Surgical treatment of gastric cancer invading the oesophagus

Introduction: There is controversy regarding which type of surgical treatment is most appropriate for upper gastric cancer invading the oesophagus. Methods: A review of the pertinent literature was carried out regarding oesophageal involvement in gastric cancer. Results: Invasion of the oesophagus occurred in 26-63% of Western surgical series. It was more frequent in Borrmann IV type, linitis plastics, pT3-pT4, diffuse type by Lauren, N + or tumours exceeding 5 cm in diameter. Lymphatic tumour spread was caudad (coeliac nodes, hepatoduodenal nodes, paraortic nodes) but mediastinal nodes were also involved if tumour growth in the oesophagus exceeded 3 cm or if there was transmural oesophageal infiltration. In Western countries there was less than 30% 5-year survival and no long-term survivors when hepatoduodenal or mediastinal nodes were metastatic. Mediastinal dissection through thoracotomy did not provide ally benefit. Conclusions: A rational approach involves total gastrectomy plus partial oesophagectomy. Abdominal transhiatal resection may be performed in the case of a localized, non-infiltrating tumour and oesophageal involvement 12 cm. However, infiltrating, poorly differentiated or Borrmann III-IV tumours require a right, thoracotomy to achieve a longer margin of clearance. When oesophageal involvement is >3 cm, or hepatoduodenal or mediastinal nodes are positive, no surgical procedure is curative and the literature demonstrates that extended aggressive surgery has no (C) 2000 Harcourt Publishers Ltd.