Ohta K, Nishi M, Ueda M, Ohyama S, Matsubara T, Takahashi T, Nakajima T
Division of Gastrointestinal Surgery, Cancer Institute Hospital, Tokyo, Japan.
Nihon Geka Gakkai Zasshi. 1998 Sep;99(9):589-94.
Cancer of the cardia is traditionally discussed with cardiac cancer of the lower portion of the esophagus and upper gastric cancer invading the esophagus, and the specific characteristics of cancer of the cardia have never been clearly defined. We reviewed the outcome of 172 patients with adenocarcinoma of the cardia who had undergone radical surgery between 1949 and 1994 in the Division of Gastrointestinal Surgery of the Cancer Institute Hospital. The centers of the tumors were located within 2 cm above and below the boundary between the esophagus and the stomach, and their longitudinal diameter was less than 8 cm. We divided the patients into an early period (1949-1979; n = 79) and a late period (1980-1994; n = 93), and focused on the historical transition. There were no differences in patient gender or histology between the two periods. However, the late period was associated with fewer cases of esophageal invasion and shorter longitudinal diameter, as the age of the population advanced. The number of advanced cancers such as the localized and infiltrative type had decreased, and early cancer and early clinical stage had become more common, but despite the fact that the number of early cancers had increased, extended dissection, such as thoracic and paraaortic lymph node dissection, was performed more frequently. By clinical stage, the long-term outcome markedly improved in Stage I patient in the late period, and tended to improve in Stage II and III patients. This appears to have been attributable to the prevention of micrometastasis by extended dissection, although the number of early cancers is another major potential cause. There were no differences in the outcome of Stage IV patients between the two periods, and further advances in multimodality therapy must be awaited. The range of resection is basically proximal gastrectomy, and if there are adequate indications, the prognosis is favorable. In view of the status of lymphatic flow and lymph node metastasis, and long-term results, lateroaortic lymph node dissection is important. Since the number of early cancer patients has been increasing, if intraabdominal recurrence is prevented, intrathoracic lymph node dissection will contribute greatly to the outcome of such patients.
传统上，贲门癌与食管下段的贲门癌以及侵犯食管的胃上部癌一并讨论，而贲门癌的具体特征从未得到明确界定。我们回顾了1949年至1994年间在癌症研究所医院胃肠外科接受根治性手术的172例贲门腺癌患者的治疗结果。肿瘤中心位于食管与胃交界处上下2厘米范围内，其纵向直径小于8厘米。我们将患者分为早期（1949 - 1979年；n = 79）和晚期（1980 - 1994年；n = 93），并重点关注历史变迁。两个时期患者的性别和组织学类型没有差异。然而，随着人群年龄的增长，晚期食管侵犯病例较少，纵向直径较短。局部浸润型等进展期癌症的数量减少，早期癌症和临床早期变得更为常见，尽管早期癌症数量增加，但胸段和主动脉旁淋巴结清扫等扩大清扫术的实施更为频繁。按临床分期，晚期I期患者的长期预后显著改善，II期和III期患者也有改善趋势。这似乎归因于扩大清扫术预防了微转移，尽管早期癌症数量也是另一个主要潜在原因。两个时期IV期患者的预后没有差异，必须等待多模式治疗取得进一步进展。切除范围基本为近端胃切除术，如果有适当指征，预后良好。鉴于淋巴引流和淋巴结转移情况以及长期结果，主动脉旁淋巴结清扫很重要。由于早期癌症患者数量一直在增加，如果能预防腹腔内复发，胸内淋巴结清扫将对这类患者的预后有很大帮助。
