@article{Potrč_Ivanecz_Krebs_Marolt_Iljevec_Jagrič_2018, title={Outcomes of the surgical treatment for adenocarcinoma of the cardia – single institution experience}, volume={52}, url={https://www.radioloncol.com/index.php/ro/article/view/2887}, abstractNote={<p style="margin: 0cm 0cm 0pt; line-height: 200%;"><strong style="mso-bidi-font-weight: normal;"><span style="line-height: 200%; font-family: ’Century Gothic’,’sans-serif’; font-size: 12pt; mso-fareast-font-family: ’Times New Roman’; mso-bidi-font-family: Arial;" lang="EN-US">Background </span></strong></p><p style="margin: 0cm 0cm 0pt; text-align: justify; line-height: 200%; tab-stops: 14.2pt 16.0cm;"><span style="line-height: 200%; font-family: ’Century Gothic’,’sans-serif’; font-size: 12pt;" lang="EN-US">Adenocarcinomas at the cardia are biologically aggressive tumors with poor long-term survival following curative resection.</span><span style="line-height: 200%; font-family: ’Century Gothic’,’sans-serif’; font-size: 12pt; mso-fareast-font-family: ’Times New Roman’; mso-bidi-font-family: Arial;" lang="EN-US"> For resectable adenocarcinoma of the cardia, mostly esophagus extended total gastrectomy or <a name="_Hlk490485602">esophagus extended proximal gastric resection </a>is performed; however, the surgical approach, transhiatal or transthoracic, is still under discussion. </span></p><p style="margin: 1em 0px 0pt; text-align: justify; line-height: 200%; mso-add-space: auto;"><strong style="mso-bidi-font-weight: normal;"><span style="line-height: 200%; font-family: ’Century Gothic’,’sans-serif’; font-size: 12pt; mso-fareast-font-family: ’Times New Roman’; mso-bidi-font-family: Arial;" lang="EN-US">Patients and methods.</span></strong></p><p style="margin: 1em 0px 0pt; text-align: justify; line-height: 200%; mso-add-space: auto;"><span style="line-height: 200%; font-family: ’Century Gothic’,’sans-serif’; font-size: 12pt; mso-fareast-font-family: ’Times New Roman’; mso-bidi-font-family: Arial;" lang="EN-US">Of altogether 844 gastrectomies performed between January 2000 and December 2016, 166 were done for the adenocarcinoma of the gastric cardia. Postoperative morbidity, mortality and long-term survival were analyzed to evaluate the potential differences in clinically relevant outcomes.</span></p><p style="margin: 1em 0px 0pt; text-align: justify; line-height: 200%; mso-add-space: auto;"><strong style="mso-bidi-font-weight: normal;"><span style="line-height: 200%; font-family: ’Century Gothic’,’sans-serif’; font-size: 12pt; mso-fareast-font-family: ’Times New Roman’; mso-bidi-font-family: Arial;" lang="EN-US">Results</span></strong></p><p style="margin: 1em 0px 0pt; text-align: justify; line-height: 200%; mso-add-space: auto;"><span style="line-height: 200%; font-family: ’Century Gothic’,’sans-serif’; font-size: 12pt; mso-fareast-font-family: Calibri; mso-bidi-font-family: Arial; mso-fareast-theme-font: minor-latin;" lang="EN-US">136 were esophagus extended total gastrectomy and 125 </span><span style="line-height: 200%; font-family: ’Century Gothic’,’sans-serif’; font-size: 12pt; mso-fareast-font-family: ’Times New Roman’; mso-bidi-font-family: Arial;" lang="EN-US">esophagus extended proximal gastric resection. A </span><span style="line-height: 200%; font-family: ’Century Gothic’,’sans-serif’; font-size: 12pt; mso-fareast-font-family: Calibri; mso-bidi-font-family: Arial; mso-fareast-theme-font: minor-latin;" lang="EN-US">D2 lymphadenectomy was performed in 88.2%, splenectomy in 47.2%, and multivisceral resections in 12.4% of patients.</span></p><p style="margin: 1em 0px 0pt; text-align: justify; line-height: 200%; mso-add-space: auto;"><span style="line-height: 200%; font-family: ’Century Gothic’,’sans-serif’; font-size: 12pt; mso-fareast-font-family: Calibri; mso-bidi-font-family: Arial; mso-fareast-theme-font: minor-latin;" lang="EN-US">R0 resection rate was 95.7%. The mean proximal resection margin on the esophagus was 42.45mm. It was less than 21mm in 9 patients. Overall morbidity regarding Clavien-Dindo classification (> 1) was altogether 28.6%. 15.5% were noted as surgical and 21.1% as medical complications. The 30-day mortality was 2.2%. The 5-year survival for R0 resections was 33.4%. Multivisceral resection, depth of tumor infiltration, nodal stage, and curability of the resection were identified as independent prognostic factors using the Cox proportional hazards model.</span></p><p style="margin: 1em 0px 0pt; text-align: justify; line-height: 200%; mso-add-space: auto;"><strong style="mso-bidi-font-weight: normal;"><span style="line-height: 200%; font-family: ’Century Gothic’,’sans-serif’; font-size: 12pt; mso-fareast-font-family: ’Times New Roman’; mso-bidi-font-family: Arial;" lang="EN-US">Conclusion</span></strong></p><p style="margin: 1em 0px 0pt; text-align: justify; line-height: 200%; mso-add-space: auto;"><span style="line-height: 200%; font-family: ’Century Gothic’,’sans-serif’; font-size: 12pt; mso-fareast-font-family: ’Times New Roman’; mso-bidi-font-family: Arial;" lang="EN-US">Transhiatal approach for resection of adenocarcinoma of the cardia is a safe procedure for patients with Siewert II and III regarding the postoperative morbidity and mortality; moreover, long-term survival is comparable to transthoracic approach. The complications associated with thoracoabdominal approach can therefore be avoided with no impact on the rate of local recurrence. </span></p><p style="margin: 1em 0px 0pt; text-align: justify; line-height: 200%; ; mso-add-space: auto; mso-layout-grid-align: none;"><strong style="mso-bidi-font-weight: normal;"><span style="line-height: 200%; font-family: ’Century Gothic’,’sans-serif’; font-size: 12pt; mso-fareast-font-family: ’Times New Roman’; mso-bidi-font-family: Arial;" lang="EN-US"> </span></strong></p><p style="margin: 0cm 0cm 0pt; line-height: 200%;"><strong style="mso-bidi-font-weight: normal;"><span style="line-height: 200%; font-family: ’Century Gothic’,’sans-serif’; font-size: 12pt; mso-fareast-font-family: Calibri; mso-bidi-font-family: Arial; mso-fareast-theme-font: minor-latin;" lang="EN-US">Key words: </span></strong><span style="line-height: 200%; font-family: ’Century Gothic’,’sans-serif’; font-size: 12pt; mso-fareast-font-family: Calibri; mso-bidi-font-family: Arial; mso-fareast-theme-font: minor-latin;" lang="EN-US">proximal gastric cancer, transhiatal resection, complications, survival<strong style="mso-bidi-font-weight: normal;"><span style="background: yellow; mso-highlight: yellow;"><br style="page-break-before: always; mso-special-character: line-break;" clear="all" /> </span></strong></span></p>}, number={1}, journal={Radiology and Oncology}, author={Potrč, Stojan and Ivanecz, Arpad and Krebs, Bojan and Marolt, Urška and Iljevec, Bojan and Jagrič, Tomaž}, year={2018}, month={Feb.} }