Skip to main content
SpringerLink
Log in

Surgical Therapy

  • Chapter
  • First Online:
Gastric Cardiac Cancer

  • 721 Accesses

Abstract

A growing body of evidence suggests that early stage pT1 gastric cardiac cancer can be better resected endoscopically, but advanced, nonmetastatic resectable tumors without esophageal invasion or with esophageal invasion but in the length shorter than 3 cm above the gastroesophageal junction may be resected via the transhiatal abdominal approach. Laparoscopic resection has also emerged as a safe, economic, minimally invasive alternative. A universally accepted resection/reconstruction protocol remains to be established for this potentially fatal cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 129.00
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Ajani JA, D’Amico TA, Almhanna K, et al. Esophageal and esophagogastric junction cancers, version 1.2015. J Natl Compr Cancer Netw. 2015;13(2):194–227.

    Article  CAS  Google Scholar 

  2. Sano T, Coit DG, KIim HH, et al. Proposal of a new stage grouping of gastric cancer for TNM classification: International Gastric Cancer Association staging project. Gastric Cancer. 2017;20(2):217–25. https://doi.org/10.1007/s10120-016-0601-9.

    Article  PubMed  Google Scholar 

  3. Orditura M, Galizia G, Fabozzi A, et al. Preoperative treatment of locally advanced esophageal carcinoma (Review). Int J Oncol. 2013;43(6):1745–53. https://doi.org/10.3892/ijo.2013.2118.

    Article  PubMed  CAS  Google Scholar 

  4. Huang L, Xu AM. Adenocarcinoma of esophagogastric junction: controversial classification, surgical management, and clinicopathology. Chin J Cancer Res. 2014;26(3):226–30.

    PubMed  PubMed Central  Google Scholar 

  5. Ono H, Yao K, Fujishiro M, et al. Guidelines for endoscopic submucosal dissection and endoscopic mucosal resection for early gastric cancer. Dig Endosc. 2016;28(1):3–15.

    Article  PubMed  Google Scholar 

  6. Huang Q, Fang C, Shi J, et al. Differences in clinicopathology of early gastric carcinoma between proximal and distal location in 438 Chinese patients. Sci Rep. 2015;5:13439. https://doi.org/10.1038/srep13439.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  7. Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer. 2017;20(1):1–19.

    Google Scholar 

  8. Huang CM, Lv CB, Lin JX, et al. Laparoscopic-assisted versus open total gastrectomy for Siewert type II and III esophagogastric junction carcinoma: a propensity score-matched case-control study. Surg Endosc. 2017;31(9):3495–503. https://doi.org/10.1007/s00464-016-5375-y.

    Article  PubMed  Google Scholar 

  9. Hashizume M, Shimada M, Tomikawa M, et al. Early experiences of endoscopic procedures in general surgery assisted by a computer-enhanced surgical system. Surg Endosc. 2002;16(8):1187–91.

    Article  PubMed  CAS  Google Scholar 

  10. Shen W, Xi H, Wei B, et al. Robotic versus laparoscopic gastrectomy for gastric cancer: comparison of short-term surgical outcomes. Surg Endosc. 2016;30(2):574–80.

    Article  PubMed  Google Scholar 

  11. Shen WS, Xi HQ, Chen L, et al. A meta-analysis of robotic versus laparoscopic gastrectomy for gastric cancer. Surg Endosc. 2014;28(10):2795–802.

    Article  PubMed  Google Scholar 

  12. Patriti A, Ceccaralli G, Ceribelli C, et al. Robot-assisted laparoscopic management of cardia carcinoma according to Siewert recommendations. Int J Med Robot. 2011;7(2):170–7.

    Article  PubMed  Google Scholar 

  13. Zhou F, Shi J, Fang C, et al. Gastric carcinomas in young (younger than 40 years) Chinese patients: clinicopathology, family history, and postresection survival. Medicine (Baltimore). 2016;95(9):e2873.

    Article  Google Scholar 

  14. Hulscher JB, van Sandwick JW, de Boer AG, et al. Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med. 2002;347(21):1662–9.

