Esophageal Invasion of Carcinoma of Gastric Cardia

As carcinoma of gastric cardia (CGC), which is defined as adenocarcinoma within 3 cm from the esophago-gastric junction, often invades into the esophagus, the determination of safe proximal margin of resection is important for curative operation. Analysis of the mode of the esophageal invasion is valuable in this sense. Of 1546 patients with gastric carcinoma resected at our hospital during from 1976 to 1988, 120 patients had CGC and were evaluated clinico-pathologically. The esophageal invasion was found in 79 of 120 CGCs histologically. Correlations between prognosis and clinical specific features and pathological findings were compared between 2 groups of the patients with and without esophageal invasion of CGC. Significant negative correlations were found between prognosis and cancer infiltration in the proximal edge resected (ow(+)). According to the microscopic appearances, types of esophageal invasions were divided into the following 5 varieties, 1) localized variety, 2) intermediate variety, 3) infiltrating variety, 4) lymphatic variety and, 5) blood vessel variety. The factor ow(+) was highly distributed in the groups of blood vessel, lymphatic and infiltrating varieties, and the blood vessel factor was found in Borrmann 1 or 2 type CGC. Invasion into the esophageal wall via muscularis propria and adventitia were uncommon routes, however, the frequency of ow(+) was higher in these routes than in the other routes. As detection of cancer infiltration in the proximal esophageal edge is impossible only by palpation, rapid and carefull detection with frozen section at operation is necessary for curative operation of CGC.