Surgical treatment of adenocarcinoma of esophagus and gastric cardia

Objective: To evaluate the role of surgery in the management of adenocarcinoma of esophagus and gastric cardia. Methods: The surgically treated patients with adenocarcinoma of esophagus and gastric cardia were included and retrospectively studied.Multivariate analysis of the SPSS software was used to identify the influencing factors.Results: There were twentytwo esophageal cancer (M∶F =3.5∶1，middle third 6，lower third 16) and eighty-six cancer of gastric cardia (M∶F =4.6∶1).The clinical stage of esophageal tumor were Ⅱ 15.4%，Ⅲ 76.9%，Ⅳ 7.7%；carcinoma of gastric cardia were: Ⅰ 2.9%， Ⅱ 7.1%，Ⅲ 74.3%，Ⅳ1 5.7%.Thirty patients had curative resection.The negative margin could be likely obtained if upper resection margin was grossly longer than 2.8cm and lower margin longer than 4.8cm (P＜0.05).The overall median survival was 3.75 months for esophageal cancer and 9.36months for carcinoma of gastric cardia.The early staged patients had significantly better survival，64months for stage Ⅰ and Ⅱ，13.7 and 7.1months for stage Ⅲ and Ⅳ (P＜0.01).Curative resection could also improve the total median survival to 26.1months in contrast with 7.1months in palliative resection (P＜ 0.05).When the number of lymph nodes metastases was more than 6，or the percentage of positive lymph nodes was greater than 65.6%，the median survival became significantly reduced (P=0.013，P=0.005).Conclusion: Surgery could only significantly improve the survival for early staged patients where curative resection could be achieved.