Operative Technique for Carcinoma of the Gastric Cardia

Abstract

The principles of surgical treatment of carcinoma of the gastric cardia are in general similar to those in carcinoma of the esophagus, but a number of technical details differ. As the lower segment of the esophagus is often involved in carcinoma of the gastric cardia, surgical resection invariably includes the adjacent portion of the esophagus. Whether gastrectomy is partial or total depends upon the extent of the growth (Fig. 14.1). Reconstruction of the food passage following resection is usually accomplished with infra-aortic esophagogastrostomy or esophagojejunostomy via the transpleural route. Other techniques, such as posterior mediastinal esophagogastrostomy through a combined median stemoabdominal approach and cervical esophagogastrostomy following inversion extraction of the thoracic esophagus without thoracotomy, are used comparatively rarely. End-to-side or Roux-en-Y esophagojejunostomy is usually performed after total gastrectomy.