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CARCINOMA OF THE CARDIA — A TWENTY‐YEAR STUDY
Author(s) -
Nelson P. G.,
Dunlop Sir Edward
Publication year - 1970
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/j.1326-5377.1970.tb77781.x
Subject(s) - medicine , surgery , dysphagia , cachexia , adenocarcinoma , resection , cancer
An independent retrospective analysis of 126 cases of carcinoma of the cardia between the years 1948 and 1968 has been made, and the results of surgical treatment have been analysed. Patients In the fourth to the eighth decade were predominantly affected, with an average age of 60 years. The predominant symptoms were weight loss, dysphagia and cachexia of 3 to 18 months' duration. Adenocarcinoma predominated, but squamous and undifferentiated growths were seen. Most tumours were locally advanced, and in most cases regional lymph glands were involved. Almost all patients were submitted to surgical exploration. In the majority, resection was possible, and two‐thirds of these procedures were regarded as potentially curative. The operative mortality of all procedures, including curative resection, palliative resection and bypass, was high, reflecting the high resection rate and the extent and hazards of major operation in elderly patients who were for the most part in poor condition. Subtotal upper gastric resection carried no less an operative mortality than total gastric resection. Suture‐line leakage and pulmonary complications were major factors In mortality. After gastric resection replacement with interposed jejunal segments provided the greatest insurance against leakage; Roux‐en‐Y replacement provided the least. Curative resection produced few long‐term survivors; but some patients survived for periods of seven to 20 years. Late recurrence Is a risk after subtotal gastric resection. Large, locally advanced tumours with regional node involvement do not preclude long‐term survival. Resection offers the swiftest and longest palliation of dysphagia, but bypass achieves good palliation in non‐resectable tumours. The continued use of surgical procedures is supported by the palliation achieved and the long‐term survival In some cases.