J.Jpn. Surg. Soc.. 80(12): 1510-1514, 1979
Report on the annual meeting
APPLEBY' PROCEDURE THROUGH THE LEFT TRANSTHORACO-DIAPHRAGMATIC APPROACH FOR GASTRIC CANCER INVADING THE ESOPHAGUS
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IInd Surgery, School of Medicine, Kanazawa University Koichi Miwa |
1) The esophagus is severed enough apart from the lesion.
2) The adjacent tissues of the tumor including the hepatogastric, gastrophrenic and gastropancreatic ligaments are widely extirpated.
3) The regional lymph nodes which belong to the left gastric, splenic, left inferior phrenic and lower mediastinal lymphatic pathways are completely dissected.
For the pupose of these principles, we have employed total gastrectomy with Appleby' procedure through the left transthoraco-diaphragmatic approach, severing celiac axisis and inferior phrenic artery at their origin, accompanying resection of the lower esophagus and lower mediastinal lymph nodes dissection in 5 patients with lymph nodes metastasis. No operative death were observed. They are all alive for 19, 14, 14, 13 and 1 months respectively.
This operation is preferable for gastric cancer invading the esophagus because of its curability and excellent exposure of the cardiac portion of the stomach and the lower esophagus locating in the abdominal and thoracic cavities.
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