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PubMed1991

Surgical management of adenocarcinoma in the gastric cardia.

From 1979 to 1988, a total of 1083 patients with gastric cancer underwent resection at Kurume University Hospital. Among these cancers, 183 (16.8%) were located in the upper third of the stomach. Of these, 56 (5.2%) were adenocarcinomas in the esophagogastric (E-G) junction. Cancer in this area was designated as cardia cancer when the focus of the cancer was macroscopically located within 2 cm of the E-G junction line and the tumor was less than 8 cm in diameter. The incidence of early gastric cancer in the cardia was only 13%, while the incidence for stage III advanced cancer was high at 46%, and the positive lymph node metastasis rate was 59%. Thirty-nine (70%) were cured by resection with a 5-year-survival rate of 64%, while for non-curative resection, this was only 10%. Twenty-two cases of either advanced cardia or advanced CE cancer underwent combined resection of the diaphragm. The rate of invisible metastasis to the diaphragm was 20% in our experimental study. The two year-survival rate for a combined resection of the diaphragm was 64%, while the rate for those who did not undergo a required combined resection was 42%.

Adenocarcinoma↗
PubMed2004

Differences in proximal (cardia) versus distal (antral) gastric carcinogenesis via the retinoblastoma pathway.

AIM: Disruption of cell cycle regulation is a critical event in carcinogenesis, and alteration of the retinoblastoma (pRb) tumour suppressor pathway is frequent. The aim of this study was to compare alterations in this pathway in proximal and distal gastric carcinogenesis in an effort to explain the observed striking epidemiological differences. METHODS: Immunohistochemistry was performed to investigate expression of p16 and pRb in the following groups of both proximal (cardia) and distal (antral) tissue samples: (a) biopsies showing normal mucosa, (b) biopsies showing intestinal metaplasia and, (c) gastric cancer resection specimens including uninvolved mucosa and tumour. RESULTS: In the antrum there were highly significant trends for increased p16 expression with concomitant (and in the group of carcinomas inversely proportional) decreased pRb expression from normal mucosa to intestinal metaplasia to uninvolved mucosa (from cancer resections) to carcinoma. In the cardia, there were no differences in p16 expression between the various types of tissue samples whereas pRb expression was higher in normal mucosa compared with intestinal metaplasia and tissue from cancer resections. CONCLUSION: Alterations in the pRb pathway appear to play a more significant role in distal gastric carcinogenesis. It may be an early event in the former location since the trend towards p16 overexpression with concomitant pRb underexpression was seen as early as between normal mucosa and intestinal metaplasia. Importantly, the marked differences in expression of pRb and p16 between the cardia and antrum strongly support the hypothesis that tumours of the two locations are genetically different which may account for some of the observed epidemiological differences.

Adult↗
PubMed2006

Influence of a microscopic positive proximal margin in the treatment of gastric adenocarcinoma of the cardia.

AIM: To investigate the influence of a positive proximal margin in total gastrectomy patients with gastric adenocarcinoma of the cardia. METHODS: Medical records of 191 patients with total gastrectomies for adenocarcinoma of the cardia between 1995 and 2000 were reviewed. The clinicopathologic features associated with a positive margin were determined, and the predictors for survival were analyzed. RESULTS: The incidence of positive proximal margin was 8.4% (16/191). The positive margins were associated with advanced diseases. The tumor size and the depth of tumor invasion were independent risk factors for a positive margin. The mean survival in the positive margin group was 33.9 mo as compared with 62.4 mo in the negative group (P < 0.001). However, the difference in survival lost significance in subgroup analysis according to stage. Multivariate analysis identified that a positive margin was not an independent prognostic factor for survival. CONCLUSION: A positive margin is more of an indication of advanced disease in patients with gastric adenocarcinoma of the cardia rather than an independent prognostic factor for survival.

Adenocarcinoma↗
PubMed1999

[The surgical correction of the disordered sphincteric function of the cardia].

