Clinicopathologic features of gastric cancer infiltrating the lower esophagus

A total of 211 patients with gastric cancer in the upper third of the stomach were clinicopathologically evaluated. Of the 211 patients, 82 had esophageal infiltration and 129 did not. These two groups were compared. The study on patients who had undergone resection and radioisotope (99mTc‐phytate)...

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Bibliographic Details
Published in:World journal of surgery 1994-05, Vol.18 (3), p.428-432
Main Authors: Takeshita, Kimiya, Ashikawa, Toshihisa, Tani, Masao, Saito, Naoya, Maruyama, Michio, Sunagawa, Masakatsu, Habu, Hiroshi, Endo, Mitsuo
Format: Article
Language:English
Subjects:
Carcinoma - diagnostic imaging
Carcinoma - pathology
Carcinoma - surgery
Esophageal Neoplasms - diagnostic imaging
Esophageal Neoplasms - pathology
Esophageal Neoplasms - surgery
Female
Gastric Cancer
Humans
Lower Esophagus
Lymph Node Excision
Lymph Nodes - diagnostic imaging
Lymphatic Metastasis - diagnostic imaging
Lymphatic Metastasis - pathology
Male
Neoplasm Invasiveness
Nous Avons
Organotechnetium Compounds
Phytic Acid
Radionuclide Imaging
Residual Cancer
Stomach Neoplasms - diagnostic imaging
Stomach Neoplasms - pathology
Stomach Neoplasms - surgery
Total Gastrectomy
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Summary:A total of 211 patients with gastric cancer in the upper third of the stomach were clinicopathologically evaluated. Of the 211 patients, 82 had esophageal infiltration and 129 did not. These two groups were compared. The study on patients who had undergone resection and radioisotope (99mTc‐phytate) uptake testing revealed that it was important to dissect the lymph nodes (predominantly nodes 7,9,11, and 16) during surgery in the patients with gastric cancer plus esophageal infiltration. When cancer infiltration of the esophagus exceeds 1 cm, the preferred surgical procedure is lower esophagectomy and total gastrectomy with abdominal and intrathoracic lymphadenectomy via the left thoracoabdominal approach. When residual cancer is suggested in the more proximal esophageal stump due to intramural metastasis from vascular invasion, rapid pathologic diagnosis should be made by frozen sections during surgery and then subtotal esophagectomy by blunt removal of the esophagus proximally from the aortic arch using a left thoracotomy considered. Résumé Dans une population de patients ayant un cancer du tiers proximal de l'estomac, nous avons comparé les données clinicopathologiques entre 82 avec une infiltration du bas oesophage et 129 sans une telle infiltration. La résection chirurgicale et le comptage radioisotopique (99mTc‐phytate) nous ont permis de constater qu'il importe d'enlever surtout les ganglions 7, 9, 11 et 16 dans le curage accompagnant la résection pour cancer gastrique envahissant le bas oesophage. Lorsque l'envahissement du bas oesophage dépasse un centimètre, il faut préconiser une gastrectomie totale et une oesophagectomie inférieure combinées a un curage abdominal et thoracique par une thoracotomie gauche. Lorsqu'un envahissement intramural d'origine vasculaire est détecté sur la tranche de section par examen extemporané, il faut envisager de compléter l'oesophagectomie au dela de la crosse de l'aorte. Resumen Hemos realizado la evaluación clinicopatológica de pacientes con cáncer del tercio superior del estómago, comparando 82 que presentaban infiltración del esófago y 129 sin extensión del esófago. El estudio de los pacientes sometidos a resección con captación de radioisótopo (99 mTc‐fitato) reveló que la disección de los ganglios linfáticos, predominantemente los grupos 7, 9, 11 y 16 fue importante para la cirugía radical realizada en los casos de cáncer gástrico con infiltración del esófago. Cuando la infiltración del esófago excede 1 cm, el
ISSN:0364-2313
1432-2323
DOI:10.1007/BF00316829