The right approach to carcinoma of the cardia and lower oesophagus

Successful surgical palliation for carcinoma of the cardia and lower oesophagus is often compromised by anastomotic failure or local recurrence. These complications follow technical difficulty in achieving adequate resection and a safe anastomosis through inappropriate surgical exposure, often via the left chest. A technique of oesophagogastrectomy is described employing a simultaneous right abdominothoracic approach without division of either costal margin or diaphragm. Synchronous laparotomy and thoractomy facilitates both resection and anastomosis, and obviates the necessity to turn the patient over and redrape halfway through the operation. Closure of the distal stomach and the gastro-oesophageal anastomosis are performed using staplers. No anastomotic leaks were detected in the 15 patients described.