Metachronous gastric carcinoma from a gastric tube after radical surgery for esophageal carcinoma

doi:10.1016/j.athoracsur.2003.09.071

The Annals of Thoracic Surgery

Volume 77, Issue 4, April 2004, Pages 1189-1192

https://doi.org/10.1016/j.athoracsur.2003.09.071 Get rights and content

Abstract

Background

Cases of metachronous gastric carcinoma arising from a gastric tube used for reconstruction have been increasing in long-term survivors of esophageal cancer in recent years. We investigated the characteristics of gastric tube carcinoma to determine the most appropriate approach to managing it.

Methods

Between 1980 and 1997, 508 patients underwent radical esophagectomy for esophageal carcinoma at Keio University Hospital. Reconstruction was performed with a gastric tube in 414 (81.5%) of them, and 8 of them developed a metachronous carcinoma in the gastric tube. The clinical and pathologic characteristics of the gastric tube carcinomas were evaluated in this study.

Results

Gastric cancer was detected during follow-up endoscopic examinations or in an upper gastrointestinal series in seven patients. All of the cancers were diagnosed as adenocarcinoma histopathologically. Endoscopic mucosal resection was performed in two patients, partial resection of the residual stomach was performed in three patients. One patient was treated by endoscopic mucosal resection as palliative therapy, since he had severe pulmonary emphysema. Total resection of the gastric tube was attempted in 2 advanced cases but was unsuccessful because of direct invasion of other organ by the cancer. The 5 patients who underwent curative resection are alive with no subsequent recurrence.

Conclusions

Since early diagnosis permits less invasive treatment and curative treatment is difficult in advanced cases, strict postoperative examinations are important after radical esophagectomy to ensure early detection of metachronous gastric carcinoma arising from gastric tubes used for reconstruction.

Section snippets

Patients and methods

Between 1980 and 1997, 872 patients with esophageal carcinoma were referred to Keio University Hospital and 508 of them were treated by radical esophagectomy. A gastric tube was used for reconstruction in 414 (81.5%) of these cases, and metachronous carcinoma has occurred in the gastric tube in 8 of them. Metachronous multiple primary carcinoma was defined according to the criteria described by Warren and Gates [10]: (1) the tumors had to be clearly malignant on histologic examination; (2) they

Results

The interval between the two malignancies ranged from 39 to 221 months (mean, 109). All patients were asymptomatic when their gastric carcinomas were detected. In 1 patient the cancer was suspected based on a high serum carcinoembryonic antigen level. The patient had been followed up by annual upper gastrointestinal (upper GI) series after the initial operation. The remaining seven cancers were detected during follow-up endoscopic examinations or upper GI series. The morphologic findings

Comment

As the prognosis of esophageal carcinoma has improved in recent years, the incidence of multiple carcinomas associated with esophageal carcinoma has been increasing, especially in gastric tube used for reconstruction 4, 5, 6, 7, 8, 9. The incidence of multiple cancers associated with esophageal carcinoma has been reported to be 8.3% to 12.6% 15, 16, 17, 18, 19.

From 1980 to 1997 the incidence of multiple cancers associated with esophageal carcinoma at Keio University Hospital was 11.5%. There

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Cited by (45)

