Does贲门癌 Require Total Gastrectomy?

Gastric cardia cancer—the malignancy arising at the junction between the esophagus and stomach—does not automatically necessitate total gastrectomy. The surgical approach depends on several critical factors, including tumor size, depth of invasion (T stage), lymph node involvement (N stage), histologic subtype, and proximity to the gastroesophageal junction.

In early-stage disease—particularly T1a tumors confined to the mucosa—endoscopic resection may be curative. For locally advanced but resectable tumors, subtotal gastrectomy is often preferred when the distal margin can be safely preserved with negative microscopic margins (typically ≥5 cm from the tumor edge). This preserves gastric reservoir function and reduces postoperative nutritional complications such as dumping syndrome and weight loss.

Total gastrectomy becomes indicated when the tumor extends significantly into the proximal stomach or involves the gastroesophageal junction with inadequate proximal margin clearance, or when multifocal disease or extensive submucosal infiltration precludes safe partial resection. Lymphadenectomy—typically D2 dissection—is performed regardless of whether subtotal or total gastrectomy is undertaken, to ensure adequate regional nodal staging and oncologic control.

Preoperative staging via high-resolution endoscopy, endoscopic ultrasound, contrast-enhanced CT, and sometimes PET-CT guides surgical planning. Multidisciplinary evaluation—including input from medical oncology, radiation oncology, and nutrition support—is essential to determine optimal treatment sequencing, especially in borderline resectable or node-positive cases where neoadjuvant chemotherapy may downstage the tumor and expand surgical options.