Cancers arising from the cardia and the proximal third of the stomach can be grouped together because they have the same histologic features and the methods of treatment are similar. They account for approximately 15% to 30% of all gastric
cancer.
The surgical management of patients with cancers of the cardia & proximal third of the stomach, heowever, is controversial, not only with regard to the surgical approach, but also to the extent of resection. Whether total gastrectomy or proximal
gastrectomy is the most effective surgical procedure for cure is controversial because of the lack of controlled, randomized studies comparing these two operative methods.
This report is a review of our experience with surgical treatment of 136 patients with adenocarcinoma of the cardia & proximal third of the stomach, to compare two operative methods.
@ES The results were as follows:
@EN 1) Males predominated in the ratio of 2:1 Age of patients ranged from 20to 72 years and the majority(60%) were within the 50~69 age group.
2) Lymph node metastases were frequently involved in paracardiac(60%), hepatoceliac and lesser curvature(49%0, pancreaticolienal(37%) and greater curvature nodes(17%)
3) The overall incidence of tumor infiltration on the proximal resection margin was 15%. The mean distance between the proximal margin and macroscopic tumor margin was , respectively, 40cm in non-infiltrated and 2.8cm in infiltrated margin. No
infiltration was found in patient when the proximal margin was greater than 5cm.
4) The degree of invasion of gastric wall and size of tumor were significantly related to the rate of infiltration. The incidence of infiltration of the proximal margin was significantly higher(20% vs 0%, p<0.05) when the tumor penetrated the
serosa
than when the lesion was confined to the mucosa, submucosa or muscular layer and the infiltration rate was higher when the size of tumor was greater than 6cm than when the tumor was less than 6cm in size (46% vs. 6%, p<0.05).
5) Most patients presented with advanced disease; 78% had stage III or IV disease at time of operation.
6) The overall actuarial 5-year survival rate was 26.2% with a median survival time of 24 months.
7) The actuarial survival rate for curative resection was 29.1%. No patient with palliative resection lived for longer than 2 years.
8) The actuarial 5-year survival rate after curative resection was 51.6% in stage I and II, 16.8% in stage III.
9) Proximal gastrectomy(3 of 4 patients, 75%) resulted in a higher incidence of local recurrence than extended total gastrectomy(1 of 20 patients, 5%) in stage I and II(p<0.01), but the difference was minimal in stage III.
10) Extended total gastrectomy(61.3%) resulted in a significantly higher 5-year acturarial survival as compared with proximal gastrectomy(25%) in stage I and II(p<0.01), but the difference was minimal in stage III.
In conclusion, we believe that the surgical treatment of adenocarcioma of the cardia and proximal 1/3 stomach is curative only in stage I & II and that extended total gastrectomy in these stages would be a better procedure than proximal
gastrectomy
to
improve survival.
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