Esophagogastrectomy for Adenocarcinoma of the Cardia Ten Yearsʼ Experience and Current Approach

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Abstract
During a 10-yr period, 94 surgical resections for [human] adenocarcinoma of the cardia (75 curative and 19 palliative) were performed using the following 3 primary approaches: Group I (46 curative, 14 palliative), esophagogastrectomy performed through a left thoracotomy or left thoraco-abdominal incision; Group II (17 curative, 4 palliative), resection done through 2 separate incisions (abdominal and thoracic) with delayed reconstruction between 2 and 3 mo. later; Group III (12 curative, 1 palliative), resection, also through abdominal and thoracic incisions, with simultaneous reconstruction. Operative mortality in the 75 procedures done for cure was 19.5%, 18% and 8.3% in Groups I, II and III, respectively. Microscopic residual tumor at the line of resection was 56%, 12% and 8%. Free margins < 3 cm had the same local recurrence rate (21%, 6% and 8%) within 18 mo. as did margins with residual microscopic tumor. The length of time from operation to 1st regular meal was 12, 110 and 7 days, respectively. Wide resection with subtotal esophagectomy and simultaneous reconstruction is advocated.