Adenocarcinoma of the gastric cardia: What is the optimal surgical approach?

Ito, Hiromichi; Clancy, Thomas E.; Osteen, Robert T.; Swanson, Richard S.; Bueno, Raphael; Sugarbaker, David J.; Ashley, Stanley W.; Zinner, Michael J.; Whang, Edward E.

doi:10.1016/j.jamcollsurg.2004.08.015

Cited by 136 publications

(122 citation statements)

References 34 publications

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“…Surgical margins were significantly greater by esophageal resection than by extended gastrectomy, which in turn resulted in better survival times [35]. Also, other authors suggest a resection margin of 5-8 cm in situ as a safe surgical margin [39,42]. The survival benefit of TAE in our patients' cohort can possibly be the result of this greater surgical margin after TAE also if the rate of R0 resections did not differ between the two groups.…”

Section: Discussionsupporting

confidence: 49%

“…Despite multiple studies [8,[35][36][37][38][39][40], the discussion is still ongoing whether the "true" carcinoma of the cardia should be resected in accordance to a carcinoma of the esophagus or stomach. Most of the studies are of a heterogeneous design, summarizing different surgical approaches under esophagectomy and gastrectomy and including not only AEG II but AEG I-III.…”

Section: Discussionmentioning

confidence: 99%

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Surgical strategies in true adenocarcinoma of the esophagogastric junction (AEG II): thoracoabdominal or abdominal approach?

et al. 2017

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Section: Discussionsupporting

confidence: 49%

Section: Discussionmentioning

confidence: 99%

Surgical strategies in true adenocarcinoma of the esophagogastric junction (AEG II): thoracoabdominal or abdominal approach?

et al. 2017

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“…Indeed, an esophagectomy is required in this case, but gastric tubulization could hinder the attainment of a safe distal margin. In the aforementioned study by Ito, a negative distal margin was found in all patients, with at least 4 cm of macroscopically free stomach below the tumor, while a 5-cm in vivo distal margin was advocated in a study from the UK [45,47].…”

Section: Resection Marginsmentioning

confidence: 99%

“…As regards the proximal margin, in 2003 Mariette published a study on Siewert type I and II tumors and proposed an 8-cm in situ margin, considering a shrinkage of 50%, thus doubling all the fresh contracted gross specimen measures [44]. Ito et al defined a proximal margin length of 6 cm as safe, whilst in 2007 Barbour observed improved survival with an in vivo proximal margin of about 5 cm (3.8 cm in the specimen) [45,46].…”

Section: Resection Marginsmentioning

confidence: 99%

Western strategy for EGJ carcinoma

et al. 2016

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In this paper, the epidemiological and clinicobiological behavior of esophagogastric junction (EGJ) adenocarcinoma in the West is compared and contrasted to that in the East, and an overview is provided of current therapeutic strategies employed for this type of tumor in Western countries. It is well known that multimodal treatment is the therapeutic standard in locally advanced EGJ adenocarcinoma, but whether neoadjuvant/perioperative chemotherapy (CT) or neoadjuvant chemoradiotherapy (CRT) is the optimal approach is still debated. Neoadjuvant CRT improves local control in locally advanced Siewert type I and II tumors, so it should be considered the treatment of choice. In the subset of these patients with microscopic systemic disease at diagnosis, more intensive exclusive chemotherapy protocols could be of benefit. Therefore, there is an urgent need to identify these patients before planning the treatment. For Siewert type III tumors, perioperative chemotherapy is the standard. While there is general agreement on the optimal surgical approach for Siewert types I and III (a two-field Ivor Lewis operation and a total gastrectomy with distal esophagectomy, respectively), no standard surgical treatment has been defined for Siewert type II tumors. When data from Western series on proximal and circumferential resection margins and on nodal spread in Siewert type II tumors are taken into account, the optimal surgical approach appears to be Ivor Lewis esophagectomy. Whether the extent of esophageal invasion can correctly predict nodal involvement in middle-upper mediastinal stations as a means to restrict indications for transthoracic esophagectomy requires further investigation in the West.

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“…The treatment of gastric tumors depends on the histology type and it is based on the wide surgical resection of the tumor and lymphadenectomy in case of the adenocarcinoma [19,20], antibiotics, chemotherapy, and surgery in selected cases of gastric lymphoma [21], and in limited resection, without lymphadenectomy, accompanied by chemotherapy in stromal tumors (GIST) [22]. In this context, the preoperative recognition of the type of the disease is extremely important for the implementation of an optimal treatment.…”

Section: Introductionmentioning

confidence: 99%

Greyscale and contrast enhanced ultrasonography for characterization of gastric malignant tumors

et al. 2018

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Aims: To evaluate the utility of grey scale ultrasonography (US) and contrast enhanced ultrasonography (CEUS) for characterization of malignant gastric tumors.Material and methods: The study was conducted prospectively and it included a number of 30 patients with malignant gastric tumors diagnosed through upper tract endoscopy and biopsy: 25 adenocarcinomas, 3 lymphomas, and 2 stromal tumors. All the patients were examined by US, followed immediately by CEUS, using both oral and intravenous contrast agents. CEUS assessed the dynamics of the contrast agent during the arterial phase and the venous phase. The distribution characteristics of the contrast agent inside the region of interest (ROI) were also evaluated. Twenty four patients underwent surgery.Results: Adenocarcinomas presented heterogeneous enhancement with variable pattern, followed by a delayed wash-out in almost all of the situations. Lymphomas presented a variable pattern, intensity and homogeneity of the enhancement, followed by delayed wash-out. Stromal tumors showed early arterial intense and homogenous enhancement followed by moderate wash-out in venous phase.Conclusions: Grey scale US and CEUS are useful methods in characterizing gastric tumors and contribute to a more adequate evaluation of the lesions. The dynamics of the contrast agent may be suggestive for the anatomopathological nature of the tumor. Larger studies will be necessary in order to determine thepractical value of the method.

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Adenocarcinoma of the gastric cardia: What is the optimal surgical approach?

Cited by 136 publications

References 34 publications

Surgical strategies in true adenocarcinoma of the esophagogastric junction (AEG II): thoracoabdominal or abdominal approach?

Surgical strategies in true adenocarcinoma of the esophagogastric junction (AEG II): thoracoabdominal or abdominal approach?

Western strategy for EGJ carcinoma

Greyscale and contrast enhanced ultrasonography for characterization of gastric malignant tumors

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