APPLICATION OF THE PULLING-UP RETRACTOR AND AUTOSUTURE IN TRANSABDOMINAL SURGERY FOR CARCINOMA OF THE GASTRIC CARDIA

Recently, application of a pulling-up retractor (divised by Morioka) to a transabdominal approach has facilitated dissection of the lymph nodes in the lower mediastinum and diffuse removal of the esophagus. In addition, application of an EEA type autosuture has made intramediastinal anastomosis at the middle or inferior esophagus possible. At present, this procedure is commonly undertaken as the curative operation for carcinoma of the gastric cardia with esophageal invasion of less than 3cm. Out of 41 operations for carcinoma of the gastric cardia over the last three years, 36 were transabdominal procedures and the others were transthoracic ones. EEA was used in 22 of these 36 cases. Anastomotic insufficiency occurred in 7.1% of the sutured group, while none in the EEA or transabdominal group suffered from this complication. Pulmonary complications were noted in 7.1% of the sutured group, 13.6% of the EEA group and 20.0% of the transabdominal group. We concluded that application of the pulling-up retractor and autosuture in transabdominal surgery is very useful for carcinoma of gastric cardia with esophageal invasion because this makes it possible to dissect the lymph nodes of the lower mediastinum and remove the esophagus sufficiently.