For comparative assessment of some methods of surgical correction of the cardia the results of surgical treatment of 180 patients were analyzed. In 33 patients hiatal diaphragmatic hernia (HDH) was detected, in 84--duodenal ulcer was combined with HDH and in 63--duodenal ulcer was detected. In 15 patients operation by Hill was performed for correction of cardial function, in 9--operation by Dor was carried out, in 3--valvular gastroplication by N.N. Kanshin, in 23--esophagofundorrhaphy and in 130--modified by N. N. Kanshin and A. F. Chernousov fundoplication was performed. In 49 patients fundoplication by improved method was carried out with the use of intraoperative esophagomanometric control for adequacy of the procedure. The effectiveness of the treatment was evaluated according to the short-term and long-term results. It was thus established, that the best procedure of surgical correction of the cardia was fundoplication. Introduction of esophagomanometry during fundoplication valve formation is the most important factor contributing to adequate restoration of the cardia.

Cardia↗
PubMedDate not supplied

Lymph node metastasis with adenocarcinoma of the gastric cardia: clinicopathological analysis and indication for D1 dissection.

PURPOSE: To establish the indications for proximal resection with dissection of perigastric lymph nodes in order to treat adenocarcinoma of the gastric cardia. METHODS: We analyzed the clinicopathological features of 110 resected adenocarcinomas of the gastric cardia with respect to the appropriate operative method and extent of lymphadenectomy for treatment. RESULTS: Of the 110 patients, 93 underwent curative resection. The D2 group (total gastrectomy with dissection of extended regional lymph nodes) revealed higher morbidity and mortality rates compared to the D1 group (proximal resection with dissection of perigastric lymph nodes). The risk of lymph node metastasis was determined by depth of invasion, size of tumors, and gross findings of tumors. CONCLUSION: The appropriate operative method for adenocarcinoma of the gastric cardia requires: (i) tumor size less than 4 cm; and (ii) gross findings indicating a superficial type of lesion, which are recommended for proximal resection with dissection of perigastric lymph nodes.

Adenocarcinoma↗
PubMed1999

Current trends in the surgical treatment of esophageal and cardia adenocarcinoma.

Since adenocarcinoma of the esophagus and cardia is increasing at an alarming rate, major efforts are currently oriented to identify patients who may benefit from extensive resection. Between November 1992 and May 1998, 218 patients with histologically proven adenocarcinoma of the distal esophagus or cardia were referred to our Department. In six patients (10.2%) with Barrett's adenocarcinoma, cancer was discovered during endoscopic surveillance program for Barrett's metaplasia. Overall, one hundred-forty-seven patients (67%) underwent resection. Fifty-one underwent an extended mediastinal lymphadenectomy. Median cumulative survival was 25.9+/-3.1 months in patients undergoing resection, and 7+/-1.3 months in patients having palliation (p<0.01). Survival was significantly longer in patients with negative nodes than in those with lymph node metastases (54+/-12.9 versus 17+/-2.8 months, p<0.01). Six of the 51 patients (11.8%) undergoing extended lymphadenectomy had metastatic upper mediastinal nodes. Additional serial sections and immunohistochemistry were performed in 46 patients. In 6 of 18 patients (33.3%) with negative nodes at conventional hematoxylin-eosin examination, immunohistochemistry demonstrated micrometastases in the lesser curve, paracardial, peripancreatic, or lower mediastinal nodes. Early diagnosis remains the prerequisite for curative treatment of adenocarcinoma of the esophagus and cardia. When a curative resection is attempted, extended lymphadenectomy improves tumor staging and may prevent local recurrences. Serial sections and immunohistochemistry provide additional accuracy in the staging of the disease and may prove useful to select patients for adjuvant therapy.

Adenocarcinoma↗
PubMed2000

Heredity and risk of cancer of the esophagus and gastric cardia.

The importance of genetic factors in the etiology of esophageal cancer is uncertain. We addressed the question of heredity in a population-based, nationwide case-control study conducted in Sweden during 1995 through 1997. The study involved 189 patients with esophageal adenocarcinoma, 262 with cardia adenocarcinoma, 167 with esophageal squamous cell carcinoma, and, for comparison, 820 control subjects. Familial occurrence of cancer was explored at face-to-face interviews. Logistic regression, with multivariate adjustment for potential confounders, was used to calculate odds ratios (ORs), which estimated relative risk. Occurrence of esophageal cancer among first-degree relatives did not increase the risk of adenocarcinoma or squamous cell carcinoma of the esophagus. Neither were there any significant associations with familial occurrence of gastric cancer or other gastrointestinal tumors. The risk of cardia adenocarcinoma was moderately increased among persons with first-degree relatives with gastric cancer (OR, 1.6; 95% confidence interval, 1.0-2.6). Familial occurrence of any cancer was not associated with increased risks of any of the three studied tumors. In conclusion, heredity does not seem to contribute importantly to the occurrence of esophageal cancer of any histological type. A weak association between familial gastric cancer and the risk of cardia cancer may represent a genetic link.

