Background: There had been a lack of international consensus about the definition of cancer of the gastric cardia until Siewert's classification was approved at a consensus conference during the second Internation...
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Background: There had been a lack of international consensus about the definition of cancer of the gastric cardia until Siewert's classification was approved at a consensus conference during the second International Gastric Cancer Congress held in 1997. Study Design: A review of the prospective gastric cancer database at Aichi Cancer Center from 1983 to 1992 identified 1,913 gastric carcinoma patients who underwent gastrectomy. These patients were classified retrospectively according to the Siewert classification, and 177 patients who fell into one of the three types form the basis of this study. Survival analyses were performed after stratifying patients by clinicopathologic variables. Results: There were 33 patients with type II and 144 with type III, although none had type I, a type frequently observed in the west. No evidence of a change in the frequency of types II or III cancers (approximately 9.3% overall) among gastric carcinoma patients was observed over the 10-year period. Clinical staging of gastric carcinoma by the TNM classification was found to reflect accurately the prognosis of these patients. There were no longterm survivors among the few patients with metastasis to the perigastric nodes of the distal stomach. Conclusions: A striking difference in the distribution of types of adenocarcinoma of the gastroesophageal junction was observed in Japan compared with previously reported western data. A subgroup of carcinoma of the proximal stomach identified as types II and III may not require proximal gastrectomy from the viewpoint of sufficient lymphadenectomy. (J Am Coll Surg 1999;189:594-601. (C) 1999 by the American College of Surgeons).
The prevalence of anastomotic strictures in esophageal anastomoses provides us with limited information about the anastomotic healing process. This prospective study evaluates the exact esophageal anastomotic diameter...
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The prevalence of anastomotic strictures in esophageal anastomoses provides us with limited information about the anastomotic healing process. This prospective study evaluates the exact esophageal anastomotic diameters in 256 patients who underwent esophagectomy and esophagogastrostomy without pyloroplasty (n = 107) or total gastrectomy and Roux reconstruction (12 = 149). NO perioperative chemoradiotherapy was given. Anastomotic strictures and diameters were assessed during endoscopy by a separately inserted (inflated to the anastomotic width) balloon catheter. The anastomotic diameters increased significantly during the first postoperative year in the esophagectomy (p = 0.001) and gastrectomy (p < 0.001) groups. The anastomoses in the gastrectomy group were significantly wider than those in the esophagectomy group 3 (25.7 versus 19.9 mm), 6 (28.5 versus 22.0 mm), and 12 (30.5 versus 23.3 mm) months after surgery (p < 0.001). Neither the anastomotic site (neck or chest) in the esophagectomy group (p = 0.176) nor that in the gastrectomy group (abdomen or chest) (p = 0.577) influenced the anastomotic diameter. Benign anastomotic strictures were most frequently found after 3 months and after esophagectomy. Esophagojejunostomies performed with 2 linear stapling devices or cartridge size 28 mm showed the widest anastomoses with only 1 stricture. Esophagogastric anastomoses following esophagectomy are narrower and develop more strictures than esophagojejunal anastomoses after total gastrectomy, but both dilate during the first year.
Why do reports from large volume single institutions continue to demonstrate low operative mortalities, short hospital stays, and prolonged patient survivals for patients with gastric cancer treated by D2 lymphadenect...
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Why do reports from large volume single institutions continue to demonstrate low operative mortalities, short hospital stays, and prolonged patient survivals for patients with gastric cancer treated by D2 lymphadenectomy when randomized trials show no survival advantage and increased operative mortality with this procedure? Should gastric cancer resections be added to the growing list of procedures with reduced mortality and improved survivorship when performed in high-volume institutions? Although not a randomized trial, the report by Dr. Sierra and colleagues from the University of Navarra in Paploma, Spain, adds credence to the concept that D2 resections can be performed safely and provide enhanced survival when performed in high-volume hospitals by a small group of experienced surgeons.1,2 The D2 dissection that they performed included total gastrectomy and splenectomy but did not require resection of the tail of the pancreas as performed in the Dutch and British randomized trials.3,4 Instead, lymph nodes along the splenic artery (station 11 in the Japanese classification) were usually dissected away from surrounding tissues to be included with the resected specimen. Pancreatic fistulas did occur in three of the eight D2 patients who required pancreatic resection. This suggests that, in the randomized trials, the pancreatic resection, rather than the splenectomy and the D2 lymphadenectomy, was the major cause of the excess operative mortality in the D2 group.3,4
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