Our surgery for esophageal and gastric cancer

Toshihiro Hirai
Department of Surgery, Kawasaki Medical School
I would like to present our two surgical techniques:
(1) Trans-diaphragmatic esophagectomy (TDE) for esophageal
cancer
Excessive surgical stress and postoperative complications cause a
storm of perioperative cytokine release, which has been shown to
enhance tumor metastasis in experimental models. We named this
phenomenon surgical oncotaxis. To lessen the impact of surgical
oncotaxis, minimally invasive surgical techniques might be used and
postoperative complications avoided whenever possible. We
generally choose TDE for patients with high risk or carcinoma of the
lower thoracic esophagus, even if the tumor is in the advanced
stage. The procedure showed less invasiveness and better
prognosis.
(1) Lower esophageal sphincter (LES) and Vagus-Nerve-Preserving
partial cardiectomy for early gastric cancer of the cardia.
We newly developed the technique which involves local resection
of early gastric cancer of the cardia, while preserving LES and
vagus nerve. A new fornix is constructed as an accommodation
space to lessen the small stomach symptom and reflux esophagitis.
This procedure showed good results from the view point of QOL.