[Cancer of the cardia. Prognostic factors and treatment].
Pronostic of carcinoma of the esogastric junction is worsened by the potential two-way route of spread in case of lymph node metastasis: mediastinum and abdomen. During the last 10 years the authors observed 71 cases of adenocarcinoma of the gastric cardia, including 7 cases of linitis plastica. Histopathologic and clinical follow-up data are presented. The aims of the study were to evaluate prognostic factors and to define the best surgical treatment. There were mainly elderly patients with a poor physical status. Ten patients did not undergo surgery (14%). Among 57 patients undergoing radial resection (80.3%), total gastrectomy and upper polar esogastrectomy were performed in respectively 29 and 28 cases. The carcinomas were truly located to the gastric cardia in only 37 cases (65%). Operative mortality was 12.3%, not depending of the surgical technique. All patients five-year survival rate was 10.2%, improving to 15% in case of curative resection. The value of lymph node metastasis (80.7% of the patients) as a prognostic factor depended of the proximal or distal localization of the nodes. A positive surgical margin (15.7% of the patients) was a poor prognostic factor with a 6.9 months mean survival. The authors conclude that an aggressive surgical approach is worthwhile, because of the carcinoma invasion (nodes, margin), but not always possible (poor physical status).
Clinique chirurgicale I, CHR de Nantes.
J
J
Visset
J P
JP
Couderc
E
E
Letessier
A
A
Hamy
J
J
Paineau
D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D002299:Cardia / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D016609:Neoplasms, Second Primary / Q000150:complications / Q000175:diagnosis; D011379:Prognosis; D012737:Sex Factors; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate
Le cancer du cardia. Facteurs pronostiques, traitement.