Total gastrectomy with left oblique abdominothoracic approach for gastric cancer involving the esophagus.

From January 1972 to December 1982, we performed 70 total gastrectomies with left oblique abdominothoracic approach for gastric cancer involving the esophagus. We emphasize that the diaphragm should be incised "U-shaped" from its origin to avoid respiratory tract failure due to phrenic nerve damage. Combined resection was performed in all cases either because of direct tumor invasion or because of lymph node dissection. Operative mortality occurred in only three cases (4.3%). There were nine cases (12.8%) of postoperative complications; in these cases, the complications were nonfatal. The five-year survival rates of patients were 60% in stage II, 27% in stage III, and 20% in stage IV, according to the Union Internationale Contre le Cancer-1978 staging classifications.