Adenocarcinoma↗
PubMed2000

Antioxidants and cancers of the esophagus and gastric cardia.

Antioxidant vitamins have attracted considerable attention in previous studies of esophageal squamous-cell carcinoma, but dietary studies of adenocarcinoma of the esophagus and gastric cardia remain sparse. Treating these tumors as distinct diseases, we studied intakes of vitamin C, beta-carotene and alpha-tocopherol in a nationwide population-based case-control study in Sweden, with 185, 165, and 258 cases of esophageal adenocarcinoma, esophageal squamous-cell carcinoma, and gastric cardia adenocarcinoma, respectively, and 815 controls. Subjects with a high parallel intake of vitamin C, beta-carotene, and alpha-tocopherol showed a 40-50% decreased risk of both histological types of esophageal cancer compared with subjects with a low parallel intake. Antioxidant intake was not associated with the risk of gastric cardia adenocarcinoma. Separately, vitamin C and beta-carotene reduced the risk of esophageal cancers more than alpha-tocopherol. We found that antioxidant intake is associated with similar risk reductions for both main histological types of esophageal cancer. Our findings indicate that antioxidants do not explain the diverging incidence rates of the 2 histological types of esophageal cancer. Moreover, our data suggest that inverse associations with esophageal squamous-cell carcinoma and adenocarcinoma may be stronger among subjects under presumed higher oxidative stress due to smoking or gastroesophageal reflux, respectively. Our results may be relevant for the implementation of focused, cost-effective preventive measures.

Adenocarcinoma↗
PubMed1999

[Analysis of patients survived over ten years after resection of gastric cardia carcinoma].

OBJECTIVE: To investigate factors affecting long-term survival in patients with resected gastric cardia cancer. METHODS: Survival was analyzed retrospectively in 584 patients with gastric cardia carcinoma who received tumor resection from 1964 through 1982. RESULTS: The 10-year survival rate was 17.1%. The major factors influencing survival were clinical staging, degree of differentiation, gross tumor type and size (P < 0.05) and status of lymph node metatasis (P < 0.01). Residual tumor at resection edge and tumor thrombi did not significantly affect survival, nor did sex/age, and course of the disease. CONCLUSION: Early detection, early diagnosis and early surgical resection are the key to improve 10-year survival of patients with resected cancer of the gastric cardia. Why residual tumor left at the resection edge and the presence of tumor thrombi do not influence survival needs to be further studied.

Adult↗
PubMed2000

[Long-term therapeutic effects of extended radical resection and radical resection of cancer of cardia and stomach fundus].

OBJECTIVE: To study the best range of radical resection in the treatment of cancer of the cardia and fundus of stomach. METHODS: 418 patients with cancer of the cardia and fundus of stomach underwent radical resection. Of them 192 were treated by extended radical resection (extended group), and 226 by radical resection (radical group). The 5-year and 10-year survival rates were followed up and compared in the two groups. RESULTS: Analysis failed to demonstrate significant difference between the two operations for TNM stage I and II (P > 0.05). For stage III, however, the 5-year and 10-year survival rates in the extended group increased by 14.2% and 15.9% as compared with those in the radical group (P < 0.05). The two groups survival rates were similar for stage IV (P > 0.05). CONCLUSIONS: To completely clean the lymph nodes of splenic hilus and artery and improve long-term survival rate, extended radical resection including spleen and body and tail of the pancreas should be recommended for stage III patients with cancer of the cardia and fundus of stomach when their serosa was involved or lymph node metastasis took place.

Cardia↗
PubMedDate not supplied

Involvement of cancer-activating genes on chromosomes 7 and 8 in esophageal (Barrett's) and gastric cardia adenocarcinoma.

