[Adenocarcinoma of the proximal stomach and cardia: problems of surgical strategy and technics]

In a total of 142 patients with adenocarcinoma of the proximal third of the stomach and cardia, curative resection was carried out in 88 during the period 1960-1980. The patients were divided in two groups. I group included 32 patients with tumor distal to the esophagogastric junction. In II group (54 patients) the tumor involved the esophagogastric junction (adenocarcinoma of the gastric cardia). In I group, when the proximal border of the cancer was well defined and sufficient length was maintained between the proximal tumor border and esophagogastric junction, the abdominal approach was preferred and the operation performed was generally a total gastrectomy combined with splenectomy and celiac node dissection. Distal pancreatectomy was performed as necessary. In most patients of the II group, the operation was performed using separate abdominal and right-sided thoracic incisions. Two principally types of operation were used: extended total gastrectomy and extended proximal subtotal gastrectomy, depending on degree of gastric wall involvement, combined with extensive esophagectomy, splenectomy and regional nodes dissection in both cases. Distal pancreatectomy was not performed routinely but only as necessary. In this group of patients there was no significant difference in the overall cure rate between the extended total gastrectomy and the extended proximal subtotal gastrectomy. Operative morbidity and mortality rates were also comparable.