Oesophagogastrectomy and total gastrectomy for carcinoma of the stomach. A plea for subdiaphragmatic resection.

Carcinoma of the stomach which involves the gastro-oesophageal junction or cardia is usually advanced by the time the diagnosis is made; resection is therefore often only palliative in nature. Resection is usually performed by a thoraco-abdominal incision. Unfortunately there is a high risk of anastomotic leakage after a total or subtotal proximal gastrectomy and if this occurs within the chest mortality and morbidity are very high. In this article a plea is made for a purely abdominal approach.