Original article: general thoracic
Results of surgical treatment of adenocarcinoma of the gastric cardia

https://doi.org/10.1016/S0003-4975(01)03571-8Get rights and content

Abstract

Background. Comparison among different studies regarding adenocarcinoma of the cardia has been difficult since the Siewert classification was introduced. This study analyzed the experience of a single institution in the treatment of gastric cardia cancer with the aim of assessing principal prognostic factors and long-term outcome.

Methods. The results of 96 patients who underwent resection with curative intent for gastric cardia cancer at the First Division of General Surgery, University of Verona, from January 1988 to February 2000, were analyzed statistically with special reference to Siewert type.

Results. Despite a high number of curative resections (85.4%), the 5-year survival rate was poor (24%) for all Siewert types (p = 0.8), and for early tumors (51%) also. Chance of cure was limited to pN0 and pN1 patients. Multivariate analysis showed that microscopic or macroscopic residual tumor and pN-positive categories had a significantly higher risk of death (risk ratio, 2.18 and 2.68, respectively) and the pN2 and pN3 category had the most negative prognostic factor (risk ratio, 7.6).

Conclusions. The long-term prognosis for gastric cardia cancer remains poor and is independent of Siewert type, with cure limited to pN0 and pN1 patients.

Section snippets

Material and methods

Between January 1988 and February 2000, 96 consecutive patients with histologically proven primary adenocarcinoma of the cardia underwent resection with curative intent at the First Division of General Surgery, University of Verona, Italy. Median age was 67 years (range, 27 to 84 years), and 84 patients were male. All of the 96 patients underwent the same staging workup including barium swallow, endoscopy with biopsy, and computed tomography of the chest and upper abdomen. Endosonography was

Results

The type of resections and reconstructions in relation to different Siewert type are reported in Table 1. In this series of 96 patients, the total number of dissected lymph nodes was 2,779, with an average (± standard deviation) of 29 ± 17.3 dissected nodes per case (median, 25.5; range, 1 to 108). The mean number of metastatic nodes was 7.5 ± 8.8 (median, 4.5; range, 0 to 39) in the overall series, and 9.3 ± 8.9 (median, 7; range, 1 to 39) in pN-positive patients. A mean of 16.4 ± 8.4 nodes

Comment

Numerous studies indicate an increase in the incidence of the adenocarcinoma of the gastroesophageal junction in Western countries 1, 2, 3, 4. The optimal treatment strategy is still a matter of debate given the peculiarities of this tumor, such as the spread to both the mediastinal and abdominal lymph nodes. In fact, the main lymphatic pathways originating from the lower esophagus advance both up into the mediastinum and down along the celiac axis [10], whereas those from the gastric cardia

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