Adenocarcinoma of the gastric cardia. The choice of gastrectomy.

A retrospective study of 101 patients with adenocarcinoma of the gastric cardia treated with proximal subtotal, extended proximal subtotal, total, and extended total gastrectomy demonstrated the following: 1) There were no five year survivors among patients with TNM stage III and IV disease. 2) Surgical treatment was curative only in the presence of stage I and II disease, where extended total gastrectomy resulted in a significantly higher survival rate than proximal subtotal gastrectomy (p less than 0.03). 3) Proximal subtotal gastrectomy resulted in a high incidence of local recurrence, particularly when it was applied in patients with stage I and II neoplasms. 4) There were no significant differences in operative mortality between the four procedures. Since the choice of operative procedure makes a difference only in patients with TNM stage I and II disease, intraoperative classification should be considered in the management of adenocarcinoma of the cardia. Classification should be based on lymph node biopsy unless the neoplasm has spread beyond the confines of gastrectomy.