Clinical studies on the transabdominal resection of esophagocardial cancer and cervical anastomosis using a by-pass method obviating thoracotomy.

Transabdominal resection of esophagocardial cancer and reestablishment of alimentary continuity using a by-pass method with gastric tube or colonic segment have been performed in 40 patients including 5 with squamous cell carcinoma. Of 40, 4 cases were at stage II, 8 cases at stage III and 28 cases at stage IV. Major factors which determined the stage were peritoneal dissemination and serosal invasion in the stage IV patients. The removal of the lesion was performed curatively in 13 (33%). Major complications in the post-operative course were the leakage of anastomosis and respiratory failure. Nine of 40 cases (23%) were combined with minor leakage at the cervical anastomosis, but such did not interfere with the resumption of oral ingestion of food. The 3 year survival rate was 46% in the cases of stages (II + III) and 16% in the cases of stage IV, indicating moderately high rates as compared with that in cases of cancer located in the upper third of the stomach with the limited proximal extension within the esophagocardial junction.