J.Jpn. Surg. Soc.. 79(9): 1217-1221, 1978

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Report on the annual meeting

THE RADICAL OPERATION FOR CARDIAC CANCER

The radical cure is our most important purpose to operate a cardiac cancer. To achieve the radical cure the resection of esophagus with enough proximal part and the removal of group 2 lymph-nodes should be considered.
The following lymph-nodes must be removed with R2 operation for a cardiac cancer: right and left cardiac lymph-nodes, lesser and greater carvature lymph-nodes, left gastric artery lymph-nodes, common hepatic artery lymph-nodes, celiac artery lymph-nodes, splenic hilar lymph-nodes, splenic artery lymphnodes, suprapyloric lymph-nodes, subpyloric lymph-nodes.
When the cancer is invading abdominal esophagus, further to the lymph-nodes above-mentioned, lower thoracic paraesophageal lymph-nodes and diaphragmatic lymph-nodes must be removed.
Upper midline incision is used. The removal of distal pancreas and spleen with lymph-nodes, and the total gastrectomy are undertaken. It is often pointed out that the total gastrectomy to cure the cardiac cancer is unnecessary. However, the total gastrectomy is absolutely necessary in order to remove suprapyloric lymph-nodes and subpyloric lymph-nodes. Because some metastasis to these lymphnodes are existing.
The thoracotomy is taken at the right 6th inter-costal space to remove mediastinal lymph-nodes.
The esophagojejunostomy Roux-Y is used as a method of reconstruction.

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