ADENOCARCINOMA OF THE CARDIA - DOES EXTEN T OF GASTRECTOMY AND LYMPHADENECTOMY INFLUENCE SURVIVAL

Objectives. - In the curative treatment of the adenocarcinoma of the c ardia (AC), the extent of the esogastrectomy and the need for lymph no de dissection are still debated. The palliative treatment of AC is now currently non-surgical. The aim of this study was: a) to assess early results of palliative surgery; b) to evaluate the results of curative resection with reference to the influence of the extent of gastrectom y and lymph node dissection on early results and long-term survival. M ethods. - From 1979 to 1989, 179 patients (mean age = 60 +/- 12 years) with AC had 45 palliative resections (mean age = 56 +/- 15) and 134 c urative resections (mean age = 61 +/- 12). Thirty-eight proximal subto tal esogastrectomies (PSOG) and 7 total esogastrectomies (TOG) were pa lliative; 72 PSOG and 62 TOG extended to the spleen were curative and associated with lymphadenectomy. Results. - The operative mortality ra te was 8.9 % regardless of the palliative or curative intent of resect ion. After palliative resection, the mortality rate was 2.6 % (1 case out of 38) after PSOG and 42.9 % (3 cases out of 7) after OGT (P = 0.0 1); the median survival was 8 months. After curative resection, the mo rtality rate was 12.5 % (9 cases out of 72) after PSOG and 4.8 % (3 ca ses out of 62) after extended TOG (P = 0.2); actuarial 5-year survival rate was 42 % after PSOG and 39 % after extended TOG. Conclusions. - These results suggest that: a) palliative PSOG for AC can be performed with a low mortality, b) resection with extensive lymphadenectomy all ows substantial survival regardless of the extent of gastrectomy.