Diagonal abdominothoracic incision as an approach to carcinoma of the cardia and upper gastric region.

An operative technique consisting of a diagonal epigastric incision extending to the left chest wall and severing the inner side of diaphragm adjacent to the pericardium to the hiatus is introduced. This technique was successfully used in 16 cases and the present surgical approach facilitates frontal visualization of the lower esophagus without disruption of the circulatory system. Furthermore, a sufficiently large operative field is obtained and radical dissection of cardia and upper gastric region or combined resection of infiltrated adjacent organs is facilitated. Postoperative recovery of pulmonary function in terms of PaO2 and PaCO2 was similar to that of patients who had received an upper median incision. We found no postoperative complications peculiar to the operative technique introduced here in any of the 16 patients.