J.Jpn. Surg. Soc.. 79(9): 1228-1231, 1978

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Report on the annual meeting

TRANSDIAPHRAGMATIC LEFT THORACOLAPAROTOMY FOR CARCINOMA OF THE ESOPHAGOGASTRIC JUNCTION (EGJ-Ca)

Based on our 16 year experience from 1957 to 1972 on 49 cases of EGJ-Ca, it is considered that a transdiaphragmatic left thoracolaparotomy (Lt-TLD) is one of the recommendable surgical procedures for such particular lesions when the indications are fulfilled.
Of the 49 lesions, 30 were removed by Lt-TLD with the 5-year-survival rate of 27.6%. Serious postoperative complications consisted of a leakage at the site of anastomosis in 2 cases (6.7%) and leftsided pyothorax in one.
The LtTLD is accomplished by the intraabdominal procedure as the first step and the intrathoracic procedure as the second after thoracotomy through the 6th or 7th intercostal space and semi-arc incision of the diaphragm. The benefits of Lt-TLD are: left thoracotomy can be accomplished following laparotomy without changing the patient's supine position, and 2) a wide surgical field thus obtained enables the surgeon to perform a satisfactory lymphectomy in the mediastinum, a sufficient lower esophagectomy and an easy esophago-jejunostomy or -gastrostomy. The surgical indications for this procedure consist mainly of 1) at least fair risk patients with satisfactory cardiopulmonary functions and 2) relatively well-circumscribed, histologically well-differentiated lesions with limited spread of regional lymph node metastasis.

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