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J Thorac Cardiovasc Surg 1997;114:544-551
© 1997 Mosby, Inc.

GENERAL THORACIC SURGERY

CLINICAL EXPERIENCE IN RADICAL LYMPHADENECTOMY FOR ADENOCARCINOMA OF THE GASTRIC CARDIA

Received for publication July 9, 1996 revisions requested Nov. 18, 1996; revisions received May 6, 1997 accepted for publication May 22, 1997. Address for reprints: Chung-Ping Hsu, MD, Division of Thoracic Surgery, Department of Surgery, Taichung Veterans General Hospital, #160, Sec 3, Taichung-Kang Rd., Taichung, Taiwan, Republic of China.

Abstract

Objectives: We evaluated the pattern of nodal metastasis and its prognosis after radical lymphadenectomy in adenocarcinoma of the gastric cardia. Methods: We conducted a retrospective cohort study of 70 patients (52 men and 18 women; mean age 63.6 years) with adenocarcinomas of the gastric cardia who underwent extended gastrectomy (65 total gastrectomies and 5 proximal gastrectomies) and radical lymphadenectomy (D2 to D4) at Taichung Veterans General Hospital between 1989 and 1995. Results: Twenty-four complications developed in 22 (31.4%) patients, and seven (10.0%) hospital deaths occurred. An overall 5-year cumulative survival of 37.6% was obtained. Lymph node metastases were identified in 53 (75.7%) patients. Nodal involvement was closely related to the depth of tumor invasion ( p = 0.005). When the gastric wall invasion was limited to the subserosal layer (T1 and T2, n = 15), no patient had N4 group nodal metastasis. Once the serosal layer had been involved (beyond T3), N4 group nodal metastasis was frequently seen (30.9%, 17 of 55 patients). A multivariable analysis revealed that the level of nodal involvement, the depth of tumor invasion, and the presence of complications were independent prognostic factors. Cumulative 5-year survivals of curability A ( n = 12), B ( n = 19), and C ( n = 32) resections were 100%, 21.2%, and 27.5%, respectively ( p = 0.0001). The long-term survival of the patients after resection was also closely related to their pTNM stages ( p = 0.0004). Conclusions: We conclude that gastrectomy accompanied by radical lymphadenectomy provides a reasonable long-term survival expectancy that is closely related to the stage of the disease and the curability of resection.

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