UNLABELLED: The incidence of adenocarcinomas of the distal esophagus (Barrett's esophagus) and proximal stomach (gastric cardia) has increased rapidly over the past decades. In contrast to this dramatic increase, genetic knowledge is sparse. MATERIALS AND METHODS: We investigated genomic amplification on chromosomes 7 and 8 by comparative genomic hybridization (CGH) and protein expression of relevant oncogenes (EGFR, HGF, MET, CTSB, MYC) by immunohistochemistry (IHC) in 22 esophageal and 22 gastric cardia carcinomas. RESULTS: The CGH and IHC patterns were very similar for the two cancer locations. IHC showed positive immunostaining in 93% of the adenocarcinomas for at least one of the investigated genes, whereas CGH disclosed genomic gains on chromosome 7 and/or 8 in 80%. CONCLUSION: Cancer-activating genes on chromosomes 7 and 8 are frequently involved in gastro-esophageal junction adenocarcinomas. Moreover, the similarities in chromosomal changes and protein expression patterns strongly suggest that esophageal and gastric cardia adenocarcinomas have a shared etiology. This is in agreement with studies addressing gastroesophageal reflux disease and intestinal metaplasia at these locations.

Adenocarcinoma↗
PubMed2002

[Surgical treatment of benign ulcer of the gastric cardia: an experience from 21 cases].

OBJECTIVE: To study the result of surgical treatment of benign ulcer of the gastric cardia. METHODS: Clinical symptom, number, position and size of ulcer, preoperative X-ray gastroscopic examine, type and complication of operation were retrospective analyzed in 21 patients with benign ulcer of the gastric cardia. RESULTS: Average age in 21 patients was 60. Ulcer complicated bleeding in 7 cases (33.3%) and perforation in 5 cases (23.8%). Diagnostic rate of preoperative X-ray and gastroscopic examine was 57.1% and 100%, respectively. Of 21 patients 18 (85.7%) were treated by upper partial gastrectomy, and 3 (14.3%) by total gastrectomy. All were not operative death and anastomotic leak. CONCLUSIONS: upper partial gastrectomy can resect focus of ulcer and decrease secretion of stomach acid. It is a simple and ideal pattern of operation for patients with benign ulcer of the gastric cardia.

Adult↗
PubMed2002

Transhiatal surgical resection for adenocarcinoma of the cardia.

Aim of this study is to define feasibility and effectiveness of the transhiatal esophagogastric resection in cardia adenocarcinoma. From 1981 to 2001, we submitted to surgery 85 patients affected by cardia adenocarcinoma. Since 1994, 34 patients, in consideration of clinical, anatomosurgical (Siewert II-III) and pathologic (T1-3, cN mediastinal negative) findings, underwent transhiatal esophagogastric resection according to Pinotti's technique. This consisted in the midline opening of the central tendon of the diaphragm, ligature and section of the left inferior phrenic vessels, exposure and anterior retraction of the pericardium. The approach allowed in all cases a satisfactory esophageal mobilization and a good dissection of the inferior mediastinal structures avoiding thoracotomy. Postoperative complications were observed in 8 patients (24%). In 4 cases the complications were medical (11.8%) and in 4 cases surgical (11.8%). Death occurred in 4 cases (11.8%): in 3 patients (8.8%) for local complications (2 anastomotic leaks and 1 hemorrage) and in 1 (2.9%) for cardiac failure. The 26 non complicated cases had an uneventful postoperative course and were discharged 12 days after surgery. Middle and long term results were evaluated in terms of locoregional recurrence rate and actuarial survival. At 1 and 2 years locoregional recurrence occurred in 8.8% and 11.8% of cases respectively. Five-year overall survival was 22.5%. In selected cases (Siewert type II-III, T1-3 tumors with clinically negative mediastinal lymphnodes) the procedure in study appears technically feasible, it provides a satisfactory volume of esophageal exeresis and an adequate extension of mediastinal lymphadenectomy, representing a safe and effective alternative to thoracotomy in cardia cancer surgery.

Adenocarcinoma↗
PubMed2002

Adenocarcinoma of the gastric cardia: treatment via a left thoracoabdominal approach.