    Article  PubMed  Google Scholar 

  15. Sasako M, Sano T, Yamamoto S, et al. Left thoracoabdominal approach versus abdominal-transhiatal approach for gastric cancer of the cardia or subcardia: a randomised controlled trial. Lancet Oncol. 2006;7(8):644–51.

    Article  PubMed  Google Scholar 

  16. Omloo JM, Lagarde SM, Hulscher JB, et al. Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the mid/distal esophagus: five-year survival of a randomized clinical trial. Ann Surg. 2007;246(6):992–1000; discussion 1000–1001.

    Article  PubMed  Google Scholar 

  17. Zhou J, Wang H, Niu Z, et al. Comparisons of clinical outcomes and prognoses in patients with gastroesophageal junction adenocarcinoma, by transthoracic and transabdominal hiatal approaches: a teaching hospital retrospective cohort study. Medicine (Baltimore). 2015;94(50):e2277.

    Article  Google Scholar 

  18. Huang Q, Fan X, Agoston AT, et al. Comparison of gastro-oesophageal junction carcinomas in Chinese versus American patients. Histopathology. 2011;59(2):188–97.

    Article  PubMed  Google Scholar 

  19. Zhang YF, Shi J, Yu HP, et al. Factors predicting survival in patients with proximal gastric carcinoma involving the esophagus. World J Gastroenterol. 2012;18(27):3602–9.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Kurakowa Y, Sasako M, Sano T, et al. Ten-year follow-up results of a randomized clinical trial comparing left thoracoabdominal and abdominal transhiatal approaches to total gastrectomy for adenocarcinoma of the oesophagogastric junction or gastric cardia. Br J Surg. 2015;102(4):341–8.

    Article  Google Scholar 

  21. Wei MT, Zhang YC, Deng XB, et al. Transthoracic vs transhiatal surgery for cancer of the esophagogastric junction: a meta-analysis. World J Gastroenterol. 2014;20(29):10183–92.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Okholm C, Svendsen LB, Achiam MP. Status and prognosis of lymph node metastasis in patients with cardia cancer—a systematic review. Surg Oncol. 2014;23(3):140–6.

    Article  PubMed  Google Scholar 

  23. Kakeji Y, Yamamoto M, Ito S, et al. Lymph node metastasis from cancer of the esophagogastric junction, and determination of the appropriate nodal dissection. Surg Today. 2012;42(4):351–8.

    Article  PubMed  Google Scholar 

  24. Yamashita H, Seto Y, Sano T, et al. Results of a nation-wide retrospective study of lymphadenectomy for esophagogastric junction carcinoma. Gastric Cancer. 2017;20(Suppl 1):69–83. https://doi.org/10.1007/s10120-016-0663-8.

    Article  PubMed  CAS  Google Scholar 

  25. 速藤和也,褂地吉弘,前原喜彦. 胃癌:喷朋部胃癌治瘵. 消化器外科. 2009;32(5):738–44.

    Google Scholar 

  26. Goto H, Tokunaga M, Sugisawa N, et al. Value of splenectomy in patients with Siewert type II adenocarcinoma of the esophagogastric junction. Gastric Cancer. 2013;16(4):590–5.

    Article  PubMed  CAS  Google Scholar 

  27. Pultrum BB, van Bastelaar J, Schreurs LM, et al. Impact of splenectomy on surgical outcome in patients with cancer of the distal esophagus and gastro-esophageal junction. Dis Esophagus. 2008;21(4):334–9.

    Article  PubMed  CAS  Google Scholar 

  28. Sano T, Yamamoto S, Sasako M. Randomized controlled trial to evaluate splenectomy in total gastrectomy for proximal gastric carcinoma: Japan Clinical Oncology Group study JCOG 0110-MF. Jpn J Clin Oncol. 2002;32(9):363–4.

    Article  PubMed  Google Scholar 

  29. Huang CM, Chen QY, Lin JX, et al. Huang’s three-step maneuver for laparoscopic spleen-preserving No. 10 lymph node dissection for advanced proximal gastric cancer. Chin J Cancer Res. 2014;26(2):208–10.

