Advertisement

Surgical Therapy

  • Jun Qian
  • Yu Gong
  • Qin Huang
  • A. Travis Manasco
  • Liming Tang
  • Jason S. Gold
Chapter

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.

Keywords

Gastric cancer Early gastric carcinoma Stomach Cancer Endoscopic resection Laparoscopic resection Gastric cardia 

References

  1. 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.CrossRefGoogle Scholar
  2. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 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.CrossRefPubMedGoogle Scholar
  4. 4.
    Huang L, Xu AM. Adenocarcinoma of esophagogastric junction: controversial classification, surgical management, and clinicopathology. Chin J Cancer Res. 2014;26(3):226–30.PubMedPubMedCentralGoogle Scholar
  5. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer. 2017;20(1):1–19.Google Scholar
  8. 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.CrossRefPubMedGoogle Scholar
  9. 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.CrossRefPubMedGoogle Scholar
  10. 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.CrossRefPubMedGoogle Scholar
  11. 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.CrossRefPubMedGoogle Scholar
  12. 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.CrossRefPubMedGoogle Scholar
  13. 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.CrossRefGoogle Scholar
  14. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 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.CrossRefPubMedGoogle Scholar
  16. 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.CrossRefPubMedGoogle Scholar
  17. 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.CrossRefGoogle Scholar
  18. 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.CrossRefPubMedGoogle Scholar
  19. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 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.CrossRefGoogle Scholar
  21. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 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.CrossRefPubMedGoogle Scholar
  24. 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.CrossRefPubMedGoogle Scholar
  25. 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. 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.CrossRefPubMedGoogle Scholar
  27. 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.CrossRefPubMedGoogle Scholar
  28. 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.CrossRefPubMedGoogle Scholar
  29. 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.PubMedPubMedCentralGoogle Scholar
  30. 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. 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.CrossRefPubMedGoogle Scholar
  32. 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.CrossRefPubMedGoogle Scholar
  33. 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.PubMedGoogle Scholar
  34. 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.CrossRefPubMedGoogle Scholar
  35. 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.CrossRefPubMedGoogle Scholar
  36. 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.CrossRefGoogle Scholar
  37. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 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.CrossRefPubMedGoogle Scholar
  41. 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.CrossRefPubMedGoogle Scholar
  42. 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.PubMedGoogle Scholar
  43. 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.CrossRefPubMedGoogle Scholar
  44. 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.CrossRefPubMedGoogle Scholar
  45. 45.
    Ishigami S, Uenosono Y, Arigami T, et al. Novel fundoplication for esophagogastrostomy after proximal gastrectomy. Hepato-Gastroenterology. 2013;60(127):1814–6.PubMedGoogle Scholar
  46. 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.CrossRefPubMedGoogle Scholar
  47. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  48. 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.CrossRefPubMedGoogle Scholar
  49. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  50. 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.CrossRefPubMedGoogle Scholar
  51. 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.CrossRefPubMedGoogle Scholar
  52. 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.CrossRefPubMedGoogle Scholar
  53. 53.
    Huang Q, Sun Q, Fan XS, et al. Recent advances in proximal gastric carcinoma. J Dig Dis. 2016;17(7):421–32.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Jun Qian
    • 1
  • Yu Gong
    • 2
  • Qin Huang
    • 3
    • 4
  • A. Travis Manasco
    • 5
  • Liming Tang
    • 6
  • Jason S. Gold
    • 7
    • 8
  1. 1.Department of General Surgery, Center of Gastrointestinal SurgeryChangzhou No 2 People’s Hospital, Affiliated Hospital of Nanjing Medical UniversityChangzhouPeople’s Republic of China
  2. 2.Department of Gastrointestinal SurgeryAffiliated Changzhou No 2 Peoples Hospital Nanjing Medical UniversityChangzhouPeople’s Republic of China
  3. 3.Pathology and Laboratory MedicineVeterans Affairs Boston Healthcare SystemWest RoxburyUSA
  4. 4.Harvard Medical School and Brigham and Women’s HospitalBostonUSA
  5. 5.Department of AnesthesiologyWashington University in St. Louis School of Medicine, Barnes Jewish HospitalSt. LouisUSA
  6. 6.Department of GastroenterologyChangzhou Second Hospital, Nanjing Medical UniversityChangzhouPeople’s Republic of China
  7. 7.Department of SurgeryHarvard Medical School/Brigham and Women’s HospitalBostonUSA
  8. 8.Veterans Affairs Boston Healthcare SystemWest RoxburyUSA

Personalised recommendations