Antrum Versus Gastric Tube after Partial Esophagogastrectomy for Adenocarcinoma of Gastric Cardia

Abstract

The basic rule in surgical oncology is to free margins from the primary tumor and resect the lymph nodes, which is usually split into three levels. For most tumors, there is evidence that unsafe margins worsen the prognosis, whereas for a few tumors there is evidence that extended lymphonodectomy (resection of all the three lymphonodal levels) improves survival. The main surgicopathological feature of adenocarcinoma of the gastric cardia (high incidence of lymphonodal metastases) has pushed surgeons more towards complete resection of regional nodes than to safe resection of the primary tumor. The dilemma of partial gastrectomy vs extended total gastrectomy is the dilemma of one level vs three level lymphonodectomy without concern for the primary tumor free margins. Most of the data comparing proximal vs total gastrectomy for adenocarcinoma of the cardia show that incidence of positive esophageal margins is more than 20% (Giuli 1980; Pa-pachristou and Fortner 1980). In one series (Papachristou and Fortner 1980) it was 43% after proximal gastrectomy and 26% after extended total gastrectomy. The best survival for Tl-3 N0–1 tumors after extended total gastrectomy has been attributed by Papachristou and Fortner (1980) to lymphonodectomy of 2–3 levels free of tumors rather than to safer esophageal margins. In retrospective studies the division between N1 and N2 may be inaccurate, as although most pathologists differentiate perigastric lymph nodes from all others, they do not usually indicate the proximity to the primary tumors (Douglas 1982).