Cardia ; Gastric Fundus ; Humans ; Stomach Neoplasms ; surgery

Both pylorus-preserving gastrectomy (PPG) and segmental gastrectomy (SG) achieve the preservation of gastric cardia and pylorus through the circumferential resection of stomach, while concepts and surgical procedures of these two operations are obviously different. In this sense, transectional gastrectomy includes both PPG and SG. PPG is one of the standard surgical procedure for early gastric cancer (EGC). The extent of lymph node dissection (No.1, 3, 4sb, 4d, 6, 7, 8a, 9) and the retention of infrapyloric vessels, hepatic and pyloric branch of vagal nerve has formed a consensus. Meanwhile, SG is regarded as an investigational treatment according to the Japanese gastric cancer treatment guidelines. It is still controversial and may generate an ethical risk in the clinical practice. This article distinguishes the difference in the concepts and surgical procedures between PPG and SG, assisting a comprehensive evaluation in further research.
Cardia ; Gastrectomy ; Humans ; Lymph Node Excision ; Pylorus ; Stomach Neoplasms/surgery*

Cardia ; Esophageal Neoplasms ; surgery ; Humans ; Neoplasm Recurrence, Local ; surgery ; Reoperation ; Stomach Neoplasms ; surgery

Adenocarcinoma of esophagogastric junction (AEG) is the adenocarcinoma locating in the boundary of esophagus and cardia. Because of its increasing incidence, it has drawn attention widely around the world. In the 11th edition of Japanese Classification of Esophageal Cancer, the diagnosis of AEG should integrate endoscopy, upper gastrointestinal barium contrast and pathology. There are two classifications for AEG, Siewert classification and Nishi classification. In the 8th TNM staging manual, cancer crossing the esophagogastric junction (EGJ) with their epicenter within the proximal 2 cm of the stomach is incorporated into the esophagus chapter, whereas cancer crossing the EGJ with their epicenter in the proximal 2 to 5 cm of the stomach is addressed in the stomach chapter. All the tumors in stomach that do not cross the EGJ are classified as stomach cancer. The surgical approach of AEG remains controversial. Previous researches have suggested that abdominal transhiatal approach should be applied to Siewert type II and III. With respect to minimally invasive surgery, for Siewert I, the mediastinal and abdominal lymphadenectomy is conducted by thoracoscopy and laparoscopy respectively. After that a gastric tube is placed and the reconstruction is performed in the cervix. For Siewert type II, the whole procedure is accessed by laparotomy, and the lower mediastinum is accessed transhiatally. After lymphadenectomy the anastomosis can be laparoscopy-assisted or totally laparoscopic. As for Siewert type III, both circular and linear stapler can be used to perform reconstruction. With the development of surgical technology and continuous renovation of equipment, laparoscopic resection for AEG will be more and more popular.
Adenocarcinoma ; surgery ; Cardia ; surgery ; Esophageal Neoplasms ; surgery ; Esophagogastric Junction ; surgery ; Humans ; Minimally Invasive Surgical Procedures ; Stomach Neoplasms ; surgery

While endoscopic submucosal dissection (ESD) is widely used to treat gastrointestinal tumors, it is rarely used for subepithelial tumors (SETs) originating from the muscularis propria of the esophagus and gastric cardia because of the risk of perforation and problems with inadequate space and field of view during procedures. Submucosal tunneling endoscopic resection (STER) is a new therapeutic method for treating SETs in specific locations in the esophagus and stomach. This technique is highly skill-dependent, using a mucosal flap that covers a deeper part of the gut wall, but is safe and minimally invasive compared with conventional endoscopic approaches such as ESD in SETs originating from the muscularis propria.We report a patient who underwent STER to remove a SET located at the gastric cardia. The patient recovered without any complications. We believe that our case shows the efficacy and safety of the STER technique for patients with a SET originating from the muscularis propria.
Cardia/pathology/surgery ; Endosonography ; Gastric Mucosa/pathology/surgery ; Gastroscopy ; Humans ; Leiomyoma/*diagnosis/surgery ; Male ; Middle Aged ; Stomach Neoplasms/*diagnosis/surgery

Endoscopic full-thickness resection (EFTR) is a natural orifice transluminal endoscopic surgery (NOTES) that was developed to overcome the limitations of laparoscopic resection and conventional endoscopic resection methods (endoscopic mucosal resection and endoscopic submucosal dissection). EFTR can be performed with endoscopy only or combined with a laparoscopic approach. During EFTR, the lesions can be exposed to peritoneum or not. Laparoscopic and endoscopic cooperative surgery (LECS) is a well-known procedure in which the lesion is exposed to peritoneum. Non-exposed endoscopic wall-inversion surgery (NEWS) and simple non-exposure EFTR were developed to escape the exposure of the lesions to peritoneum. Submucosal tunneling method may be a good candidate for treatment of subepithelial tumors at the esophagogasric junction and gastric cardia. This review will give an overview about current EFTR techniques to treat subepithelial tumors and adenocarcinoma of stomach.
Adenocarcinoma ; Cardia ; Endoscopy ; Natural Orifice Endoscopic Surgery ; Peritoneum ; Stomach ; United Nations

OBJECTIVETo study the result of surgical treatment of benign ulcer of the gastric cardia.

