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Surgical Endoscopy

, Volume 6, Issue 2, pp 62–67 | Cite as

Endoscopic evaluation of gastric cancer infiltrating the lower esophagus

  • K. Takeshita
  • H. Habu
  • N. Saito
  • T. Honda
  • M. Iida
  • S. Watanuki
  • M. Sunagawa
  • M. Endo
Original Articles

Summary

Endoscopic and histopathological findings were compared in 74 patients with gastric cancer infiltrating the lower esophagus who had undergone gastrectomy to evaluate mode of esophageal infiltration. There were no early cancers. Cancer infiltration modes were histopathologically broken down into three types: superficial, whole layer, and deep layer. Endoscopic findings were broken down into five types for proximal infiltration. Endoseopy used for histological evaluation frequently revealed the protruded type to be whole layer and had a highly accurate diagnosis rate (94%); it revealed the histology of the other four types to be primarily superficial. Extent of cancer invasion was underestimated in giant-rugae tumors (40%), as endoseopy could barely detect the small nest of esophageal infiltrations. Lugol staining was useful in preventing underestimation. For flat cancer, which is poorly demarcated and is often accompanied by vascular invasion, preoperative evaluation is very difficult, requiring preoperative examination of a frozen section taken from the proximal edge of resected specimen.

Key words

Esophageal infiltration Cancer of upper third of stomach Cardiac cancer Preoperative examination of frozen section 

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References

  1. 1.
    Akiyama H, Sakamoto K, Teshima N, Kogure T, Itai Y (1972) Esophageal invasion in cancer of the stomach. Stomach Intestine (I To Chou) 7: 97–104 (in Japanese with English abstract)Google Scholar
  2. 2.
    Baba K, Misumi A, Murakami A, Akagi M (1990) A biometrical study on esophageal invasion of carcinoma of the upper stomach. Part II: Radiographic evaluation of esophageal invasion on the basis of its occurring point and size. Int Surg 75: 39–42Google Scholar
  3. 3.
    Endo M, Takashita K, Yoshida M (1986) How can we diagnose the early stage of esophageal cancer? endoscopic diagnosis. Endoscopy 18 (Suppl 3): 11–18Google Scholar
  4. 4.
    Fein R, Kelsen DP, Geller N, Bains M, McCormack P, Brennan MF (1985) Adenocarcinoma of the esophagus and gastroesophageal junction. Cancer 56: 2512–2518Google Scholar
  5. 5.
    Goldfaden D, Orringer MB, Appelman HD, Kalish R (1986) Adenocarcinoma of the distal esophagus and gastric cardia. J Thorac Cardiovasc Surg 91: 242–247Google Scholar
  6. 6.
    Higashi G (1974) Clinicopathological and surgical study on carcinoma of cardia—especially about invasion into esophagus and operative procedure. Igaku Kenkyu 54: 648–678 (in Japanese with English abstract)Google Scholar
  7. 7.
    Husemann B (1989) Cardia carcinoma considered as a distinct clinical entity. Br J Surg 76: 136–139Google Scholar
  8. 8.
    Japanese Research Society of Gastric Cancer (1981) The general rules for the gastric cancer study in surgery and pathology. Jpn J Surg 11: 127–139Google Scholar
  9. 9.
    Kaku S, Baba Y, Ninomiya T, Takemoto N, Shimizu H, Kawano Y, Fujii A, Harashima S, Takekoshi T, Maruyama M, Saito T, Takagi K, Ohashi I, Kato Y (1984) Roentgenological and endoscopic studies of esophageal infiltration of cardiac carcinoma. Progress of Digestive Endoscopy (Shoukaki Naisikyou No Sinpo) 25: 79–83 (in Japanese with English abstract)Google Scholar
  10. 10.
    Keighley MRB, Moore J, Lee JR, Malins D, Thompson H (1981) Preoperative frozen section and cytology to assess proximal invasion in gastro-oesophageal carcinoma. Br J Surg 68: 73–74Google Scholar
  11. 11.
    Ohashi S, Asai T, Okamura S, Hamajima E, Itoh H, Shimodaira M, Katoh T, Tsukamoto Y, Niwa Y (1991) Endoscopic ultrasonography in the assessment of invasive cardiac cancer. Nippon Shoukakibyou Gakkai Zasshi 88: 1397–1403 (in Japanese with English abstract)Google Scholar
  12. 12.
    Paolini A, Tosato F, Cassese M, Marchi GD, Grande M, Paoletti P, Gherardini P, Fegiz G (1986) Total gastrectomy in the treatment of adenocarcinoma of the cardia. Am J Surg 151: 238–243Google Scholar
  13. 13.
    Papachristou DN, Agnanti N, D'Agostino H, Fortner JG (1980) Histologically positive esophageal margin in the surgical treatment of gastric cancer. Am J Surg 139: 711–713Google Scholar
  14. 14.
    Takeshita K, Honda T, Saito N, Sato Y, Sunagawa M, Habu H, Endo M (1987) An endoscopic study on the depth of cancer invasion into the gastric wall; with a special reference to so-called advanced cancer mimicking early cancer. Progress of Digestive Endoscopy (Shoukaki Naisikyou No Sinpo) 31: 61–66 (in Japanese with English abstract)Google Scholar

Copyright information

© Springer-Verlag New York Inc 1992

Authors and Affiliations

  • K. Takeshita
    • 1
  • H. Habu
    • 1
  • N. Saito
    • 1
  • T. Honda
    • 1
  • M. Iida
    • 1
  • S. Watanuki
    • 1
  • M. Sunagawa
    • 1
  • M. Endo
    • 1
  1. 1.The First Department of SurgeryTokyo Medical and Dental University, School of MedicineTokyoJapan

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