An approach to the surgical treatment of carcinoma of the oesophagus and cardia.

No method of surgical treatment of carcinoma of the oesophagus and cardia is universally accepted. An approach to the problems of the choice of the side for thoracotomy, the organ for reconstruction of the continuity of the oesophagus and the combination of the abdominal and thoracic stages of the surgical procedure is presented. It is based on the following principles: (1) Selecting the side for the thoracotomy on the basis of the distance from the upper incisors to the upper margin of the tumour, determined by oesophagoscopy. (2) Separation of the laparotomy and the thoracotomy. (3) Starting the operative procedure with the laparotomy. The operative mortality in a series of 44 patients operated upon according to these principles is compared with that in a previous series of 77 patients and the advantages and disadvantages of this approach are discussed.