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En bloc resection for cancer of the gastric cardia without thoracotomy
Author(s) -
Tanigawa Nobuhiko,
Shimomatsuya Takumi,
Horiuchi Tetsuya,
Masuda Yasuhiko,
Ihaya Akio,
Chiba Yukio,
Muraoka Ryusuke
Publication year - 1993
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.2930540108
Subject(s) - medicine , thoracotomy , surgery , esophagus , atelectasis , dissection (medical) , diaphragm (acoustics) , mediastinum , mediastinal lymph node , diaphragmatic breathing , adenocarcinoma , chylothorax , cancer , lung , metastasis , physics , alternative medicine , pathology , acoustics , loudspeaker
Thirty‐five consecutive patients underwent en bloc resection of cardia cancer without thoracotomy. All tumors were adenocarcinoma. The operative procedure involved wide resection of the peri‐hiatal diaphragm, dissection of the upper abdominal and lower mediastinal lymph nodes, and resection of the stomach including a portion of the lower thoracic esophagus without thoracotomy. The resection area of the diaphragm included not only the crural muscle as in other methods, but also the diaphragmatic tissue surrounding the esophageal hiatus. Through the enlarged hiatus, dissection of the mediastinum was possible up to the carina from the abdominal cavity. The mediastinal node stations were affected in 25% of patients whose tumor invaded to the serosa. Hypotension with or without atrial arrythmias and pleural tears occurred during surgery in 20 patients (57%) and in 18 patients (51%), respectively. Postoperatively, hypoxia requiring reintubation developed in 7 patients (19%), pleural effusions needed tube drainage in 16 patients (46%), atelectasis in 5 patients (14%), and anastomotic leaks in 3 patients (9%). They were all successfully treated. The cumulative 5‐year survival rate for 21 patients with stages I (2 patients), II (9), and III (10) diseases was 62%, whereas none of the patients with stage IV disease lived 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 thoracotomy approach for resection of cancer of the gastric cardia. © 1993 Wiley‐Liss, Inc.