[Adenocarcinomas of the distal esophagus and cardia: surgical management]

Adenocarcinoma of the esogastric junction is increasing more rapidly than any other cancer in western country. Patients with carcinoma of the cardia often present at an advanced stage of disease. Accurate preoperative staging of cancer of the cardia need computed tomography, endoscopic ultrasound: laparoscopy is useful for advanced cancer to detect liver and peritoneal metastatis, preventing an unnecessary laparotomy in up to 20% of patients. The Siewert's classification of the cancer of the esogastric junction is accepted internationally: type I: tumor center within the late 5 cm of the distal esophagus, treated with subtotal esophagectomy; type II: located at the esogastric junction, treated with distal esophagectomy and, either proximal or total gastrectomy; and type III: subcardial cancer, treated by extended total gastrectomy. The dominating independent prognostic factors are a complete resection (R0) and the lymph node status (pN0) Expected 5 year survival rate is 30% in patients undergoing surgery with curative intent (R0) and less than 1% in patients undergoing palliative surgery.