of resections for technical reasons. 120 patients are the bas is of the present analysis. More than 75% of patients were in stage II I or IV. Follow-up was completed in 92.5% of cases; all surviving pati ents had at least 5 years of follow-up. Results. Four (3.3%) patients died in the postoperative period. In 6 cases (5%) an anastomotic leaka ge occurred and this caused the death of 2 patients. Nine (7.5 %) pati ents had severe pulmonary complications. Dysphagia was relieved in all non complicated patients. 13 (10.8%) patients had anastomotic recurre nce, Overall survival I ate after 5 years was 25.62+/-6.1%. A signific ant difference in survival was noted in patients at stages II and III after 5 years (61.3% vs 18.6, p<0.02). Conclusions. This operation has proved to be a good option providing satisfying long-term results and a lower incidence of complications if compared with more extended pro cedures. It can be performed in the majority of patients with carcinom a of the cardia with a low mortality and morbidity and with excellent palliation of dysphagia, In our opinion it remains an optimum treatmen t for cardial cancer.