PALLIATIVE TREATMENT FOR ADENOCARCINOMA OF THE CARDIA - IS THERE A PLACE FOR SURGERY

Objectives. - The value of palliative surgery for adenocarcinoma of th e cardia (AC) is controversial, and specific studies are lacking. The aim of this study was to report the, results of a palliative resection for AC in 69 patients. Methods. - From 1980 to 1993, 69 patients (mea n age 59 +/- 10 years) underwent a palliative resection for AC. Pallia tive resection was defined by macroscopically incomplete resection, tu moral involvement of resection margins visceral or serosal metastasis, or N3 metastatic nodes. Patients were classified according to the dia gnosis of palliation established preoperatively (group A, n=26), perop eratively (group B, n = 35), or postoperatively (group C, n = 8) respe ctively. Results. - Sir patients (8.7 %) died postoperatively. Mortali ty rates were 3.8 % 8.6% and 25 % in groups A, B and C, respectively. Twenty one patients (30 %) had postoperative non-fatal complications. Median global survival was 9 months (mean II +/- 7 months) without sig nificant difference between groups A, B and C. Forty-four out of 51 pa tients (86 %) followed until death did not have dysphagia. The other p atients were free of dysphagia during an average of 70 % of the follow -up duration. Among the 14 patients surviving postoperatively with a t umoral esophageal margin, none experienced dysphagia from anastomotic recurrence during follow-up. Conclusions. - In selected patients with AC, a palliative resection can be achieved with an acceptable mortalit y and a very good functional result. This result can justify, a prospe ctive comparison between palliative surgery and alternative treatments .