Adenocarcinoma in the upper third part of the stomach

Two hundred and twenty-three patients who underwent gastrectomy for adenocarcinoma arising from the cardia and upper third part of the stomach were studied with regard to esophageal invasion. One hundred and twenty-seven (57 per cent) had a malignant invasion into the esophagus and 96 (43 per cent) did not. In the curative instances, 52 of 74 patients (70.3 per cent) without esophageal invasion survived for five years, while 14 of 52 patients (26.9 per cent) with esophageal invasion survived: The prognosis of patients with esophageal invasion was poor regardless of the presence or absence of metastases to the lymph nodes. No patient who underwent noncurative resection survived for five years. To elucidate the high risk factors of esophageal invasion, a proportion of patients with esophageal invasion was statistically compared with patients without esophageal invasion, according to clinicopathologic factors. High risk factors included anatomic location, advanced disease and Borrmann IV type in gross appearance, more than 5 centimeters in diameter, positive serosal in filtration and positive metastases to the lymph nodes. Histologic type and mode of invasion did not relate to the esophageal invasion. The patients with high risk factors had a significantly poorer prognosis than did those without high risk factors. The results of the present study clearly show that high risk factors for esophageal invasion have an untoward effect on the rate of curative resection and the prognosis after removal of a lesion from the upper third part of the stomach.