The term “cardioectomy,” while not a formal medical procedure name, commonly refers to the surgical removal of the stomach’s upper section, known as the cardia. This procedure is formally designated as a proximal gastrectomy or an esophagogastrectomy. The surgery is typically performed to treat malignant tumors, particularly early-stage cancers located in the upper third of the stomach or at the gastroesophageal junction. The goal is to achieve complete removal of the diseased tissue while preserving healthy stomach function.
Understanding the Cardia: Location and Function
The cardia is the anatomical gateway between the tubular esophagus and the stomach. It is situated just below the diaphragm and surrounds the opening where food passes into the stomach cavity. This region is functionally significant because it contains the lower esophageal sphincter (LES), a ring of muscle tissue.
The function of the cardia and its sphincter is to act as a one-way valve, allowing swallowed food to enter the stomach while preventing acidic contents from flowing back up into the esophagus. This anti-reflux barrier is achieved through the muscle’s resting pressure and the angle at which the esophagus enters the stomach.
Specific Tissues Excised
The surgical procedure to remove the cardia, known as proximal gastrectomy, involves the excision of several distinct anatomical structures. The core tissue removed is the cardia and the gastroesophageal junction (GEJ). To ensure all cancerous or diseased cells are removed, a margin of healthy tissue is also taken.
This includes a segment of the lower esophagus, typically 2 to 3 centimeters, and the adjacent upper portion of the stomach, known as the fundus. Removing the fundus and upper stomach is necessary to obtain a clear margin around the tumor.
A crucial part of the procedure, especially when performed for cancer, is a regional lymphadenectomy, or lymph node dissection. Lymph nodes surrounding the stomach and lower esophagus are removed for staging the disease and to eliminate any microscopic spread of cancer. The specific lymph node groups excised depend on the tumor’s location but typically include those along the lesser and greater curvatures of the stomach and those near the celiac artery.
Reconstruction of the Upper Digestive Tract
Following the removal of the cardia and the upper stomach segment, the remaining digestive tract must be surgically reconnected to restore the passage of food. This reconnection, called an anastomosis, is a complex step because the natural anti-reflux mechanism has been removed.
The most straightforward method is an esophagogastrostomy, where the remaining esophagus is directly sewn to the remaining portion of the stomach. While esophagogastrostomy is simpler, it often results in severe acid reflux.
To counter this, surgeons employ more complex anti-reflux reconstruction techniques. One method is jejunal interposition, which involves taking a segment of the small intestine (the jejunum) and inserting it between the esophagus and the remnant stomach. The interposed jejunal segment acts as a replacement barrier, leveraging peristaltic action to push food downward and resist upward flow. Another approach is double-tract reconstruction, which creates two pathways for food, allowing some food to pass through the remaining stomach and some to bypass it.