Two options for the surgical therapy of Adenocarcinoma of the esophagus and cardia (ADEC): a modulated resection + extended lymphoadenectomy, the gastric pull up at the thoracic dome or the Roux en Y esophagojejunostomy at the azygos vein level

Background: In spite of the recent simplifi cation operated by the TNM 7th edition, pathogenesis of ADEC and consequently its surgical therapy are controversial. In 1988 our group decided to operate differently tumors prevalently located in the esophagus (Siewert type I sub total esophagectomy – gastric pull up at the dome) or cardia (Siewert type II, esophageal resection at the azygos vein total gastrectomy). The approach (right thoracotomy + laparotomy), complete lymphoadenectomy of thoracic stations (#2,3,4r-l, 7, 8, 9) and abdominal (perigastric+empathic, splenic artery, celiac trunk) are the same for both techniques except for greater curve nodes. Methods: In this video we show the steps of sub total esophagectomy, esophageal resection + total gastrectomy, thoracic and abdominal lymphoadenectomy, the gastric pull up and preparation of the jejunal loop to anastomose with the esophagus at the azygos vein. Results: Results in terms of mortality, morbility, survival, # of nodes resected, modalities of nodal methastatization recorded in two groups of patients consecutively operated upon in recent years (group 1, 54 patients in which Barret’s epithelium was hysthologically diagnosed nearby the tumor gastric pull up) and, group 2, 140 patients in which it was not (total gastrectomy) are offered for discussion. Discussion: Results are offered for discussion. Disclosure: All authors have declared no confl icts of interest.