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2007 | 79 | 9 | 600-609
Tytuł artykułu

Esophagogastric Junction Versus Gastric Carcinoma - Implications for Surgical Tactics on the Basis of Own Experience

Treść / Zawartość
Warianty tytułu
Języki publikacji
EN
Abstrakty
EN
The exact prevalence and results of treatment of the carcinoma of esophagogastric junction (gastric cardia) are difficult to assess, and the data concerning thereof, presented in different series of patients, are frequently inconsistent. This phenomenon may result from terminological mess, resulting in different comprehension of the sole term "esophagogastric junction". That can be why the results of treatment of patients with this type of cancer are dispersed in the literature and may be as well found under "esophageal", as well as "gastric cancer" headings.The aim of the study was to present the current view of the pathogenesis, pathology and terminological issues concerning this tumor, interesting at least for its localization at the border of two viscera and two body cavities. On the basis of our own material, we also tried to delineate the implications of such a localization to surgical tactics.Material and methods. The patients with esophagogastric junction and more peripherally located gastric cancer were analysed in two groups, according to the date of resectional surgery performed: From 1989 to 1998 (group I), and from 1999 to 2005 (group II). In each group the patients with esophagogastric junction and peripheral gastric cancer were investigated separately. The influence of more aggressive approach to cardial cancer (additional thoracotomy approach) in group II patients on the cancer free tissue margin, number of metastatic lymph nodes excised, as well as on survival rate during a 5-years follow-up was assessed.Results. The results show, that the additional thoracotomy, despite the increase in postoperative complications rate (mainly affecting the respiratory system- 19 vs 4.3% at laparotomy alone), did not influence the perioperative motality in our patients (approximately 5% in all subgroups). Despite the additional thoracotomy approach, facilitating the safe lower esophageal resection, the cancer free margins of the excised specimens remained unsatisfactory (the target safe margin value of 7 cm), although some improvement can be noted as compared with group I patients. The interesting finding was, that the survival rates following gastrectomy for ‘peripheral’ gastric carcinoma has been remaining practically unchanged during the 20 years of this study. Survival rates following gastric cardia resection improved in group II patients, but the differences did not reach the statistically significant level. The difference in survival rate was increasing with time in favor of group II patients, its value being triple at 5 years from surgery (18 vs 6%) as compared with group I.Conclusions. We see the need for the development of a method allowing to select the patients with good prognosis, in whom further radicalization of resectional procedures (and subsequent treatment) would be justified by long-term disease-free survival.
Wydawca

Rocznik
Tom
79
Numer
9
Strony
600-609
Opis fizyczny
Daty
wydano
2007-09-01
online
2008-02-11
Twórcy
  • Department of General, Transplant and Liver Surgery, Medical University, Warsaw
  • Department of General, Transplant and Liver Surgery, Medical University, Warsaw
  • Department of General, Transplant and Liver Surgery, Medical University, Warsaw
  • Department of General, Transplant and Liver Surgery, Medical University, Warsaw
  • Department of General, Transplant and Liver Surgery, Medical University, Warsaw
  • Department of Pathology, Medical University, Warsaw
  • Department of General, Transplant and Liver Surgery, Medical University, Warsaw
Bibliografia
  • Dicken BJ, Bigam DL, Cass C: Gastric Adeno-carcinoma: Review and Consideration for Future Direction. Ann Surg 2005; 241: 27-39.
  • Hamilton SR, Aaltonen LA: World Health Organization Classification of Tumours. Pathology and Genetics, Tumours of the Digestive System. IARC Press, Lyon 2000.
  • Siewert JR: Kardiakarcinom: Versuch einer therapeutisch relevanten Klassifikation. Chirurg 1987; 58: 25-32.
  • Siewert JR, Stein HJ, Sendler A: Surgical resection for cancer of the cardia. Semin Surg Oncolog 1999; 17: 125-31.
  • Stein HJ, Feith M, Siewert JR:. Individualized surgical strategies for cancer of the esophagogastric junction. Ann Chir Gynaecol 2000; 89: 191-98.
  • Kakar S, Burgart LJ: Adenocarcinoma of the Esophagus and Gastic Cardia: Two Diseases or One? Pathol Case Rev 2002; 7: 43-47.
  • Frączek M (red.): Chirurgia Nowotworów. Alfa-Medica Press; Bielsko-Biała 2003.
  • Frączek M, Krawczyk M: Chirurgia żołądka i dwunastnicy. W: Podstawy Chirurgii. Szmidt J, Gruca Z, Krawczyk M, Kuzdżała J, Lampe P, Polański J (red.). Medycyna Praktyczna. Kraków 2004.
  • Karl RC, Schreiber R, Boulware D: Factors Affecting Morbidity, Mortality, and Survival in Patients Undergoing Ivor Lewis Esophagogastrectomy. Ann Surg 2000; 231(5): 635-43.
  • Souza RF, Spechler SJ: Concepts in the Prevention of Adenocarcinoma of the Distal Esophagus and Proximal Stomach. CA Cancer J Clin 2005; 55: 334-51.
Typ dokumentu
Bibliografia
Identyfikatory
Identyfikator YADDA
bwmeta1.element.-psjd-doi-10_2478_v10035-007-0094-7
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