J.Jpn. Surg. Soc.. 91(9): 1200-1203, 1990

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Report on the annual meeting

CURATIVE OPERATION FOR CANCINOMA ARISING IN THE CARDIA

An extended radical surgery for cancer arising in the cardia was evaluated. It consisted of total gastrectomy accompanying resection of lower esophagus through thoracoabdominal incision and complete removal of Groups 1 and 2 lymph nodes accomplished by resection of the pancreas tail and spleen. A curative procedure was performed on forty of sixty-one operated cases. There was one death, an operative mortality of 2.5%. Metastases to lymph nodes were found in a half of the patients. The five and ten-year survival rates were 48.4% and 38.7%, respectively. In regard to lymph nodes metastases the five-year survival rate was 50% for patients with no metastasis, 50% for either n1(+) or n2(+), and 0% for n2 * (+) (metastases to lower mediastinal lymph nodes). And two patients with metastases of para-aortic nodes along the left inferior phrenic artery are alive for twelve and four years respectively. Thus lymph nodes dissection to Groups 1 and 2 should be extended in range to left lateral para-aortic lymph nodes around left adrenal gland and left kidney. The most frequent cause of death related with tumor recurrence was hepatic metastasis. In order to reduce the incidence of recurrent disease, the no-touch isolation technique is also indicated.

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