Prognostic differences of adenocarcinoma arising from the cardia and the upper third of the stomach.

Of 1,012 patients who underwent gastrectomy for carcinoma of the stomach from 1980 to 1990, 33 with adenocarcinoma arising from the gastroesophageal junction (group C) and 55 with adenocarcinoma of the upper third of the stomach (group U) were compared with regard to their clinicopathologic features. Twenty-five patients (76%) in group C and 49 patients (89%) in group U underwent curative resection. The 5-year survival rates following curative resection were 32 and 70 per cent, respectively (P < 0.001). The poor prognosis of group C was ascribed to a greater propensity for esophageal invasion and nodal involvement, as well as to more advanced disease at diagnosis. The rich lymphatic drainage around the cardia may account for the wide spread of such tumors. Most patients presented with an advanced disease, so earlier detection of carcinoma of the cardia is mandatory to improve the results of surgery. At operation, it is important to dissect all the involved lymph nodes from the mediastinum to the abdominal paraaortic nodes and to ensure a tumor-free esophageal margin.