We examined the outcome of adenocarcinomas of the gastric cardia treated by total or proximal gastrectomy, lower esophagectomy, and D2 lymphadenectomy via a left thoracoabdominal approach. We compare these results with those of other methods as well as review the literature. During a 10-year period (1991-2000) 180 patients with primary gastric cancer were admitted to our department. Thirty-six of the patients had adenocarcinoma of the cardia. Twenty-four patients underwent total gastrectomy, D2 lymphadenectomy, and esophagectomy, and four others underwent proximal gastrectomy and esophagectomy with esophagogastric anastomosis via a left thoracoabdominal approach. These latter 28 patients compose our study group. We had no operative mortality, the morbidity varied, and the quality of life and the loss of body weight ranged within satisfactory levels, but the survival rate was rather poor. The median survival time was 19 +/- 1.2 months. Survival was significantly longer in patients with less than 40 per cent positive resected lymph nodes (P = 0.035). From the resulting data and our experience we believe that the left thoracoabdominal approach gives excellent exposure for radical resection of cancer of the gastric cardia and should be the procedure of choice for curative resection of such tumors. This approach combined with total gastrectomy and D2 lymphadenectomy can be performed with an acceptably low mortality rate; it provides good palliation but not encouraging survival rates. Although it is less radical proximal gastrectomy gives the same results and a better quality of life but may be performed only in the early stages of the disease.

Adenocarcinoma↗
PubMed2002

[Goseki classification in adenocarcinoma of the cardia].

BACKGROUND: To assess an additional prognostic value of Goseki histological classification to TNM staging system in adenocarcinoma of the cardia. METHODS: Sixty-one patients curatively resected for advanced (T2, T3 and T4) cardia cancer at the I Division of General Surgery, University of Verona were classified in four different grades according to Goseki. Survival curves were estimated with Kaplan-Meier method and compared by the log-rank test. Multivariate analysis was performed by Cox regression model. c2 test was used to compare Goseki to Lauren classification and grading. After discharge from hospital all patients were followed with a mean follow-up of 39.5 months. RESULTS: Lauren classification and grading were significantly related to tubular differentiation (p<0.01). Kaplan-Meier estimates of survival showed a better 5-year outcome for tumors with good tubular differentiation (19%), even though the difference with poor tubular differentiated tumors was not statistically significant (p'0.06). Diffuse type carcinomas and tumors with poor cytological differentiation showed a worse prognosis at univariate analysis (p<0.01). Multivariate analysis showed no additional prognostic significance of any of the histological classification analyzed. Only T (p<0.02; RR 2.2; IC 1.2-4) and N (p<0.01; RR 5; IC 2.4-11) were independent prognostic factors. CONCLUSIONS: In adenocarcinoma of the cardia, Goseki classification did not add any information to Lauren classification and to TNM staging system.

Adenocarcinoma↗
PubMedDate not supplied

[Our experience with the use of a plastic prosthesis and self-expanding stents in the palliative treatment of malignant neoplastic stenoses of the esophagus and cardia. Comparative analysis of results].

