Carcinoma of the gastric cardia.

The general term "carcinoma of the gastric cardia" includes three different types of adenocarcinomas. Carcinoma of the distal oesophagus (Type I), true carcinoma of the cardia (Type II) and subcardial gastric carcinoma (Type III). The preoperative classification of these carcinomas of the gastro-oesophageal junction is primarily based on radiologic and endoscopic examination. The most accurate method for preoperative staging is endosonography; if this shows that complete tumour resection is not possible, preoperative chemotherapy for downstaging of the tumour is suggested. As the serosal cover on the back wall of the cardia and the gastric fundus is lacking, the Union Internationale Contre le Cancer (UICC) pT2 classification includes wall penetrating tumours which would be equivalent to pT3 in other parts of the stomach. For prognostic reasons these advanced carcinomas should be classified as pT2b in contradistinction to tumours limited to the muscularis propria (pT2a). The results of surgical resection of 445 carcinomas of the gastric cardia are presented (Type I 38%, Type II 28%, Type III 34%). The overall 30-day and 90-day mortality rates were 4.9% and 10.4%, respectively. Long term survival after resection of carcinoma of the gastric cardia was mainly associated with complete tumour removal, limited wall penetration and absence of lymph node metastases. Patients with Type I cancers showed a tendency for a better outcome compared to Type II and III because of a higher percentage of early cancers and a higher rate of complete tumour resection.