J.Jpn. Surg. Soc.. 91(9): 1196-1199, 1990

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Report on the annual meeting

IMPROVED OPERATIVE CURABILITY FOR CANCER OF THE CARDIA USING A HOOK SUSPENDER WITHOUT THORACOTOMY

The hook suspender, which has been improved in this unit by us, suspends the costal arch superioanteriorly, stretching the diaphragm and widening the operative sight around the esophagogastric junction. Through an opening in the hiatal portion of the stretched diaphragm, surgical procedures are able to be performed in the inferior part of the mediastinum without a thoracotomy Between 1983 and 1985 fifty-three patients with cancer of the cardia were operated on using this method resulting in a 54.1 ± 7.5% (M±SD) 3-year-cumulative postoperative survival rate. This is a satisfactory result compared with our previous results and those of other institutions. During the same period two cases whose cancers were not able to be removed using this procedure, had thoracotomies.
Analysis of the cases with postoperative recurrence of cancer revealed no evidence of intramediastinal recurrence indicating that our procedure removed all the cancerous tissue in the mediastinum. Many peritoneal recurrences occurred.
In some cases cancerous serosal involvement was observed to be localized in the anterior wall of the stomach near the esophagogastric junction, which is contact with and covered by the left hepatic lobe. In these cases latent dissemination on the lobe could be removed through a lateral segmentectomy of the liver.

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