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KMID : 0371319660080080453
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Journal of the Korean Surgical Society
1966 Volume.8 No. 8 p.453 ~ p.458
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Surgical Management of Carcinoma of the Gastric Cardia:The Use of an Extended En-Block Resection in Five Cases
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Rice, R.G.
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Abstract
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According to the literature the cure rate for gastric cancer is directly affected by the presence or absence of metastasis to the lymphnodes. This has been found to be true for all other types of cancer. Therefore, any improvement in the cure rates for gastric cancer is dependent upon the development of safe technics for wider excisions of the primary lesion along with the areas of lymphatic spread.
It is not anatomically posible to perform an En-Block removal of the gastric lymphatic pathways using the conventional subtotla resection or total gastrectomy when the lesion is in the proximal stomach, the cardia.
Embryologically the stomach is a part of a straight tube which is suspended by the dorsal mesogastrium, and is parallel to the aorta. The spleen and the body of the pancreas develop within this dorsal mesogastrium. The developing and enlarging liver displaces the stomach with its mesogastrium to the left side of the abdomen. Thereafter, the left lateral leaf of the mesogastrium becomes attached to the posterior abdominal wall. The opposing mesothelial surfaces are resorbed which leaves only a potential plane of Cleavage as a remnant of the early embryological development. The body and tail of the pancreas are fused in the retroperitoneum. It is possible to reopen the plane left to the attachment of the left lateral leaf of the mesogastrium to the posterior abdominal wall without injury to an organ or any major blood vessels.
Visalli and Grimes have published an approach to cardiac gastric concer which, using he above embryological facts, allows an En-Block resection of the lesion nd its lymphatic spread. The basic principle of this technic is a complete removal of the gastric mesentery with the patbhays for gastric lymphatic drainage. This procedure requires the removal of the spleen, the body of the pancreas, the greater and lesser omenta, along with a proximal subtotal gastric resection. From January, 1965 to August, 1965 five patients having carcinoma of the gastric cardia have had this extended gastrectomy at Severance Hospital, Y.U.M.C.. There have been no operative deaths. Two patients developed wound infection which was cleared with conservative treatment.
In spite of the preasence of extremely large tumors, we have been impressed with the ease with which the En-Block resection following embryologic tissue planes, could be carried out. It is felt that this procedure is based on sound anatomic and physiologic principles and is in keeping with the current concepts of the best in cancer surgery. It would be considered in patients with cardiac cancer when the primary lesion is potentially curable.
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