What first, laparotomy or right thoracotomy ?
In small obviously resectable tumours the laparotomy is performed first, the stomach mobilised, and the laparotomy closed. The patient is then rolled onto their left side and the right thoracotomy part of the operation is performed. In borderline resectable tumours the thoracotomy may be performed first to assess operability. The thoracotomy does not need to be formally closed, for the patient to be rolled onto their back for the laparotomy to be performed for the gastric mobilisation ( a large Tegaderm can be used for this). The patient is then rolled back onto their left side and the Tegaderm removed and the operation completed.
