The right approach to carcinoma of the cardia: preliminary results

Surgical treatment of carcinoma of the lower oesophagus and cardia can be compromised by technical difficulties associated with inadequate exposure of the operative field. This may lead to anastomotic failure or local recurrence. A simultaneous right abdominothoracic approach to the oesophagogastric junction without division of either the costal margin or diaphragm facilitates access, allowing radical resection and the performance of a safe anastomosis without the necessity of redraping the patient part way through the procedure. Maintaining the costal margin and diaphragm reduces the pulmonary problems associated with a conventional abdominothoracic incision. Thirty two consecutive patients who have been operated upon between 1983 and 1990 using the synchronous right abdominothoracic approach and who have had a stapled anastomosis have been reviewed. The post-operative complication rate was low and the 5 year survival figure is 17%.