Since the carcinomas of the cardia and the adenocarcinomas of the esophagus show many similarities in their histological and morphological descriptions, a detailed comparative study was attempted on the basis of 66 esophageal carcinomas in adenoid differentiation, 359 carcinomas of the cardia, 1288 gastric carcinomas in infracardial localisation, and 492 squamous carcinomas of the esophagus. The evaluation yielded no significant differences between the adenocarcinomas of the esophagus and the cardia neither in age and sex distribution nor with regard to the classifications of Borrmann, WHO, Ming, and Laurén, but a significant discrimination was possible between esophageal and cardial adenocarcinoma together, on the one hand, and infracardial gastric carcinoma on the other. Furthermore, esophageal adenocarcinomas were localized preferentially in the lower third, unlike squamous carcinomas of the same organ. These results suggest that esophageal adenocarcinoma and carcinoma of the cardia must be considered as one separate entity, probably originating from a common stem cell. They further suggest that the cardia belongs to the esophagus rather than to the stomach.

Several etiopathogenetic factors responsible for carcinogenesis in the operated stomach have been proposed in the literature, but exact proof is still lacking. An experimental assay was planned to determine the pathogenetic roles of surgical trauma, of duodenogastric reflux, and of carcinogen application and its effects. Five different techniques of gastric surgery were performed on a collective of 466 Wistar rats: Billroth I resection, Billroth II resection, Billroth II plus gastroenterostomy with Roux-en-Y technique, Billroth II plus Braun's anastomosis, and gastroenterostomy without resection. Forty-two animals were left unoperated as controls. The appropriate date for autopsy was determined by general clinical observation and random endoscopic and radiologic examinations, and eventually fixed on the 56th postoperative week.Carcinomas developing in the resected stomach were found in animals with and without carcinogen exposure. The actual rate of carcinoma incidence was strongly dependent on the surgical procedure chosen for the respective group. The lowest carcinoma incidence (0%) was found in gastroenterostomy without Roux-en-Y anastomosis, the highest rate (70% without carcinogen, 50% with carcinogen application) in gastroenterostomy alone.Tumor development was found to be connected with alterations of the physiological environment induced by the surgical intervention; a direct association between duodenogastric reflux and tumorigenesis can be postulated. The results of the present study are interpreted with an emphasis on reflux-preventing techniques for gastric surgery that should be included in clinical routine.

In a part retrospective, part prospective study, 354 carcinomas of the cardia were compared with 1259 infracardial gastric carcinomas with regard to the age and sex of the patients, macroscopic classification, microscopic classifications, depth of invasion, and survival rates. Mortality rates are generally higher in cardia carcinoma than in stomach carcinoma. The difference is due to the significantly poorer survival of cardia carcinoma patients in stage I, while mortality rates in stages II, III, and IV of both types are approximately similar. Highly significant differences were also found with regard to sex ratio, incidence of macro- and microscopic subtypes, and invasive growth. The typical cardia carcinoma occurs preferentially in men, is mostly well-delineated, and is manifested as an ulcerated or polypoid, well-differentiated tumor of expansive growth, corresponding to Laurén's intestinal type. These results confirm the concepts of McPeak and Warren, MacDonald, and Siewert et al., that the carcinoma located in the cardia must be seen as a separate entity of gastric carcinoma.

No abstract

No abstract