title: Transhiatal approach to total gastrectomy for adenocarcinoma of the gastric cardia.
abstract: BACKGROUND
  A thoracoabdominal approach has traditionally been described for the resection of tumours of the gastric cardia. The aim of this study was to evaluate a transhiatal approach for resection of cancers of the gastric cardia.
  
  
  METHODS
  Twenty consecutive patients undergoing transhiatal gastro-oesophagectomy for cancer of the gastric cardia were studied. Data were collected prospectively with regard to operating time, operative blood loss, intensive care unit (ICU) stay, analgesia use, duration of hospital stay, and pathological details of resection margin clearance and lymph node yield. Results were compared with those of the 20 preceding patients for whom the same prospective information had been recorded following resection via the standard thoracoabdominal approach.
  
  
  RESULTS
  The transhiatal approach required a shorter operating time (median 190 (range 105-255) versus 280 (225-330) min; P = 0.004). It resulted in less blood loss (median 405 (180-2000) versus 1000 (420-3200) ml; P = 0.03) and fewer days in the ICU (median 0 (0-31) versus 2 (1-8) days; P = 0.005) despite being performed in an older patient population (median 71 (43-78) versus 63 (59-70) years; P = 0.016). There was no difference in either the lymph node harvest or length or involvement of upper resection margins.
  
  
  CONCLUSIONS
  The transhiatal approach to the resection of tumours at the gastric cardia is a valid and safe alternative to the standard thoracoabdominal technique. This technique avoids thoracotomy and its associated morbidity and is accompanied by reduced blood loss, decreased operating time and a shorter ICU stay.
authors.affiliation: Northern Oesophago-Gastric Cancer Unit, Cumberland Infirmary, Carlisle and Royal Victoria Infirmary, Newcastle upon Tyne, UK.
authors.forename: J
authors.initials: J
authors.lastname: Wayman
authors.forename: S M
authors.initials: SM
authors.lastname: Dresner
authors.forename: S A
authors.initials: SA
authors.lastname: Raimes
authors.forename: S M
authors.initials: SM
authors.lastname: Griffin
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D002299:Cardia; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000601:surgery*