Case report: Gastric tube cancer after esophagectomy—Retrograde perfusion after proximal resection of right gastroepiploic artery
2019, International Journal of Surgery Case Reports
We report a case of a 57-year-old patient with gastric tube cancer after subtotal esophagectomy and retrosternal gastric pull up.
The patient developed gastric cancer 4 years after undergoing treatment for esophageal squamous cell cancer; the treatments included thoracoscopic subtotal esophagectomy, gastric pull-up reconstruction via a retrosternal route in salvage setting following definitive chemoradiation. Because the gastric tube cancer was located around the pylorus, transabdominal partial resection, which is much less invasive than total resection via sternotomy, was performed. During surgery, retrograde pulsation of the proximally resected right gastroepiploic artery was observed. Owing to an ample blood supply to the oral remnant of the gastric tube, vascular reconstruction of the right gastroepiploic artery was omitted. The postoperative recovery was eventless.
The right gastroepiploic artery is considered essential for blood supply to the gastric tube. However, there was no sign of ischemia after proximal resection of this artery, which suggests the vasculature was altered after gastric tube construction.
This case shows that partial distal resection of the gastric tube can be performed safely without vascular reconstruction of the right gastroepiploic artery. Favorable long-term results after gastric tube reconstruction support the possibility of bilateral blood supply to the gastroepiploic arcade.
Advanced feasibility of endoscopic submucosal dissection for the treatment of gastric tube cancer after esophagectomy
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Citation Excerpt :
The number of patients with advanced esophageal SCC exhibiting long-term survival after undergoing radical esophagectomy has been increasing.3,12 In these cases, especially those in which the patient underwent radical esophagectomy with gastric tube reconstitution for advanced esophageal SCC, the development of GTC has been a major problem affecting survival for more than a decade.4-8 Because surgical resection of GTC is highly invasive and complicated,5 EMR is used to treat GTC when the lesion is superficial.6-8
Endoscopic submucosal dissection for gastric tube cancer after esophagectomy
2014, Gastrointestinal Endoscopy
Citation Excerpt :
We believe that these differences are attributed to the following factors: visualization of lesion margins was more difficult because of the long and narrow anatomic structure of the reconstructed gastric tube, 13% of our ESD procedures involved lesions outside the established indications (Table 3), and ESD for GTC was technically more difficult. The precise incidence of adverse events was not clearly established in previous reports because such reports involved small numbers of patients or mixed patients with surgical resections and ESDs for cancer in the remnant stomach after gastrectomy.11,19-24 In this study, perforations and delayed bleeding each occurred in 3.8% of the patients, which was similar to the adverse event results for ESDs performed in unresected stomachs.18,22,26,32
Recent improvements in the survival of patients after esophagectomy have led to an increasing occurrence of gastric tube cancer (GTC). Removal of the reconstructed gastric tube, however, can lead to high morbidity and mortality.
To assess the feasibility and effectiveness of endoscopic submucosal dissection (ESD) for GTC.
Retrospective study.
National Cancer Center Hospital, Tokyo, Japan.
We investigated patients with GTC after esophagectomy undergoing ESD from 1998 to 2011.
ESD.
Patient characteristics, endoscopic findings, technical results, histopathology including curability and Helicobacter pylori gastritis, and long-term outcomes.
There were 51 consecutive patients with 79 lesions including 38 lesions (48%) meeting the absolute indication, 31 (39%) satisfying the expanded indications, and 10 (13%) falling outside such indications. The median procedure time was 90 minutes. There were 73 en bloc resections (92%), 59 en bloc resections with tumor-free margins (R0 resections, 75%), and 51 curative resections (65%) based on the Japanese Gastric Cancer Association criteria. Fifty patients (98%) were assessed as H pylori gastritis positive. Adverse events included 3 perforations (3.8%) during ESD and 2 delayed perforations (2.5%) without any emergency surgery and 3 delayed bleeding (3.8%). Local recurrence was detected in 4 patients (7.8%), and metachronous GTCs were identified in 18 patients (35%). Five patients (10%) died of GTC including 3 metachronous lesions. The 5-year overall survival rate was 68.4%, and the disease-specific survival rate was 86.7% with 100% for curative and 72.7% for non-curative patients during a median follow-up period of 3.8 years (range, 0-12.1 years).
Single-center retrospective study.
ESD for GTC was feasible and effective for curative patients; however, long-term outcomes for non-curative patients were less satisfactory.
Thoracoscopic endoscopic cooperative surgery for gastric tube cancer after esophagectomy: a case report
2024, Journal of Surgical Case Reports
Successful Robot-Assisted Surgery for Advanced Metachronous Cancer in a Gastric Conduit after Esophagectomy: A Case Report
2024, Annals of Thoracic and Cardiovascular Surgery
Gastric Conduit Cancer following Ivor-Lewis Esophagectomy for Esophageal Adenocarcinoma: A Case Report and Literature Review
2023, Case Reports in Oncology

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Original article: general thoracicMetachronous gastric carcinoma from a gastric tube after radical surgery for esophageal carcinoma

Abstract

Background

Methods

Results

Conclusions

Section snippets

Patients and methods

Results

Comment

J Am Coll Surg

Semin Roentgenol

Radical lymph node dissection for cancer of the thoracic esophagus

Ann Surg

Improvement in the results of surgical treatment of advanced squamous esophageal carcinoma during 15 consecutive years

Ann Surg

Mortality and morbidity rates, postoperative course, quality of life, and prognosis after extended radical lymphadenectomy for esophageal cancer

Ann Surg

Secondary early carcinoma in a reconstructed gastric tube after subtotal esophagectomy for early carcinoma of the esophagus

Hepatogastroenterology

Metachronous early gastric carcinoma in a reconstructed gastric tube after radical operation for oesophageal carcinoma

J Gastroenterol Hepatol

Gastric tube gastrectomy

Dis Esophagus

Cancer of the gastric tube reconstructed through the posterior mediastinal route after radical surgery for esophageal cancer

Jpn J Thorac Cardiovasc Surg

Five cases of early gastric cancer in the reconstructred gastric tube afer radical resection for esophageal cancer

Jpn J Clin Oncol

Multiple primary malignant tumorsa survey of the literature and a statistical study

Am J Cancer

Original article: general thoracic
Metachronous gastric carcinoma from a gastric tube after radical surgery for esophageal carcinoma