Surgical treatment of gastric cancer invading the oesophagus.
BACKGROUND
There is controversy regarding which type of surgical treatment is most appropriate for upper gastric cancer invading the oesophagus.


METHODS
A review of the pertinent literature was carried out regarding oesophageal 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 plastica, pT3-pT4, diffuse type by Lauren, N+ or tumours exceeding 5 cm in diameter. Lymphatic tumour spread was caudad (coeliac nodes, hepatoduodenal nodes, paraortic nodes) but mediastinal nodes were also involved if tumour growth in the oesophagus 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. Mediastinal dissection through thoracotomy did not provide any benefit.


CONCLUSIONS
A rational approach involves total gastrectomy plus partial oesophagectomy. Abdominal transhiatal resection may be performed in the case of a localized, non-infiltrating tumour and oesophageal involvement <2 cm. However, infiltrating, poorly differentiated or Borrmann III-IV tumours require a right thoracotomy to achieve a longer margin of clearance. When oesophageal involvement is >3 cm, or hepatoduodenal or mediastinal nodes are positive, no surgical procedure is curative and the literature demonstrates that extended aggressive surgery has no benefits.
Bozzetti
F
F
Unit of Surgical Oncology of the Digestive Tract, National Cancer Institute, Via Venezian, Milan, 1,20133, Italy. dottfb@tin.it
Bignami
P
P
Bertario
L
L
Fissi
S
S
Eboli
M
M
D004938:Esophageal Neoplasms / Q000556:secondary* / Q000601:surgery*; D005743:Gastrectomy / Q000379:methods; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D016019:Survival Analysis