[Surgical treatment of locally advanced esophago-gastric cancer; preliminary results].
The aim of this paper is to sustain the palliative resection in neoplasm of the esophago-gastric junction, as a surgical approach that allows a better post-operative life comfort in comparison with simple gastrostomy. 62 observations with proximal neoplasm of the stomach (12.5%) were identified between January 1996-August 2001, representing 12.5% of the 496 patients with gastric neoplasm admitted in our unit in the same period. Out of these 62 cases, 55 (88.71%) underwent surgical procedures. Our attitude was aggressive in 25 cases. 40.32%, including the locally advanced lesions with palliative surgical indications (18 obs.). The other 30 patients underwent: 10 laparotomies, 5 gastrostomies and 15 jejunostomies. Local invasion to the neighboring organs imposed partial resection of the transverse colon--1 obs., of the transverse mesocolon--2 obs., and corporeo-caudal pancreatectomies--3 obs. The surgical approach was a left abdomino-thoracic incision, with total gastrectomy and distal esophagectomy, with N1 and N2 lymphadenectomy, splenectomy, and esojejunal intrathoracic anastomosis, with a Roux-en-Y loop, with or without jejunostomy (13 obs.). The immediate post-operative complications were 8 anastomotic leakage, one duodenal stump fistula, one occlusion due to a jejunostoma, and 13 extradigestive complications. There were 5 post-operative deaths.


CONCLUSIONS
Neoplasm of the esophago-gastric junction is lately diagnosed, but whenever is possible, total gastrectomy with distal esophagectomy should be carried out.
Clinica a III-a Chirurgicală, UMF Gr. T. Popa, Isşi Str. Independenţei nr. 1 Iaşi.
C
C
Diaconu
C
C
Dogaru
V
V
Scripcariu
Camelia
C
Chifu
C
C
Iftime
Cr
C
Dragomir
D000230:Adenocarcinoma / Q000601:surgery*; D000713:Anastomosis, Roux-en-Y; D004938:Esophageal Neoplasms / Q000601:surgery*; D004943:Esophagogastric Junction / Q000601:surgery*; D006801:Humans; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome