Cardia Cancer: Personal Experience

Yoon, Ho Young; Kim, Kook Jin; Lee, Sang Hoon; Kim, Choong Bai

Abstract

PURPOSE: Due to the biological characteristics of cardia cancer, prognosis is poor. It is therefore essential to achieve a sufficient proximal resection margin to maximize survival. The authors studied gastric cardia cancer, focusing on adenocarcinoma.
METHODS
One-hundred fifty patients who were diagnosed with gastric cardia cancer and underwent surgery between January 1990 and December 2006 by a single surgeon were included in this study.
RESULTS
Of the 150 cases, 141 were adenocarcinomas, 4 were carcinomas, and 3 were leiomyosarcomas. In the adenocarcinoma group, the male-to-female ratio was 2.62:1. There were 2, 60, and 79 (56.0%) cases of adenocarcinoma type I, II, and III, respectively, and there were 32 (22.7%), 18 (12.8%), 70 (49.6%), and 21 (14.9%) cases of stage I, II, III, and IV tumors, respectively. The mean distance from the proximal tumor to the resection margin was 1.93+/-2 cm pathologically, and there was tumor invasion of the resection margin in 4 cases (2.8%). In the 10 cases of extended surgery in type II, the mean distance was 5.85+/-3.67 cm, with no tumor invasion of the resection margin. Recurrence occurred in 30 (21.3%) cases, and 5 of those cases were local anastomotic site recurrences. Cumulative survival was 81.3%, 77.8%, 51.4%, and 28.6% for stage I, II, III, and IV tumors, respectively.
CONCLUSION
Although it is possible to remove the tumor with an appropriate resection margin by only an abdominal incision, the surgeon should always keep in mind the possibility of a thoracoabdominal incision when operating on a patient with esophageal infiltration.