Total Gastrectomy for Gastric Cancer Involving the Cardia

Kim, Boo Gang; Cho, Byung Sun; Kang, Yoon Jung; Park, Joo Seung

Abstract

BACKGROUND: Gastric cardia cancers are relatively rare neoplasms althougth it is reported that their relative incidence among gastric cancers is increasing. At the time of diagnosis, gastric cardia cancers in many cases are already in a more advanced stage in terms of depth of invasion or metastasis to lymph nodes. The purpose of this study was to evaluate the effect of the proximal resection margin on the survival rates for cardia cancer patients who underwent a total gastrectomy without a thoracotomy.
METHODS
We retrospectively analyzed 87 patients who had undergone operations for gastric cardia cancers at Eulji College Hospital during the 8 years from Jan. 1988 to Dec. 1995.
RESULTS
The most prevalent age group was in the 6th decade (34.5%) and the male-to-female ratio was 2.2:1.0. The TNM classification showed stage I (13.8%), II (10.3%), III (54%) and IV (21.8%). The overall 5-year survival rate was 35.6%, and the survival rates according to the stage were 83.3% in stage I, 87.5% in stage II, 27.1% in stage III, and 0% in stage IV. The 5-year survival rates according to the length of the proximal resection margin (PRM) for all patients were as follows: 22.0% for PRM< or =2 cm (N=34) and 44.0% for PRM>2 cm (N=52) 44.0% (p=0.0783). The 5-year survival rates according to the length of the PRM for stage III cancers were as follows: 19.7% for PRM< or =2 cm (N=18) and 31.7% for PRM>2 cm (N=28)(p=0.4090).
CONCLUSIONS
These results suggest that the length of the proximal resection margin is not significant as a prognostic factor. We believe a total gastrectomy without a thoracotomy is a reasonable and safe alternative to a thoracotomy approach to the dissection of the mediastinal lymph node in cases of gastric cardia cancer.