Cardiac Carcinoma Treatment
Surgical treatment for Cardiac Carcinoma:
Cardiac Carcinoma surgery indications: Surgical is recognized as the first choice for the Cardiac Carcinoma treatment. Because of its histology as adenocarcinoma or mucinous adenocarcinoma, radiotherapy is almost null and void, chemical treatment has little effect. Cardiac surgery indications:
Because of the anatomical characteristics of cardiac, liver, spleen, transverse colon, pancreas tail, kidney, adrenal gland, small intestine, diaphragm, retroperitoneal organ, and many other adjacent, but also has a rich lymphatic drainage and upward into the mediastinum, down along the greater curvature and small bending the proliferation of the two main channels, but also within the infiltration in the stomach wall, even to the whole stomach, the digestive tract imaging is generally impossible to show all of the above-mentioned process, the application of foam double contrast radiography may be clear that mass, soft tissue shadow, mucosal damage, ulcers, stomach wall, such as thickening of the scope, but to change the regular X-ray light than the actual situation. Application of abdominal CT, tumor can understand the relationship with the surrounding organs, but the comparison of CT seen in esophageal and cardiac carcinoma is often found in the positive not quite sure, for example, whether the invasion of the pancreas, often wrong, CT suspected infiltration of pancreatic tail and there was no adhesion, CT that is not associated with the pancreas, but the abdominal tumor adhesion and invasion of pancreatic agglomerans. CT help to identify liver metastases, regional lymph node metastasis but not very accurate judgments. In short, pre-operative to determine the extent of cardiac development, it is estimated that the possibility of its removal is a very difficult thing, is currently unresolved clinical problem. In order not to lose patients to treatment. Abdominal B-, CT angiography, such as esophagus and stomach, as well as positive inspection found that unless there is a general spread of the transfer of evidence should be given to exploration for resection of lesions and to restore the continuity of the digestive tract.
Methods of the Cardiac Carcinoma surgical treatment:
The use of standard posterolateral thoracotomy left chest incision, the rib section 7, and then at the top of the left diaphragm in order to make a radial axis of esophageal abdominal incision. Such an approach, a good showing on the cardia area, enough to line sub-total gastrectomy and gastric week and left gastric lymph node dissection of blood vessels. Such as the need to expand the scope of resection, the combined resection of the entire stomach or spleen, pancreas and other parts can move forward under the extension of the incision to the abdominal wall, cutting off the left arch costal diaphragm and abdominal muscles, it is easy to become a thoraco-abdominal incision fully exposed on the abdomen.
In mind and old age patients with lower reserve of lung function, can use the second ventral neck incision thoracotomy from esophageal allocate part of varus gastrectomy, cervical esophagogastric anastomosis. To open exploration after lesions can be removed through the gastric or abdominal esophagus to esophageal bougie openings to the neck, esophagus and neck at this time has shown, in preparation for the anastomosis of the bottom of the site will be fixed in the ligation of esophageal bougie, the cut off the top of esophagus, continuous and evenly stretch bougie will flip esophageal drawing from top to bottom. Free part of the stomach of conventional gastric resection, the cut into a tube bending, transesophageal bed to fit into the neck and esophagus, the shortcomings of this operation is limited by the scope of gastric resection, can lead to lateral margin of gastric remnant cancer is not a net there. When the past mediastinal inflammation, such as the lymph nodes occurred in the nuclear and adhesion, the flip will have difficulties drawing, drawing, or fixed membranous tracheobronchial tear, occurred in the latter case required immediate open heart repair, such as prior has been estimated that there are difficulties in drawing the best way to remove the use of thoracotomy.
Commonly used surgical method is proximal subtotal gastrectomy. Adapted to small volume cardia tumor along the lesser curvature invasion not exceeding a total length of the extension of the 1 / 3. Specific surgical operations are as follows: No. 7 left outside the rib bed or intercostal thoracotomy, exploration under the esophagus, and then left before the hole cut for the axis of the diaphragm, abdominal exploration, liver, peritoneal metastasis, or when extensive lymph node metastasis along the major turn off from the greater omentum, the left gastroepiploic artery and splenic ligament in gastric short gastric artery, the left side of the diaphragm away from the broken foot, fully exposed under the esophagus to clear the site (including under the pulmonary ligament) lymph nodes. Gauze pad to open the pancreatic body and tail, to show blood vessels in and around the left gastric lymph nodes, lymph node dissection carefully, cut off the left gastric vascular ligation, devascularization hepatogastric ligament, proximal stomach completely free, in the greater curvature side of stomach cut, such as sewing machines have a stomach operation time can be saved. Request from the tumor margin Edge <5cm. Rotate the tube 90 °, then lower the residual end-to-end anastomosis, is a full-thickness layer in nodules suture, the outer up to the stomach muscle plasma enveloping the anastomotic invagination about 2cm, such as a telescope-like. With the former in order to prevent excessive appetite mucosa, muscular side effects of valgus coverage with operations, can be ring-open mouth stomach muscle, relaxation of the mucosa at this time due to back and in the case of distal muscular cuff exposed. Adequate hemostasis for submucosa, muscularis Qi distal mucosa of the plane cut off excess, when the gastric mucosa of the mouth is level with the muscular phase, with very clear vision when, close to the combined help.
When the tumor-infiltrating more than half the length of the stomach at the lesser curvature, should perform total gastrectomy. Need to break away from all the 5 groups of the blood supply of the stomach, total gastrectomy duodenal end after the suture for esophageal anastomosis in the jejunum. The simplest is the end-to-side anastomosis of esophagus jejunum, jejunum jejunal side-to-side anastomosis or Roux-Y jejunal esophageal anastomosis on the side, jejunum jejunum end-to-side anastomosis. Authors believe that the former operation than the simple preservation of jejunal blood better than the latter.
If the tumor has invaded the spleen and stomach or pancreatic tail ligament may be subtotal or total gastrectomy at the same time the spleen, pancreas tail excision. Proper attention to suture the cut surface pancreas, greater omentum and then the best coverage in order to prevent the occurrence of pancreatic fistula.
Cardiac Carcinoma surgery when the scope of gastric resection has been controversial. There are lines that total gastrectomy, and some authors advocate en bloc resection of the entire stomach, spleen, pancreatic tail, omentum and regional lymph nodes improved survival achieved. Also have more time and the whole effect after total gastrectomy and found no difference between survival, it is recommended only when the tumor involving the gastric body for total gastrectomy. The authors also found that when total gastrectomy splenectomy preventive splenoportography for lymph node metastasis are not good in the long-term survival, but no cases of lymph node metastasis splenoportography, not instead of splenectomy in a high survival rate. Splenectomy group there are high rates of postoperative recurrence of phenomena such as the death fast. Cardia for limited small-bend length of not more than 1 / 3 of the lesions, should be held in subtotal gastrectomy plus regional lymph node dissection, which is a more appropriate treatment approach.
Effects of the surgical treatment of Cardiac Carcinoma:
Effects of Cardiac Carcinoma surgery is worse than the esophagus surgery. Resection rate of the three major groups of domestic 73.7% ~ 82.1%, removal rate of 2.4% ~ 1.7%. The three group 5-year survival rate of 19.0% ~ 24.0%, 10-year survival rate of 8.6% ~ 14.3%.
Long-term survival of cardiac effects of the main factors for lymph node metastasis, serosal infiltration, as well as whether the tumor is removed in nature (radical or palliative). Cardiac international TNM staging, as a result of a combination of the first two variables is also a forecast of a valid indicator of patient prognosis.