Study Of Surgical Manner Selection Of Adenocarcinoma Of Cardia

Recent years, the incidence rate of adenocarcinoma of the distal esophagus,esophagogastric junction and cardia was increasing prominently, whereas that of distal stomach was decreasing steadily. This made this kind of carcinoma received more and more attention as a special disease. Surgical management is the only treatment possible to cure, but its results is not satisfactory by now. There are many aspects included in the management manner of adenocarcinoma of cardia, such as: the selection of apporach, the extent of resection of esophagus and stomach, combining viscera resection, the extent of lymph disection and the manner of reconstruction, these aspects has influence on the result of surgical management of cardia more or less. This research randomly sample 217 cases of resectable adenocarcinoma of cardia which have complete follow-up treated in tianjin cancer hospital from 1983 to 1998, and discuss the reasonable manner of surgical treatment of adenocarcinoma of cardia after retrospective study the relationship of the surgical manner, the clinical and pathology characters and the survival rate after resection. The calculation of survival rate is by life-table method. The statistical management is by t-test,one-way ANOVA, SNK-q test, chi-square test and log-rank test. The results suggested that: the approaches of transabdominal, trafisthoracic and transabdomino-thoracic has their own merit and deficiency, the surgery apporach alone is not the independented factor of prognosis. To avoid the positive proximal margins, the esophagus should be resected 7cm or more above the primary. Total gastrectomy is very important for disection of lymph node NO5,6. The survival rate of proximal gastrectomy is higher than that of total gastrectomy in all patients ' and every stage. The invasion of pancreas is not common and cannot be recognized exactly by naked eyes; and metastasis to spleen is rare(l%); pancreas and spleen combined resection is helpful to the disection of lymph nodes NO10,11 and maybe helpful to patients of stage III, but to patients of stage IV it sanies not nessersory. The lymph metastasis of adenocarcinoma of cardia is mainly to abdominal lymph nodes; its fashion is station by station and combined with skipping over station. The survival rate of D2 maybe higher than D1 in stage III, but D2 isnot necessary for stage IV. The extent of resection should be more extensive for stage III whereas more limit for stage IV. To improve the survival rate after surgery, resection rank A should be taken to the best of surgeon's abilities, to avoid tumor remains and assure wide esophagectomy.