Anatomical classification and results of surgical treatment for adenocarcinoma of the cardia

ABSTRACT

One hundred and eight patients with histologically proven adenocarcinoma of the cardia were treated. The Siewert's classification was used to categorize these lesions into three types according to the relation of the tumor mass to the anatomical cardia. Total esophagectomy with resection of lymph nodes in the paracardial and posterior mediastinal regions was carried out for all type I lesions and a total gastrectomy with D2 lymphadenectomy as described for gastric cancer was the principal procedure for type III disease. For type II disease, a D2 lymphadenectomy was the essential part of the procedure in addition to either total gastrectomy or total esophagectomy based on the tumor extent. The average follow up period was 15-108 months [median 42.8 +/- 13.7 months]. The analysis included the surgical approaches used, the extent of resection, 30-day death rate, postoperative complications, depth of tumor invasion [pT], nodal status in resected specimens and the overall survival. The study concluded that adenocarcinoma of the cardia continues to carry a dismal prognosis. The topographic and anatomical classification of these lesions provides a useful tool for selecting the surgical approach and guide the extent of resection