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Surgical management of adenocarcinoma in the gastric cardia
J Takeda1, K Hashimoto, K Koufuji
1Department of Surgery, Kurume University School of Medicine, Japan.
Insights
Cardia gastric cancer is often advanced, with high lymph node metastasis rates. Curative resection significantly improves 5-year survival, and combined diaphragm resection benefits selected advanced cases.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Pathology
Background:
- Gastric cancer incidence in the upper third of the stomach was analyzed.
- Esophagogastric (E-G) junction adenocarcinomas, defined as cardia cancer, were specifically investigated.
- Cardia cancer presented unique challenges due to its location and advanced stage at diagnosis.
Purpose of the Study:
- To evaluate the clinicopathological features of cardia gastric cancer.
- To assess the outcomes of surgical resection for cardia cancer, including curative vs. non-curative approaches.
- To determine the impact of combined diaphragm resection on survival for advanced cardia cancer with potential diaphragmatic involvement.
Main Methods:
- Retrospective analysis of 1083 gastric cancer resections performed between 1979 and 1988.
- Classification of cardia cancer based on macroscopic location (within 2 cm of E-G junction) and tumor diameter (<8 cm).
- Evaluation of lymph node metastasis, survival rates (5-year and 2-year), and outcomes of combined diaphragm resection.
Main Results:
- Cardia cancers represented 5.2% of all gastric cancers, with a high incidence of advanced stage (46% Stage III) and lymph node metastasis (59%).
- Curative resection achieved a 64% 5-year survival rate, compared to only 10% for non-curative resection.
- Combined diaphragm resection in advanced cases showed a 2-year survival rate of 64%, compared to 42% without it, with a 20% rate of invisible diaphragmatic metastasis.
Conclusions:
- Cardia gastric cancer is frequently diagnosed at an advanced stage, necessitating aggressive surgical management.
- Curative resection is crucial for improving long-term survival in cardia cancer patients.
- Combined diaphragm resection should be considered for advanced cardia cancer cases with suspected or confirmed diaphragmatic invasion to improve survival outcomes.
Abstract:
From 1979 to 1988, a total of 1083 patients with gastric cancer underwent resection at Kurume University Hospital. Among these cancers, 183 (16.8%) were located in the upper third of the stomach. Of these, 56 (5.2%) were adenocarcinomas in the esophagogastric (E-G) junction. Cancer in this area was designated as cardia cancer when the focus of the cancer was macroscopically located within 2 cm of the E-G junction line and the tumor was less than 8 cm in diameter. The incidence of early gastric cancer in the cardia was only 13%, while the incidence for stage III advanced cancer was high at 46%, and the positive lymph node metastasis rate was 59%. Thirty-nine (70%) were cured by resection with a 5-year-survival rate of 64%, while for non-curative resection, this was only 10%. Twenty-two cases of either advanced cardia or advanced CE cancer underwent combined resection of the diaphragm. The rate of invisible metastasis to the diaphragm was 20% in our experimental study. The two year-survival rate for a combined resection of the diaphragm was 64%, while the rate for those who did not undergo a required combined resection was 42%.