[Proximal gastrectomy for adenocarcinoma of the gastroesophageal junction in a selected set of patients immediate and long-term results].
BACKGROUND
The authors present the results of surgical resection in the form of proximal gastrectomy in a selected set of patients with adenocarcinoma of the gastroesophageal junction. The selection criteria included: ASA III-IV, internal comorbidities and elderly patients.


METHODS
Between 2007 and 2015, 28 patients with adenocarcinoma of the gastroesophageal junction underwent proximal gastrectomy at the 1st Department of Surgery. The patient set consisted of 19 (67.8%) men and 9 (32.3%) women aged 5289 years with the median age of 72.5 years. Endoscopic examination revealed a tumour of the gastroesophageal junction, which was evaluated according to the Siewert classification: type I was present in 4 (16.7%) cases, type II in 12 (42.3%), and type III in 12 (42.3%). Histological analysis revealed adenocarcinoma in all cases. Proximal gastrectomy with lymphadenectomy was performed in all patients. Splenectomy was performed in eleven patients. The continuity of the gastrointestinal tract was ensured by esophagogastroanastomosis, and pyloromyotomy was performed as a standard procedure. Cryostatic examination revealed positive resection margins in the esophagus in five patients, which led to the resection of the distal esophagus from the right-sided thoracotomy.


RESULTS
Injury to the biliary tract was observed in one case in the perioperative period, which was treated by hepaticojejunoanastomosis onto an excluded jejunal loop. The following complications were observed postoperatively: bleeding, respiratory complications, anastomotic dehiscence, laparotomy wound dehiscence, and inflammatory infiltration in the abdominal cavity. Thirty-day mortality was 10.7% in our patient set.


CONCLUSIONS
Proximal gastrectomy with lymphadenectomy is an appropriate alternative for polymorbid patients with adenocarcinoma of the gastroesophageal junction and provides good short- and long-term results.Key words: cancer of gastroesophageal junction proximal gastrectomy complications of therapy.
R
R
Vrba
R
R
Aujeský
Č
Č
Neoral
M
M
Stašek
M
M
Loveček
J
J
Tesaříková
K
K
Vomáčková
M
M
Horáková
J
J
Zapletalová
D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D001659:Biliary Tract / Q000293:injuries; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects / Q000379:methods; D004943:Esophagogastric Junction / Q000601:surgery*; D005260:Female; D005629:Frozen Sections; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D008297:Male; D000072662:Margins of Excision; D008875:Middle Aged; D009026:Mortality; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D019106:Postoperative Hemorrhage / Q000453:epidemiology; D011708:Pylorus / Q000601:surgery; D013156:Splenectomy / Q000379:methods; D013274:Stomach Neoplasms / Q000601:surgery*; D013529:Surgical Wound Dehiscence / Q000453:epidemiology