RESUMEN
Objective To explore the new operation approach and the effect of surgical therapy on cardial carcinoma. Methods A total of 78 patients with cardial carcinoma received surgical therapy by the transabdominal route from January 1992 to January 2002, of which 30 cases were treated by total gastrectomy by substitution of P shaped jejunum and 48 cases were treated by subtotal gastrectomy. All patients were followed-up postoperatively from 6 months to 5 years. Results The average length of resected lower part of the esophagus above the tumors was over 5cm, without cancer tissue retained in resected edge. The rate of intramediastinal lymph node metastasis was 18.4%. 5-year survival rate of the patients with total gastrectomy was higher than that of the patients with subtotal gastrectomy, and the morbidity rate of reflux esophagitis of the former was lower than that of the latter. Conclusions The patients of cardial carcinoma in Ⅲ stage or Ⅱstage with lymph node metastasis of 5 or 6 groups should be treated by radical total gastrectomy. The P shaped reconstruction of stomach with jejunum as a replacement satisfies the physiological needs and causes less compications.