J.Jpn. Surg. Soc.. 91(9): 1208-1210, 1990

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Report on the annual meeting

TO ELEVATE PROGNOSIS FOR ADENOCARCINOMA IN THE GASTRIC CARDIA

We report our review of 56 cases of cardia cancer with particular attention to establishing optimal surgical management for elevating prognosis. From 1979 to 1988, 1083 gastric cancers were resected in our department. Among these cancers, 183 (16.8%) were located in the upper third of the stomach, of these, 56 (5.2%) were adenocarcinoma in the gastroesophageal junction, involving 7 early and 49 advanced cancers. The curative resection rate was 69% and in these the 5-year-survival rate was 63.7%, while only 10% for non-curative resection. A rate of 23% for lower mediastinal lymph node metastasis was confirmed histologically, and 6 (85.7%) died within 3 years.
The mean number of diaphragmatic lymph nodes (no. 111), including those in the hiatus was 5.4 generally in autopsy cases. Combined resection of the diaphragm was performed in 13 cases and reconstruction was mainly achieved using a latissimus dorsi muscle flap. The 2-year-survival rate of those PS(+) was 64% for combined resection of the diaphragm and 41.8% for non-combined. To improve surgical results for advanced cancer of the gastric cardia, extended lymph node dissection, including paraaortic lymph node dissection, and combined resection of the diaphragm are required by the thoracoabdominal approach.

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