Survival of proximal third gastric carcinoma.

BACKGROUND AND

OBJECTIVES

Proximal third gastric carcinoma is a distinct clinical entity compared with tumors located in other parts of the stomach with a rapid increasing incidence and a poor prognosis. This study was done to evaluate therapy for, and survival of, patients with gastric cardia carcinoma.

METHODS

Clinical features and prognosis of 49 patients with proximal third gastric carcinoma between 1985 and 1995 (mean age 69.7 years) were evaluated.

RESULTS

In 20 of the 49 patients, laparotomy was excluded because of widespread disease and/or poor clinical condition at presentation. Palliative therapy consisted of gastric tube implantation (n = 4), dilation (n = 3), or radiotherapy (n = 4). In 9 patients, no specific palliative therapy was indicated. Twenty-nine patients underwent laparotomy (59%). In 13 patients, a total gastrectomy with esophagojejunostomy was performed, and in 7 patients a partial gastrectomy was performed. In 9 cases, the tumor was irresectable. In 8 of these 9 patients, a Celestin tube was implanted. Median survival in all patients was 7 months and the expected probability of survival after 50 months was zero. The median survival of patients who underwent a resection was significantly better than in those in whom no resection was performed (23 vs. 4 months, P = 0.047).

CONCLUSIONS

We conclude that long-term survival of patients with proximal third gastric carcinoma is poor. However, long-term survival may be best warranted when patients present at an early stage and resection can be performed.