CLINICAL SIGNIFICANCE OF COMBINED RESECTION OF THE DIAPHRAGM IN THE TREATMENT OF GASTRIC CANCER WITH ESOPHAGEAL INVASION

Abstract

Since 1985, we have been performing an extensive combined resection of the unilateral diaphragm under left thoracotomy in cases of gastric cancer with esophageal invasion, involving invasion to the serosa without distant or disseminated metastasis. From 1976 to 1988, the resection was performed in 111 cases of upper gastric cancer with esophageal invasion. When classified by the approach route, there were 77 cases of left thoracoabdominal approach and mediastinal incision, and 34 of abdominal approach alone. Of the 77 cases of left thoracoabdominal approach, combined resection of the diaphragm was performed in 22, and the surgical results were evaluated form 17, after excluding 3 of only partial resection of the diaphragm, one of remnant gastric cancer and one of multiple cancer. The 2 year survival rates all ps (+) cases were 64% for combined resection and 41.8% for non-combined resection. When classified by stage, the survival rates in stage IV cases were 55.6% for combined resection, and 12.5% for non-combined resection, showing a significant different.