Thoracoabdominal approach for cure of patients with an adenocarcinoma in the upper third of the stomach.
In 134 patients with an adenocarcinoma in the upper third of the stomach and involving the lower esophagus, the authors retrospectively assessed the significance of a thoracoabdominal approach (TAA). Nineteen (48.7%) of 39 with TAA had major postoperative complications, while 25 (26.3%) of 95 with the abdominal approach (AA) had similar complications (P less than 0.02). The most frequent complication was anastomotic leakage. In the case of TAA, seven (18.0%) experienced this, and nine (9.5%) did so after AA. However, deaths resulting from complications were few for both TAA (five, or 12.8% and AA nine, or 9.5%). There was one (2.6%) patient with histologically positive cancer cells at the proximal stump of the resected specimen in patients with TAA, while there were seven (7.7%) such patients with AA. In the histologically curative cases without palliative factors, patients with TAA had a significantly better prognosis than did those with AA (P less than 0.05). In the histologically noncurative cases and in cases with palliative factors, the prognosis was poor for both TAA and AA patients. These results suggest that the surgeon should perform the TAA in order to obtain tumor-free margins at the proximal stump and a better prognosis in patients without palliative factors, while the surgeon need not consider doing the TAA in patients with palliative factors.
Okamura
T
T
Second Department of Surgery, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
Korenaga
D
D
Baba
H
H
Saito
A
A
Watanabe
A
A
Sugimachi
K
K
D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D004938:Esophageal Neoplasms / Q000601:surgery*; D004947:Esophagus / Q000601:surgery; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011379:Prognosis; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*; D013908:Thoracotomy