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[Therapeutic effects of transabdominal radical total gastrectomy on cardiac cancer: analysis of 56 cases].

OBJECTIVE
To evaluate the therapeutic effects of transabdominal radical total gastrectomy on cardiac cancer and analyze the factors influencing the prognosis.


METHODS
The clinicopathologic data of 56 cardiac cancer patients, 42 males and 14 females, aged 59 (27 - 81), who underwent transabdominal radical total gastrectomy from April 1993 to March 2003 were analyzed retrospectively.


RESULTS
The total lymph node metastatic incidence of the 56 patients was 71.4% (40/56). In 19 patients who underwent para-aortic lymphadenectomy, the metastatic rate of lymph node group 16 was 31.6% (6/19). The important factors influencing lymph node metastasis included the depth of tumor invasion, Borrmann type of the tumor, tumor size, and esophageal infiltration. The postoperative morbidity rate was 21.4% (12/56) and the postoperative complication rate was 3.6% (2/56). The overall 1-, 3-, and 5-year postoperative survival rates for the entire patient cohort were 77.6%, 47.7%, and 37.1% respectively. Univariate analysis showed that lymph node metastases, tumor size, histopathological type of the tumor, Borrmann type of the tumor, depth of tumor invasion, and esophageal infiltration significantly influenced the postoperative survival. The 5-year survival rate of the patients without lymph node metastasis was 63.3%, significantly higher than that of the patients with lymph node metastasis (25.4%, P = 0.011). Multivariate analysis by Cox regression showed that lymph node metastasis was an independent prognostic factor (P = 0.042).


CONCLUSION
Transabdominal radical total gastrectomy is an effective and safe procedure for treatment of Siewert type II and type III cardiac cancer. Lymph node metastasis is an important prognostic factor of these tumors.