A New Surgical Approach for Resection of Cancer of Gastric Cardia

Thirty-five consecutive patients with adenocarcinoma of the gastric cardia were operated with a new technique which 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 esophagus without thoracotomy. The mediastinal node stations were affected in 25% of patients, whose tumor invaded to the serosa. Hhypotension with or without atrial arrythmias and pleural tears occurred during surgery in 20 patients (57%), and in 18 (51%), respectively. Postoperatively, hypoxia requiring reintubation developed in 7 patients (19%), pleural effusions needed tube drainage in 16 (46%), atelectasis in 5 (14%) and anastomotic leaks in 3 (9%). The cumulative 5 year survival rate for 21 patients was 62%, whereas none of the patients with stage IV disease lived for more than 2 years after surgery. We believe this technique is a reasonable and safe alternative to the left thoracotomy approach for resection of cancer of the gastric cardia.