Esophageal Adenocarcinoma Methods and Protocols

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axis, the left gastric or coronary vein requires ligation. The ori-

gin of the left gastric artery is identified separately as it comes off

the celiac axis, and it is doubly ligated and cut between ligatures.

Further dissection toward the left will clear the lymphatic tissues

on the proximal splenic artery. The areolar tissue superior to the

common hepatic artery and splenic artery is therefore cleared en

bloc with the abdominal esophagus toward the hiatus.

●● On the lesser curvature, the right gastric vessels are divided at

the angular incisura (Fig. 4 ). One linear stapler is used to tran-

sect the stomach from this point upwards toward the fundus.

Fig. 3 Coeliac trifurcation lymphadenectomy. The left gastric artery is seen com-

ing off the coeliac axis. The coronary vein has been ligated and divided (black

stitch). The surface of the hepatic artery is clearly seen

Fig. 2 The abdominal esophagus is mobilized from the esophageal hiatus. Both

vagi have been divided

Simon Law