From the Guidelines
For a mass at the cardia, the most appropriate surgical approach would be an Ivor Lewis esophagectomy (option A). This procedure is specifically designed to address tumors at the cardia while ensuring adequate margins, as it involves removing the lower portion of the esophagus, the gastroesophageal junction, and the upper portion of the stomach, followed by reconstruction using the remaining stomach pulled up into the chest to create an anastomosis with the remaining esophagus 1.
Key Considerations
- Total gastrectomy would remove the entire stomach but might not address esophageal involvement adequately.
- Subtotal gastrectomy would likely leave positive margins for a cardia tumor.
- Gastrojejunostomy is merely a bypass procedure that doesn't remove the tumor and would be inappropriate for cancer management.
- The Ivor Lewis procedure allows for proper oncologic resection with lymph node removal from both the abdomen and chest, which is essential for staging and potential cure of gastroesophageal junction malignancies.
Evidence Support
The most recent and highest quality study, published in 2017 by the Italian Research Group for Gastric Cancer, supports the use of an Ivor Lewis esophagectomy for tumors at the cardia, emphasizing the importance of ensuring adequate margins and addressing both abdominal and thoracic lymph node involvement 1. This approach is consistent with guidelines for the management of oesophageal and gastric cancer, which recommend extended total gastrectomy or oesophago-gastrectomy for cardia, subcardia, and some type II oesophago-gastric junctional cancers 1.
Surgical Approach
The choice of surgical approach depends on the location and stage of the cancer, with the goal of achieving clear longitudinal and circumferential margins and appropriate lymphadenectomy. For a mass at the cardia, an Ivor Lewis esophagectomy is the most appropriate surgical approach, as it allows for proper oncologic resection and reconstruction, minimizing the risk of positive margins and ensuring the best possible outcome for the patient.
From the Research
Mass at Cardia Treatment Options
- The treatment for a mass at the cardia, which is the region where the esophagus meets the stomach, often involves surgical procedures to remove the tumor and affected areas.
- The choice of surgical procedure depends on the location, size, and type of tumor, as well as the patient's overall health.
Surgical Procedures
- Ivor Lewis Esophagogastrectomy: This procedure involves the removal of the lower part of the esophagus and the upper part of the stomach, and is often used to treat tumors in the cardia region 2, 3, 4, 5.
- Total Gastrectomy: This procedure involves the removal of the entire stomach, and may be used to treat tumors that are located in the upper part of the stomach or that have spread to the entire stomach 6.
- Subtotal Gastrectomy: This procedure involves the removal of a portion of the stomach, and may be used to treat tumors that are located in the lower part of the stomach.
- Gastrojejunostomy: This procedure involves the creation of a connection between the stomach and the small intestine, and may be used to treat tumors that are blocking the flow of food from the stomach into the small intestine.
Considerations
- The choice of surgical procedure will depend on the specific characteristics of the tumor and the patient's overall health.
- Minimally invasive surgical techniques, such as laparoscopy and thoracoscopy, may be used to perform these procedures, which can result in less pain and a faster recovery time for the patient 2, 3.