2008 Annual Meeting Abstracts

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Cardia Ca is characterized by different features compared with the remaining gastric Ca; its incidence in Western countries is increasing.The aim of the study was to investigate diagnostic, therapeutic & outcome measures of cardia Ca in daily surgical practice.Patients &
Methods: All consecutive patients with cardia Ca out of a pool of patients with histologically confirmed diagnosis of gastric Ca who were treated in surgical departments were enrolled in this prospective observational multicenter study through a period of 12 months. Detailed patient, diagnostic & treatment characteristics were recorded in a computer-based format for analysis. Short-term outcome was characterized by hospital stay, complication rate, morbidity & hospital mortality.
Results: From 01/01-12/31/2002, 1,139 patients with gastric Ca from 80 surgical departments of each level of care were registered, out of them 198 subjects (17.4%) with cardia Ca. Tumor localization was classified in 186 patients according to Siewert: TypI, n=44 (22.2%); TypII, n=80 (40.4%); TypeIII, n=62 (31.3%). 172 patients underwent surgical intervention (operation rate, 86.9%) of whom 145 individuals underwent resection (rate, 84.3%). A potentially curative resection could be offered to 111 patients (R0 resection rate, 56.1% versus 82,3% in all gastric Ca). Fresh frozen section was only used in 72 resections (rate, 49.7%). Of 142 standard resections (distal esophagectomy with proximal or total gastrectomy), systematic D1, D2 & D3 lymphadenectomy was performed in 81.0%, 67.6% & 7.7% , resp. Histologic investigation revealed UICC stage I/II in 39.5% of all operated patients; III/IV, 54%; not classified, 6.5%. Distant metastases occurred most frequently at the peritoneal site (15.2%), liver (10.6%) & non-regional lymph nodes (7.1%). Postoperative morbidity was 33.7%. Anastomotic leakage occured in 13 patients (9.1% versus 5.8% in total of all gastrectomies in gastric Ca) from whom 8 subjects (5.6%) underwent surgical reintervention. Hospital mortality was 8.6% (n=17) compared to 8.0% in all patients with gastric Ca.
Conclusion: More than 50% of patients diagnosed with cardia Ca show an advanced tumor stage at the time of surgical intervention. Not all resections estimated as potentially curative were accompanied by D2 lymphadenectomy. In particular, to further improve R0 resection rate, to consequently use intraoperative fresh frozen section for the detection of an adequate tumor-free resection margin & to lower the rate of anastomotic insufficiency, it is suggested to treat patients with cardia Ca at surgical centres for optimal outcome (5-year survival rate is being under investigation).

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