Rapid palliation of malignant dysphagia is usually possible by means of the endoscopic implantation of a plastic prosthesis, but this device has a high morbidity rate. Recently, expandable metal stents have become available and may reduce the morbidity and mortality rates. The aim of this retrospective study was to evaluate self-expanding metal stents compared with conventional plastic prosthesis in malignant strictures of the oesophagus and cardia. One hundred and thirteen endoscopic tube implantations were carried out in 120 patients with malignant stenosis of the oesophagus and cardia using a plastic prosthesis over the period 1980-1993 (72 cases) and self-expanding metal stents over the period 1993-2001 (48 cases). The underlying causes of strictures were oesophageal or cardial cancer in 108 cases and oesophageal invasion by lung cancer in 12. The indications for endoscopic intubation were advanced tumour stage and/or risk factors which made resection inadvisable. The stents used in the conventional group were the Celestin pulsion tube in 18, the Atkinson prosthesis in 23 and the Wilson-Cook tube in 27, while the Ultraflex stent was always employed in the other group. Dysphagia was scored according to the Atkinson and Ferguson classification and the preoperative median score (3.6) was comparable in the two groups. The technical success rate was 94.4% with the plastic prosthesis (68/72) and 93.7% with the self-expanding metal stents (45/48) because in 4 and 3 patients, respectively, it proved impossible to implant the stent. After intubation the dysphagia score was improved in both groups (median score = 0.9) and the functional success rates were 85.2% (58/68) and 88.8% (40/45), respectively, while 10 and 5 patients showed no improvement of symptoms. The early complication rate was 5.9% (4/68) in the conventional stent group (1 perforation, 2 severe bleedings and 1 stent proximal migration) and nil in the other group. Late complications occurred in 14 (20.6%) (7 food obstruction, 4 neoplastic obstructions and 3 dislodgements) and 9 patients (20%) (3 neoplastic obstructions, 1 food obstruction, 3 distal migrations and 2 bleedings), respectively, but all the complications were easily corrected. Three deaths occurred with the plastic prosthesis (4.4%), while the mortality was nil with the metal stents. The median survival times were 183 (range: 58-486) and 151 days (range; 25-545), respectively. Our experience suggests that endoscopic placement of self-expanding metal stents is effective and safe for the management of dysphagia in malignant strictures of the oesophagus and cardia and has to be preferred to conventional plastic prostheses for easier implantation. The technical and functional success rates are similar in both groups, but the acute complication and mortality rates of the Ultraflex prosthesis are lower as compared to the traditional prosthesis.

Adult↗
PubMed2002

Adrenal insufficiency combined with gastric cardia ulcer due to herpes simplex virus type 1 infection.

Adrenal insufficiency combined with gastric ulcer due to herpes simplex virus (HSV) infection is a very unusual condition. A 75-year-old woman suffered from a 4-day history of poor appetite, constipation, dysuria, severe headache, generalized pain and malaise. Hyponatremia was noted. Escherichia coli infection was identified from urine culture. Poor pituitary-adrenal axis response to hyponatremia and infection, as well as a history of intermittent treatment with steroids, led to a diagnosis of iatrogenic tertiary adrenal insufficiency. During hospitalization, the patient passed tarry stools. In addition to an antral ulcer, panendoscopy revealed an ulcer in the gastric cardia with a clean base and irregular margins. Biopsy of the cardia demonstrated multinucleated giant cells in the stratified squamous epithelium. Polymerase chain reaction studies confirmed HSV type 1 infection. In patients suffering from gastric cardia ulcer, the possibility of herpes infection must be considered, especially when complicated by steroid treatment or misuse. Because herpes infection in the squamous epithelium is self-limiting, practitioners should be aware of it, so that overtreatment can be avoided.

Adrenal Insufficiency↗
PubMed2003

[Therapeutic effects of operation in tumor invades adjacent structures cancer of cardia and stomach fundus].

OBJECTIVE: To study the best style of operation in the treatment of tumor invades adjacent structures (T(4)) cancer of the cardia and stomach fundus. METHODS: Two hundred and one patients with T(4) cancer of the cardia and stomach fundus underwent operation. Of them, 31 were treated by laparotomy, and 170 by combined resection of the involved organs. The 3- and 5-year survival rates and the postoperative complication rate and mortality rate were analyzed in the patients who had under gone combined resection of the involved organs. RESULTS: The median survival of the patients undergoing combined resection of the involved organs (29.3 months) was significantly longer than that of those receiving laparotomy (4.9 months). The 3- and 5-year survival rates of 170 patients who had under gone combined resection of the involved organs were 46.2% and 22.8%, respectively. The 3- and 5-year survival rates of patients undergoing total gastrectomy and proximal gastrectomy were 54.9% and 29.2% and 32.2% and 12.5%, respectively, and the difference was statistically significant (chi(2) = 7.589, P < 0.01;chi(2) = 5.792, P < 0.05).The postoperative mortality rate and complication rate were 4.1% and 24.1%, respectively. CONCLUSIONS: The patients without liver metastasis, widespread nodal involvement, peritoneal dissemination and local focus allowed by an en bloc combined resection in T(4) cancer of cardia and stomach fundus should undergo gastrectomy with a combined resection of the involved organs. Total gastrectomy should be performed to improve the curative effect.

Adult↗