Left thoracophrenotomy and cervical approach in the surgery of distal third oesophageal and cardia tumours.
BACKGROUND
The aim of the present study was to assess and report the results of left thoracophrenotomy + cervical approach in the surgery of distal third oesophagus and cardia tumours.


METHODS
Thirty patients who were treated between 1999 and 2003 were retrospectively reviewed taking into consideration the result of the surgical method used.


RESULTS
Eighteen (60%) patients were men with a mean age of 61.3 +/- 8.5 years (range, 32-75 years). The main complaints were dysphagia (particularly with hard food), weight loss and odynophagia. There were 14 cases of adenocarcinoma and 16 cases of squamous cell carcinoma. The serum albumin and protein levels were found to be low in 90% of the cases. Minimal anaemia was detected in 80% of the cases. Fifteen (50%) of the cases were stage III, 10 (35%) were stage IIb and five (15%) were stage IIa. Histopathologically, intrathoracic lymph node metastasis was present in eight (27%) patients and intra-abdominal lymph node metastasis was present in 12 (40%) cases. There were no mortalities related to surgery. Early anastomosis leakage occurred in two (6%) cases. Minor complications occurred in three cases. The mean hospitalization time was 10 days postoperatively. Five years of follow up was possible in 20 of the cases. The mean survival was 26 months in four cases with stage IIa, 22 months in six cases with stage IIb and 16 months in 10 cases with stage III.


CONCLUSIONS
This exposure from this technique provides easy access to both the oesophagus and stomach. Surgical dissection is easy and safe, and complications related to surgery are rare. Lymph node dissections of both systems can be made and a safe surgical margin is possible with cervical anastomosis. It is highly tolerable by the patient. This technique can be used in distal third oesophageal and cardia tumours. It has acceptable morbidity and mortality, with some potential benefits.
Han
Serdar
S
Department of Thoracic Surgery, Ankara Numune Education and Research Hospital, Ankara, Turkey. serdarhan1@yahoo.com
Sakinci
Unal
U
Dural
Koray
K
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D002299:Cardia; D013505:Digestive System Surgical Procedures / Q000379:methods*; D004938:Esophageal Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010791:Phrenic Nerve / Q000601:surgery*; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*