CLINICAL-EXPERIENCE IN RADICAL LYMPHADENECTOMY FOR ADENOCARCINOMA OF THE GASTRIC CARDIA

Objectives: We evaluated the pattern of nodal metastasis and its progn osis after radical lymphadenectomy in adenocarcinoma of the gastric ca rdia, Methods: We conducted a retrospective cohort study of 70 patient s (52 men and 18 women; mean age 63.6 years) with adenocarcinomas of t he gastric cardia who underwent extended gastrectomy (65 total gastrec tomies and 5 proximal gastrectomies) and radical lymphadenectomy (D2 t o D4) at Taichung Veterans General Hospital between 1989 and 1995, Res ults: Twenty-four complications developed in 22 (31.4%) patients, and seven (10.0%) hospital deaths occurred. An overall 5-year cumulative s urvival of 37.6% was obtained, Lymph node metastases were identified i n 53 (75.7%) patients, Nodal involvement was closely related to the de pth of tumor invasion (p = 0.005), When the gastric wall invasion was limited to the subserosal layer (T1 and T2, n = 15), no patient had Nl group nodal metastasis. Once the serosal leger had been involved (bey ond T3), N4 group nodal metastasis was frequently seen (30.9%, 17 of 5 5 patients), A multivariable analysis revealed that the level of nodal involvement, the depth of tumor invasion, and the presence of complic ations were independent prognostic factors, Cumulative 5-year survival s of curability A (n = 12), B (n = 19), and C (n = 32) resections were 100%, 21.2%, and 27.5%, respectively (p = 0.0001). The long-term surv ival of the patients after resection was also closely related to their pTNM stages (p = 0.0004). Conclusions: We conclude that gastrectomy a ccompanied by radical lymphadenectomy provides a reasonable long-term survival expectancy that is closely related to the stage of the diseas e and the curability of resection.