    PubMed  PubMed Central  Google Scholar 

  30. Mocellin S, McCulloch P, Kazi H, et al. Extent of lymph node dissection for adenocarcinoma of the stomach. Cochrane Database Syst Rev. 2015;(8):CD001964.

    Google Scholar 

  31. Sasako M, Sano T, Yamamoto S, et al. D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. N Engl J Med. 2008;359(5):453–62.

    Article  PubMed  CAS  Google Scholar 

  32. Wang L, Liang H, Wang X, et al. Risk factors for metastasis to para-aortic lymph nodes in gastric cancer: a single institution study in China. J Surg Res. 2013;179(1):54–9.

    Article  PubMed  Google Scholar 

  33. Liang XY, Liang H, Ding XW, et al. N3 gastric cancer D2 combined with para-aortic lymph node dissection on the prognosis of patients with survival. Chin J Surg. 2013;51(12):1071–6.

    PubMed  Google Scholar 

  34. de Manzoni G, Verlato G, Bencivenga M, et al. Impact of super-extended lymphadenectomy on relapse in advanced gastric cancer. Eur J Surg Oncol. 2015;41(4):534–40.

    Article  PubMed  Google Scholar 

  35. Yoshikawa T, Sasako M, Yamamoto S, et al. Phase II study of neoadjuvant chemotherapy and extended surgery for locally advanced gastric cancer. Br J Surg. 2009;96(9):1015–22.

    Article  PubMed  CAS  Google Scholar 

  36. Tsubaraya A, Mizusawa J, Tanakay Y, et al. Neoadjuvant chemotherapy with S-1 and cisplatin followed by D2 gastrectomy with para-aortic lymph node dissection for gastric cancer with extensive lymph node metastasis. Br J Surg. 2014;101(6):653–60.

    Article  CAS  Google Scholar 

  37. Barbour AP, Rizk NP, Gonen M, et al. Adenocarcinoma of the gastroesophageal junction: influence of esophageal resection margin and operative approach on outcome. Ann Surg. 2007;246(1):1–8.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Bickenbach KA, Gonen M, Strong V, et al. Association of positive transection margins with gastric cancer survival and local recurrence. Ann Surg Oncol. 2013;20(8):2663–8.

    Article  PubMed  CAS  Google Scholar 

  39. Squires MH, Kooby DA, Pawlik TM, et al. Utility of the proximal margin frozen section for resection of gastric adenocarcinoma: a 7-Institution Study of the US Gastric Cancer Collaborative. Ann Surg Oncol. 2014;21(13):4202–10.

    Article  PubMed  Google Scholar 

  40. Postlewait LM, Squires MH, Kooby DA, et al. The importance of the proximal resection margin distance for proximal gastric adenocarcinoma: a multi-institutional study of the US Gastric Cancer Collaborative. J Surg Oncol. 2015;112(2):203–7.

    Article  PubMed  Google Scholar 

  41. Squires MH, Kooby DA, Poultsides GA, et al. Is it time to abandon the 5-cm margin rule during resection of distal gastric adenocarcinoma? A multi-institution study of the U.S. Gastric Cancer Collaborative. Ann Surg Oncol. 2015;22(4):1243–51.

    Article  PubMed  Google Scholar 

  42. Pu YW, Gong W, Wu YY, et al. Proximal gastrectomy versus total gastrectomy for proximal gastric carcinoma. A meta-analysis on postoperative complications, 5-year survival, and recurrence rate. Saudi Med J. 2013;34(12):1223–8.

    PubMed  Google Scholar 

  43. Fein M, Fuchs KH, Thalheimer A, et al. Long-term benefits of Roux-en-Y pouch reconstruction after total gastrectomy: a randomized trial. Ann Surg. 2008;247(5):759–65.

    Article  PubMed  Google Scholar 

  44. Tsiouris A, Hammoud Z, Velanovich V. Barrett’s esophagus after resection of the gastroesophageal junction: effects of concomitant fundoplication. World J Surg. 2011;35(8):1867–72.