METHODSClinical symptom, number, position and size of ulcer, preoperative X-ray gastroscopic examine, type and complication of operation were retrospective analyzed in 21 patients with benign ulcer of the gastric cardia.

RESULTSAverage age in 21 patients was 60. Ulcer complicated bleeding in 7 cases (33.3%) and perforation in 5 cases (23.8%). Diagnostic rate of preoperative X-ray and gastroscopic examine was 57.1% and 100%, respectively. Of 21 patients 18 (85.7%) were treated by upper partial gastrectomy, and 3 (14.3%) by total gastrectomy. All were not operative death and anastomotic leak.

CONCLUSIONSupper partial gastrectomy can resect focus of ulcer and decrease secretion of stomach acid. It is a simple and ideal pattern of operation for patients with benign ulcer of the gastric cardia.

Adult ; Aged ; Cardia ; Female ; Humans ; Male ; Middle Aged ; Prognosis ; Stomach Ulcer ; surgery

OBJECTIVE: To assess the value of proximal gastrectomy (PG) and total gastrectomy (TG) for the treatment of cancer of cardia and fundus. METHODS: Publications on comparision between PG and TG in the treatment of cancer of cardia and fundus were collected, the data from the publications were matched with the PG group and the TG group respectively according to its corresponding surgical resection, and the data on postoperative complications, motality and 5-year survival rate were meta-analyzed by fixed effect model and random effect model. RESULTS: Thirteen reseaches on 2 219 patients were included in this study, 2 of which were randomly controlled studies. There were no significant differences in the postoperative complications (OR=1.00, 95%CI: 0.44-2.28,P>0.05) and mortality (OR=1.25, 95%CI: 0.62-2.48,P>0.05) between the PG group and the TG group, while there was significant difference in the 5-year survival rate (HR=0.87, 95%CI: 0.76-0.99,P=0.04). The 5-year survival rate in the TG group was higher than that in the PG group. CONCLUSION Total gastrectomy for the treatment of cancer of cardia and fundus has better long-term therapetic effect.
Cardia ; pathology ; Gastrectomy ; methods ; Gastric Fundus ; pathology ; Humans ; Prognosis ; Stomach Neoplasms ; mortality ; surgery ; Survival Rate

OBJECTIVETo study the feasibility and influence of vagus nerve preservation in radical operation for proximal gastric cancer.

METHODSThirty-two patients with early or T2 cardia cancer from May 2007 to May 2009 were enrolled and randomized into two groups, i.e. vagus nerve preservation group(n=16) and control group(n=16). Two groups were compared with regard to operative time, anastomotic fistula, digestive discomforts, body weight, survival rate, findings on gastroscope and abdominal ultrasonography.

RESULTSThere were no statistically significant differences between the two groups in operative time (2.8 vs. 2.5 h), postoperative complications rate (25.0% vs. 31.3%). No recurrence or mortality was observed after one-year follow-up. However, patients who underwent vagus nerve preservation had less postprandial discomforts(3 vs. 12 cases), bile reflux(3 vs. 10 cases), atrophic gastritis(1 vs. 9 cases), gallstones(1 vs. 8 cases), body mass index, and diarrhea(P<0.05).

CONCLUSIONFor patients with early gastric cancer, preservation of the vagus nerve during radical gastrectomy results in less complications and does not compromise patient survival.

Adult ; Aged ; Cardia ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Prospective Studies ; Stomach Neoplasms ; surgery ; Vagus Nerve ; surgery

OBJECTIVETo study the biological behavior of cardial cancer and its influence on surgical management.

METHODSComplete clinicopathologic data of 46 cases with cardial cancer undergoing radical gastrectomy was investigated retrospectively. The relationships between tumor Borrmann type, depth of invasion, growth pattern, lymph node metastasis and 5-year survival rate postoperative were analyzed.

RESULTSOf 46 cases, Borrmann type III, Type IV and Type II was 76% (35/46), 18% (8/46) and 6% (3/46) respectively; 5-year survival rate was 40% (14/35), 0 (0/8) and 100% (3/3) respectively. In respect of the depth of invasion, pT(2) was 31% (14/46) cases with 71% (10/14) lymph node metastasis; and 5-year survival rate was 64% (9/14). pT(3) was 15% (7/46) cases with 86% (6/7) lymph node metastasis; and 5-year survival rate was 57% (4/7). And pT(4) was 54% (25/46) cases with 92% (23/25) lymph node metastasis; and 5-year survival rate was 12% (3/25). The growth pattern in 87% (40/46) cases was infiltrative; and 5-year survival rate was 28% (11/40); the growth pattern in 13% (6/46) cases was expansive; and 5-year survival rate was 100% (6/6).

CONCLUSIOND(2)(+) radical total gastrectomy should be performed on the developed cardial cancer, and if necessary, resection of body and tail of pancreas should be chosen.

Aged ; Aged, 80 and over ; Cardia ; Female ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Invasiveness ; Prognosis ; Stomach Neoplasms ; pathology ; surgery