A trial of total gastrectomy, combined with total thoracic oesophagectomy without formal thoracotomy, for carcinoma at or near the cardia of the stomach.

There is a high incidence of residual tumour in the cut ends following orthodox resections for gastric adenocarcinoma and oesophageal squamous carcinoma at or near the cardia. In the hope of preventing the tragic recurrence of malignant dysphagia in patients who have survived a high-risk operation for its relief, the whole stomach and thoracic oesophagus were resected in 6 patients, establishing continuity using jejunum or colon, with anastomosis in the neck. Of 6 patients, 5 survived the operation. Of 2 followed up for more than 1 year, 1 has survived 5.5 years without recurrence, 1 died after 1 year with no post-mortem evidence of recurrence. This radical operation merits and extended trial in suitable patients.