Outcomes After Resection of Adenocarcinoma of the Gastric Cardia by Surgical Approach

Total gastrectomy and esophagectomy are commonly used surgical approaches for cardia gastric adenocarcinoma (GA) resection. However, the preferred approach remains unclear. The objectives of this study were to identify predictors of receipt of surgical approach type and compare surgical approach outcomes.

Patients with stage IB-IIIC cardia GA from 2004 to 2017 were identified within the National Cancer Database. Patients were compared on the basis of receipt of total gastrectomy versus partial gastrectomy with esophagectomy. Predictors of receiving esophagectomy were identified using multivariable logistic regression. Predictors associated with overall survival (OS) were assessed using a multivariable Cox proportional hazards model.

A total of 9841 patients were included. More patients underwent esophagectomy compared with total gastrectomy (77.2% vs. 22.8%). Surgical approach utilization did not vary significantly over time (p = 0.6). Patients who were non-white or female (OR 0.8, 95% CI 0.7-0.9) were less likely to receive esophagectomy. The median number of lymph nodes resected was greater for total gastrectomy versus esophagectomy (18 vs. 15, p < 0.01). There was no difference in resection margins (93.6% vs. 94.5%, p = 0.3) or 30-day mortality (3.0% vs. 2.5%, p = 0.2). Total gastrectomy and esophagectomy had similar OS (40.2 vs. 40.1 months, p = 0.7). On multivariate analysis, there was no difference in survival for total gastrectomy versus esophagectomy (HR 1.0, 95% CI 0.9-1.0).

Utilization of total gastrectomy and esophagectomy has remained stable over time with esophagectomy being more utilized. These approaches exhibit similar oncologic outcomes for proximal GA. Surgeons should consider long-term outcomes, such as quality of life and nutritional status, when selecting an approach.