[Surgical treatment and prognosis analysis for patients with gastric cancer infiltrating esophagus].
OBJECTIVE
To investigate the reasonable operative approaches,rang e of lymph node dissection and prognostic factors for patients with gastric cancer infiltrating esophagus.


METHODS
Six hundred and ninety-three patients were treated surgically for gastric cancer from August 1994 to February 2004. Clinica l data of 63 cases with esophagus invasion were reviewed retrospectively. The range of lymph node metastasis rounding stomach and lymph node metastasis rates were analyzed. The survival rate was compared between the patients with operation performed through upper abdomen median incision and the patients through combined left thoracotomy and abdomen incision. Different factors influencing survival rates were analyzed.


RESULTS
Radical resection rate was 85.7%, combined viscera excision was performed in 25 cases (39.7%). The overall rate of lymph node metastasis was 73.0%, and lymph node metastasis rate involving abdominal cavity and thoracic cavity was 73.0% and 12.7% respectively. Upper abdomen median incision was applied in 35 cases with 18% of 5-year survival rate, while combined left thoracotomy and abdomen incision was performed in 28 cases with 38% of 5-year survival rate. There was a significant difference in 5-year survival rate between the two groups (P< 0.05). The survival rate was 16% in combined viscera excision group. Logistic analysis revealed that age, histologic type, tumor diameter, Borrmann type, lymph node metastasis, lymph node metastasis involving thoracic cavity and operative approach were important factors influencing postoperative survival rate.


CONCLUSIONS
Radical resection of gastric cancer infiltrating esophagus ought to include dissection of upper abdominal cavity, lower thoracic cavity and para-midkiff lymph nodes. Combined left thoracotomy and abdomen incision may improve the efficacy of radical resection and postoperative 5-year survival rate for patients with gastric cancer infiltrating oesophagus.
Han
Fang-hai
FH
Department of Gastrointestinopancreatic Surgery, Sun Yat-sen University, Guangzhou 510080, China.
Zhan
Wen-hua
WH
He
Yu-long
YL
Li
Yu-ming
YM
Zheng
Zhang-qing
ZQ
Peng
Jun-sheng
JS
Cai
Shi-rong
SR
Ma
Jin-ping
JP
D034841:Abdominal Cavity / Q000473:pathology; D000368:Aged; D004947:Esophagus / Q000473:pathology*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D015996:Survival Rate