Resection of esophageal and gastric cardia long-term effect

By | March 22, 2012

The treatment of esophageal and gastric cardia, in the present surgical resection is effective treatment of choice, our scholars through the efforts of several generations of esophageal and gastric cardia in the etiology, pathology, epidemiology, diagnosis, treatment and other aspects has made considerable progress, a leading position. But the overall treatment effect is not ideal, the total operation rate is only about 20% -30%, surgical resection is about 90%. Operative mortality of esophageal and gastric cardia were 2.3% -5.5% and 0.9% -2.4%. The overall 5 year survival rate of esophageal cancer, Parkinson doors were responsible for 22% -40% and 16% -24%, early surgical resection of esophageal and gastric cardia was 100% survival rate after 5 years 92.6% 10-year survival rate reached 72.6%. Although the surgical treatment of esophageal and gastric cardia has been significant progress, but the long-term results are not satisfactory, nearly 2 / 3 of the surgery patients died within 5 years after surgery, these patients died early after operation, mostly in advanced cancer, death The main reason for tumor recurrence and metastasis. That the surgical treatment of esophageal and gastric cardia should focus on early diagnosis, early treatment, surgery should be as thorough a wide range of resection, and then adjuvant therapy to improve efficacy. According to several groups of large numbers of domestic case report of surgical treatment, surgical resection of esophageal and cardiac causes long-term effects are the following.
Resection of esophageal and gastric cardia long-term effect (1), tumor length. The length and long-term efficacy of cancer have a certain relationship. The development of esophageal cancer in the growth process, both to the length of the development, but also to the deep violation. Therefore, the more elderly disease, its external invasion of surrounding tissue and the more the chance of lymph node metastasis, radical resection of the lesion is low too.
(2) regional lymph node metastases. Cancer, lymph node excision, metastasis pathologically confirmed, their 5-year survival rate was significantly reduced. Esophageal and gastric cardia the transfer of the lymphatic system is a major way. Cancer cases of lymph node metastasis, distant lymph node metastasis may be the same time. This often in the postoperative patient or any other place because of mediastinal lymph node metastasis and death.
(3) complete resection of cancer. Resection of esophageal cancer should pay attention to the length and breadth. Cut down the length of required resection of normal esophageal cancer 5cm, breadth required by the cancer invading adjacent tissues and lymph nodes with cancer to be removed. According to the literature, the upper and lower cancer resection by 5cm, the pathological examination of its cutting edge is still about 10% are found in cancer cells. Therefore, the complete removal of cancer, but also with long-term effect of surgery has a certain relationship.
Resection of esophageal and gastric cardia long-term effect of the factors, in addition to the above three aspects, the patient's age, tumor histologic type, tumor differentiation and the immune capacity of patients are on long-term effect after a certain impact. To improve the resection of advanced esophageal and gastric cardia long-term effect, with the exception should be based on lesion length, tumor histological type, cancer and other conditions with or without foreign invasion, but also to grasp the principles of cancer surgery, strict and meticulous selection of surgical indications . Removal of the cancer should pay attention to the length and breadth, as far as possible radical resection of cancer. Improve operative techniques, such as cancer free operation during the rough, over powerhouse squeezing and kneading, the line may cause cancer cells to blood or lymphatic metastasis, long-term effect of surgery. Soft and delicate surgical operation, suture ligation of solid and reliable, not only can reduce the chance of metastasis, and can reduce the complications and improve surgical outcomes.

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