Carcinoma of the Cardiac Portion of Stomach
GEORGE CRILE, M.D.
Department of General Surgery
DONALD B. EFFLER, M.D.
Department of Thoracic Surgery
J. E. SCHEID, M.D.
Fellow in Surgery
SUCCESSFUL treatment of cancer arising in the cardiac portion of the stomach demands total extirpation of the cancer-bearing tissue within and adjacent to the stomach including the spleen, the tail of the pancreas, the lesser peritoneal sac, the great omentum, and the lymph nodes in the gastro-hepatic ligament and in the infraduodenal area. Incomplete removal of these structures diminishes the chance of cure.
The need for more adequate exposure of the cardiac portion of the stomach prompted Von Mikulicz1 to attempt transthoracic resection in 1896. The patient died. In 1916 Brunn2 performed the first successful cardiectomy and esophagogastrostomy. The combined thoraco-abdominal approach was suggested by Janeway and Green3 in 1910 but it was not until after 1933 that the feasibility of the combined thoraco-abdominal approach to the upper stomach and its adjacent structures was demonstrated by Oshawa.4
The development of the thoraco-abdominal incision has depended less upon the boldness of the surgeon than it has upon evolution of safe anesthesia. Management of the open thorax has become a commonplace procedure and in qualified hands does not increase the risk of operation.
The series of cases to be presented represents the combined experience of the authors in 22 operable cases of gastric carcinoma involving the cardiac end of the stomach. In each case the thoraco-abdominal approach was employed and some form of gastric resection was performed. As might be expected there was considerable variation in the operative procedures, some of which were essentially palliative. Increased familiarity with this approach has. . .