    Article  PubMed  Google Scholar 

  45. Ishigami S, Uenosono Y, Arigami T, et al. Novel fundoplication for esophagogastrostomy after proximal gastrectomy. Hepato-Gastroenterology. 2013;60(127):1814–6.

    PubMed  Google Scholar 

  46. Nakamura M, Nakamori M, Ojima T, et al. Reconstruction after proximal gastrectomy for early gastric cancer in the upper third of the stomach: an analysis of our 13-year experience. Surgery. 2014;156(1):57–63.

    Article  PubMed  Google Scholar 

  47. Ding X, Yan F, Liang H, et al. Functional jejunal interposition, a reconstruction procedure, promotes functional outcomes after total gastrectomy. BMC Surg. 2015;15:43.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Ahn SH, Lee JH, Park DJ, et al. Comparative study of clinical outcomes between laparoscopy-assisted proximal gastrectomy (LAPG) and laparoscopy-assisted total gastrectomy (LATG) for proximal gastric cancer. Gastric Cancer. 2013;16(3):282–9.

    Article  PubMed  Google Scholar 

  49. Chen K, Pan Y, Cai JQ, et al. Totally laparoscopic versus laparoscopic-assisted total gastrectomy for upper and middle gastric cancer: a single-unit experience of 253 cases with meta-analysis. World J Surg Oncol. 2016;14:96.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Hosoda K, Yamashita K, Moriya H, et al. Laparoscopically assisted proximal gastrectomy with esophagogastrostomy using a novel “Open-Door” technique: LAPG with novel reconstruction. J Gastrointest Surg. 2017;21(7):1174–80. https://doi.org/10.1007/s11605-016-3341-6.

    Article  PubMed  Google Scholar 

  51. Bilici A, Selcukbiricik F. Prognostic significance of the recurrence pattern and risk factors for recurrence in patients with proximal gastric cancer who underwent curative gastrectomy. Tumour Biol. 2015;36(8):6191–9.

    Article  PubMed  CAS  Google Scholar 

  52. Li F, Zhang R, Liang H, et al. The pattern and risk factors of recurrence of proximal gastric cancer after curative resection. J Surg Oncol. 2013;107(2):130–5.

    Article  PubMed  Google Scholar 

  53. Huang Q, Sun Q, Fan XS, et al. Recent advances in proximal gastric carcinoma. J Dig Dis. 2016;17(7):421–32.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General Surgery, Center of Gastrointestinal Surgery, Changzhou No 2 People’s Hospital, Affiliated Hospital of Nanjing Medical University, Changzhou, Jiangsu, People’s Republic of China

    Jun Qian

  2. Department of Gastrointestinal Surgery, Affiliated Changzhou No 2 Peoples Hospital Nanjing Medical University, Changzhou, Jiangsu, People’s Republic of China

    Yu Gong

  3. Pathology and Laboratory Medicine, Veterans Affairs Boston Healthcare System, West Roxbury, MA, USA

    Qin Huang

  4. Harvard Medical School and Brigham and Women’s Hospital, Boston, MA, USA

    Qin Huang

  5. Department of Anesthesiology, Washington University in St. Louis School of Medicine, Barnes Jewish Hospital, St. Louis, MO, USA

    A. Travis Manasco

  6. Department of Gastroenterology, Changzhou Second Hospital, Nanjing Medical University, Changzhou, People’s Republic of China

    Liming Tang

  7. Department of Surgery, Harvard Medical School/Brigham and Women’s Hospital, Boston, MA, USA

    Jason S. Gold

  8. Veterans Affairs Boston Healthcare System, West Roxbury, MA, USA

    Jason S. Gold

Authors
  1. Jun Qian
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yu Gong
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Qin Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Travis Manasco
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Liming Tang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jason S. Gold
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Harvard Medical School/Brigham and Women’s Hospital, Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts, USA

    Qin Huang

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Qian, J., Gong, Y., Huang, Q., Manasco, A.T., Tang, L., Gold, J.S. (2018). Surgical Therapy. In: Huang, Q. (eds) Gastric Cardiac Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-79114-2_13

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-79114-2_13

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-79113-5

  • Online ISBN: 978-3-319-79114-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation