title: Esophageal extension encountered during transhiatal resection of gastric or gastroesophageal tumors: attaining a negative margin.
abstract: BACKGROUND
  Over the last several decades, the incidence of gastroesophageal junction tumors has been increasing. Often, patients present late in the course of their disease. However, if the disease is localized, then complete surgical resection remains the standard of cure and the best chance for cure. On occasion, these tumors involve a significant portion of both the distal esophagus and proximal stomach.
  
  
  METHODS
  In order to completely remove these tumors with an adequate surgical margin and lymph node dissection, a total gastrectomy and total esophagectomy with colonic interposition may be required. We have utilized this approach on six patients with excellent clinical results. In this manuscript, we discuss the technical considerations involved in this approach and present our results.
authors.affiliation: Penn State University, 500 University Dr., Hershey, PA 17033, USA.
authors.forename: Diego
authors.initials: D
authors.lastname: Avella
authors.forename: Luis
authors.initials: L
authors.lastname: Garcia
authors.forename: Brett
authors.initials: B
authors.lastname: Hartman
authors.forename: Eric
authors.initials: E
authors.lastname: Kimchi
authors.forename: Kevin
authors.initials: K
authors.lastname: Staveley-O'Carroll
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000713:Anastomosis, Roux-en-Y; D015331:Cohort Studies; D003964:Diaphragm; D004766:Enterostomy; D016629:Esophagectomy / Q000379:methods*; D004943:Esophagogastric Junction; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome