BACKGROUND: The optimal extent of resection for adenocarcinomas of the
gastroesophageal junction is controversial. This study was conducted
to examine whether the extent of resection is an independent prognosti
c factor in cardia cancer. METHODS: The records and survival data of 1
25 patients who underwent resection for cancer of the cardia were retr
ospectively analyzed. Multiple regression was used to evaluate prognos
tic factors in patients who underwent proximal gastric resection (PR)
or total gastrectomy (TG) for cancer of the cardia. RESULTS: Seventy-f
ive patients underwent PR and 50 TG. The 5-year survival was 40% for t
umors confined to the esophageal wall (T1, T2), and 13% in more advanc
ed cases (T1, T2; P = 0.0001), Twenty-two percent of the patients with
tumor-free margins, 10% of those with microscopic residual tumor, and
none with macroscopic residual tumor survived longer than 5 years (P
= 0.0001 for any residual tumor versus no residual tumor). Lymph node
involvement (P = 0.002) and stage (P = 0.0001) were also significant i
n the univariate analysis. Five-year survival was 18% after TG, and 17
% after PR (P = NS). CONCLUSION: Multiple regression identified residu
al tumor and penetration depth as independent predictors of survival (
P = 0.0002, and P = 0.0001, respectively). After correction for these
factors, none of the following variables were of additional significan
ce: extent of resection (TG versus PR), lymph node involvement, age, o
r Lauren's classification. In 19 of 20 cases with microscopic incomple
te resection, it was the oral margin that was positive. We conclude th
at the extent of resection (TG versus PR) does not influence survival
in adenocarcinoma of the gastroesophageal junction.