Laparoscopic transhiatal approach for cardiac cancer with lower esophageal invasion for patients with compromised respiratory function.

Abstract

The thoracoabdominal approach with extended abdominal incision and a left thoracotomy is the traditional approach for the treatment of cardiac cancer with lower esophageal invasion. However, this procedure entails high morbidity and mortality. We evaluated the effectiveness of the laparoscopic transhiatal approach without a thoracotmy. We retrospectively analyzed the data obtained from 40 patients who underwent total gastrectomy with lower esophagectomy for cardiac cancer with lower esophageal invasion. These patients were divided into 2 groups: patients who underwent surgery via the conventional thoracoabdominal approach with extended abdominal incision and a left thoracotomy group (CTA group) and patients who underwent surgery via the laparoscopic transhiatal approach without a thoracotomy group (LTH group). All the LTH group patients were successfully treated without a thoracotomy. The 1- second forced expiratory volume was significantly lower in LTH group than in CTA group. No difference was observed between the groups with respect to the mean length of resected esophagus. The LTH group patients did not develop postoperative pneumonia. The laparoscopic transhiatal approach is safe and feasible for the resection of gastric cardiac cancer with lower esophageal invasion in patients with compromised respiratory function.