A Study on the Usefulness of the Thoracoabdominal Oblique Continuous Incision as a Surgical Approach

Abstract Background The left thoracoabdominal (LTA) approach has not shown oncological superiority over the transhiatal approach based on the results of JCOG9502. However, in cases of advanced tumors at the esophagogastric junction, factors such as direct invasion into adjacent organs, securing the oral-side margin, and the creation of a sufficiently long reconstructive organ become important considerations when selecting the surgical approach. We investigated the utility of the LTA approach. Methods We retrospectively reviewed 12 cases who underwent the LTA approach at our department between April 2022 and December 2024. We examined the underlying disease, reasons for choosing the LTA approach, surgical approach, blood loss, operative time, reconstruction method, and postoperative complications. Results The median age of the 12 patients was 75 years. The diseases included esophageal and gastric cancers. The reasons for selecting LTA were direct invasion in 5 cases, abscess formation in 3 cases, prior laparotomy in 2 cases, and dissection of station No. 16 lymph nodes in 2 cases. In all cases, the abdominal lower esophagus was resected. In cases where reconstruction using a pedicled jejunum was difficult, a pedicled colon was used instead. Conclusion In cases involving abscess formation or invasion of adjacent organs, the LTA approach provides excellent surgical exposure. It also allows for safe dissection of No. 16 lymph nodes when necessary. Additionally, in cases requiring resection of the lower esophagus, this approach facilitates vascular handling and length confirmation during jejunal reconstruction. Including its usefulness in emergency situations, the LTA approach is considered a technique worth gaining experience in.