Figure 1
List of surgical (A) and general complications (B) occurring within 90 days after resection (n = 161)
| n | % | ||
|---|---|---|---|
| No complications | 136 | 84.5 | |
| Intraabdominal abscess | 6 | 3.7 | |
| Intraabdominal bleeding (within 48h) | 4 | 2.5 | |
| Acute gangrenous cholecystitis | 2 | 1.2 | |
| Leak from the esophagojejuno anastomosis | 3 | 1.9 | |
| Enteric fistula | 1 | 0.6 | |
| Disruption of laparotomy | 1 | 0.6 | |
| Ileus | 2 | 2.5 | |
| Ischemic colitis | 1 | 0.6 | |
| Pancreatitis | 4 | 2.5 | |
| Late rupture of pseudoaneurysm of splenic a. | 1 | 0.6 | |
| Total complications | 25 | 15.5 | |
| n | % | ||
| No complications | 127 | 78.9 | |
| Heard failure | 9 | 5.5 | |
| Bronchopneumonia | 11 | 6.8 | |
| Pneumo/ fluidothorax | 3 | 1.9 | |
| Pulmonary embolia | 2 | 1.2 | |
| Brain stroke | 3 | 1.9 | |
| Febrile state of unknown origin | 5 | 3.1 | |
| Decompensation of liver cirrhosis | 1 | 0.6 | |
| Total complications | 33 | 21.1 | |
Multivariate analysis (Cox regression) for long-term survival after resection for adenocarcinoma of the cardia (n = 149, 90-day mortality excluded)
| B | HR | 95,0% CI | p | ||
|---|---|---|---|---|---|
| Lower | Upper | ||||
| Multivisceral resection | -0.716 | 0.489 | 0.273 | 0.876 | 0.016 |
| T < 3 vs. T> 2 | -1.065 | 0.345 | 0.181 | 0.655 | 0.001 |
| N 0 vs. N > 0 | -0.620 | 0.538 | 0.307 | 0.942 | 0.030 |
| Curability of resection (R) | 0.747 | 2.110 | 1.359 | 3.276 | 0.001 |
Pattern of recurrence after resection of the cardia for adenocarcinoma (n = 149, 90-day mortality excluded)
| n | % | |
|---|---|---|
| No recurrence | 95 | 63.8 |
| Infradiaphragmal local recurrence | 24 | 16.1 |
| Supradiaphragmal local recurrence | 2 | 1.3 |
| Liver metastases | 8 | 5.4 |
| Liver metastases and infradiaphragmal recurrence | 8 | 5.4 |
| Lung metastases | 1 | 0.7 |
| Lung metastases and infradiaphragmal recurrence | 1 | 0.7 |
| Lung metastases and supradiaphragmal recurrence | 3 | 2.0 |
| Liver and lung metastases | 5 | 3.4 |
| Dissemination - other (bones, neck) | 2 | 1.3 |
| Total | 149 | |
Clinicopathological characteristics of the patients resected for adenocarcinomas of the cardia (ACC)
| Gender (n=161) | Male | 120 | 74.5% | |
| Female | 41 | 25.5% | ||
| Age(Mean, 95% CI) (n = 161) | 64. 6 ± 10.1 | Lower: 62.90 | Upper: 66.31 | |
| American Society of Anesthesiology score (ASA) (n = 161) | 1 | 53 | 32.9% | |
| 2 | 83 | 51.6% | ||
| 3 | 25 | 15.5% | ||
| Type of resection (n=161) | Distal esophagectomy and total gastrectomy | 136 | 84.5% | |
| Distal esophagectomy and proximal gastrectomy | 25 | 15.5% | ||
| Extend of lymphadenectomy (n = 161) | D1 | 19 | 11.8% | |
| D2 | 142 | 88.2% | ||
| Metastatic lymph nodes(mean, 95% CI) (n = 161) | 6.11 ± 7.7 | Lower: 4.91 | Upper: 7.32 | |
| All harvested lymph nodes(mean, 95% CI) (n = 161) | 23.20 ± 11.7 | 21.37 | 25.03 | |
| Splenectomy (n = 161) | 76 | 47.2% | ||
| Additional oncological resections | 20 | 12.4% | ||
| R0 resection | 154 | 95.7% | ||
| Proximal resection margin in mm(mean, 95% CI) (n = 142) | 42.45 ± 20.7 | Lower: 39.0 | Upper: 45.80 | |
| Proximal resection margin < 20 mm (in fixed specimen + 0,9cm stapler ring) (n = 142) | 9 | 5.6% | ||
| Diameter of the tumor in mm(mean, 95% CI) (n = 161) | 63.16 ± 23.1 | Lower: 58.18 | Upper: 68.15 | |
| Any type of oncological treatment completed | 56 | 34.8% | ||
Type of additional oncological resections (n = 161)
| n | % | |
|---|---|---|
| Left pancreatectomy | 9 | 5.6 |
| Liver resection | 1 | 0.6 |
| Local peritonectomy | 6 | 3.7 |
| Segmental resection of the jejunum | 1 | 0.6 |
| Resection of left suprarenal gland | 2 | 1.2 |
| Segmental colon resection | 1 | 0.6 |
| Total | 20 |
Correlation for long-term survival in univariate analysis (Log Rank) for different clinicopathological characteristics_ (n = 149, 90-day mortality excluded)
| Median survival (days) | HR | 95% CI | p | |||
|---|---|---|---|---|---|---|
| Lower | Upper | |||||
| Splenectomy | No | 1004 ± 148 | 1.502 | 0.998 | 2.260 | 0.049 |
| Yes | 616 ± 168 | |||||
| Multivisceral resection | No | 929 ±132 | 3.045 | 1.709 | 5.425 | < 0.0001 |
| Yes | 324 ± 158 | |||||
| Gradus of the tumor | 1 | 1377 ± 504 | ||||
| 2 | 855 ± 180 | 1.478 | 1.095 | 1.994 | 0.011 | |
| 3 | 613 ± 97 | |||||
| Perineural invasion | No | 1308 ± 466 | 2.118 | 1.377 | 3.260 | 0.001 |
| yes | 660 ± 65 | |||||
| T stage | T1 and 2 | 3839 ± less than 50% of patients censored | 4,147 | 2.297 | 7.488 | < 0.0001 |
| T3 and 4 | 611 ± 79 | |||||
| N stage | N0 | 1915 ± 424 | 3.037 | 1.810 | 5.096 | < 0.0001 |
| > N0 | 540 ± 70 | |||||
| Curability of the procedure (R) | R 0 | 846 ± 118 | 2.110 | 1.359 | 3.276 | < 0 0001 |
| R 1/2 | 260 ± 107 | |||||
Pathological classifications: depth of tumor infiltration (T), lymph node metastases (N), Lauren type, perinevral (n = 161)
| n | % | ||
|---|---|---|---|
| T0 | 1 | 0.6 | |
| T1 | 20 | 12.4 | |
| T2 | 21 | 13.0 | |
| T3 | 87 | 54.0 | |
| T4a | 22 | 13.7 | |
| T4b | 10 | 6.2 | |
| N0 | 48 | 29.8 | |
| N1 | 21 | 13.0 | |
| N2 | 41 | 25.5 | |
| N3a | 33 | 15.6 | |
| N3b | 18 | 11.2 | |
| Lauren type | Intestinal | 97 | 67.8 |
| Diffuse | 26 | 18.2 | |
| mixed | 20 | 14.0 | |
| Presence of perineural invasion | 82 | 54.2 | |