Surgical treatment of gastric cancer invading the oesophagus

Introduction: There is controversy regarding which type of surgical treatme nt is most appropriate for upper gastric cancer invading the oesophagus. Methods: A review of the pertinent literature was carried out regarding oes ophageal involvement in gastric cancer. Results: Invasion of the oesophagus occurred in 26-63% of Western surgical series. It was more frequent in Borrmann IV type, linitis plastics, pT3-pT4 , diffuse type by Lauren, N + or tumours exceeding 5 cm in diameter. Lympha tic tumour spread was caudad (coeliac nodes, hepatoduodenal nodes, paraorti c nodes) but mediastinal nodes were also involved if tumour growth in the o esophagus exceeded 3 cm or if there was transmural oesophageal infiltration . In Western countries there was less than 30% 5-year survival and no long- term survivors when hepatoduodenal or mediastinal nodes were metastatic. Me diastinal dissection through thoracotomy did not provide ally benefit. Conclusions: A rational approach involves total gastrectomy plus partial oe sophagectomy. Abdominal transhiatal resection may be performed in the case of a localized, non-infiltrating tumour and oesophageal involvement 12 cm. However, infiltrating, poorly differentiated or Borrmann III-IV tumours req uire a right, thoracotomy to achieve a longer margin of clearance. When oes ophageal involvement is >3 cm, or hepatoduodenal or mediastinal nodes are p ositive, no surgical procedure is curative and the literature demonstrates that extended aggressive surgery has no (C) 2000 Harcourt Publishers Ltd.