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Jiang R, Wang Y, Xu J, Chen Z, Pang L. Reconstruction using the colon or jejunum in patients with synchronous advanced esophageal and gastric cancers: a retrospective study from a single institutional database. BMC Surg 2023; 23:175. [PMID: 37370053 DOI: 10.1186/s12893-023-02072-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
PURPOSE The aim of this study was to evaluate the feasibility and efficacy of simultaneous resection of synchronous advanced esophageal and gastric cancers. METHODS We retrospectively analyzed the clinical data of 16 patients who underwent resection of synchronous advanced esophageal squamous cell carcinoma (ESCC) and gastric adenocarcinoma from January 2009 to Dec 2021. Subtotal esophagectomy and total gastrectomy were performed using the Ivor-Lewis or McKeown approach. Reconstruction was performed using a pedicled jejunal graft or colon interposition. Perioperative and postoperative data of all patients were analyzed. RESULTS There were no in-hospital mortalities following surgery, but 9 patients (56.3%) suffered major perioperative complications. Comparison of the groups that received reconstruction using the jejunum and the colon indicated similar incidences of perioperative complications, overall survival, and disease-free survival. Cox regression analysis indicated that lymph node metastasis of both cancers was independent risk factor for overall survival. CONCLUSION The existence of synchronous tumors of the esophagus and stomach is not unusual, the radical surgical treatment could be carried out whenever possible.
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Affiliation(s)
- Rongrong Jiang
- Department of Cardiothoracic Surgery, Huashan Hospital, Fudan University, #12 Wulumuqi Rd. (M), Shanghai, 200040, P.R. China
| | - Youbo Wang
- Department of Cardiothoracic Surgery, Huashan Hospital, Fudan University, #12 Wulumuqi Rd. (M), Shanghai, 200040, P.R. China
| | - Juefeng Xu
- Department of Nursing, Huashan Hospital, Fudan University, Shanghai, P.R. China
| | - Zhiming Chen
- Department of Cardiothoracic Surgery, Huashan Hospital, Fudan University, #12 Wulumuqi Rd. (M), Shanghai, 200040, P.R. China
| | - Liewen Pang
- Department of Cardiothoracic Surgery, Huashan Hospital, Fudan University, #12 Wulumuqi Rd. (M), Shanghai, 200040, P.R. China.
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Papaconstantinou D, Tsilimigras DI, Moris D, Michalinos A, Mastoraki A, Mpaili E, Hasemaki N, Bakopoulos A, Filippou D, Schizas D. Synchronous resection of esophageal cancer and other organ malignancies: A systematic review. World J Gastroenterol 2019; 25:3438-3449. [PMID: 31341367 PMCID: PMC6639548 DOI: 10.3748/wjg.v25.i26.3438] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 05/01/2019] [Accepted: 06/01/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Neoplasms arising in the esophagus may coexist with other solid organ or gastrointestinal tract neoplasms in 6% to 15% of patients. Resection of both tumors synchronously or in a staged procedure provides the best chances for long-term survival. Synchronous resection of both esophageal and second primary malignancy may be feasible in a subset of patients; however, literature on this topic remains rather scarce.
AIM To analyze the operative techniques employed in esophageal resections combined with gastric, pancreatic, lung, colorectal, kidney and liver resections and define postoperative outcomes in each case.
METHODS We conducted a systematic review according to PRISMA guidelines. We searched the Medline database for cases of patients with esophageal tumors coexisting with a second primary tumor located in another organ that underwent synchronous resection of both neoplasms. All English language articles deemed eligible for inclusion were accessed in full text. Exclusion criteria included: (1) Hematological malignancies; (2) Head/neck/pharyngeal neoplasms; (3) Second primary neoplasms in the esophagus or the gastroesophageal junction; (4) Second primary neoplasms not surgically excised; and (5) Preclinical studies. Data regarding the operative strategy employed, perioperative outcomes and long-term outcomes were extracted and analyzed using descriptive statistics.
RESULTS The systematic literature search yielded 23 eligible studies incorporating a total of 117 patients. Of these patients, 71% had a second primary neoplasm in the stomach. Those who underwent total gastrectomy had a reconstruction using either a colonic (n = 23) or a jejunal (n = 3) conduit while for those who underwent gastric preserving resections (i.e., non-anatomic/wedge/distal gastrectomies) a conventional gastric pull-up was employed. Likewise, in cases of patients who underwent esophagectomy combined with pancreaticoduodenectomy (15% of the cohort), the decision to preserve part of the stomach or not dictated the reconstruction method (whether by a gastric pull-up or a colonic/jejunal limb). For the remaining patients with coexisting lung/colorectal/kidney/liver neoplasms (14% of the entire patient population) the types of resections and operative techniques employed were identical to those used when treating each malignancy separately.
CONCLUSION Despite the poor quality of available evidence and the great interstudy heterogeneity, combined procedures may be feasible with acceptable safety and satisfactory oncologic outcomes on individual basis.
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Affiliation(s)
- Dimitrios Papaconstantinou
- Third Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens 12462, Greece
| | - Diamantis I Tsilimigras
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH 43210, United States
| | - Dimitrios Moris
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, United States
| | | | - Aikaterini Mastoraki
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens 11527, Greece
| | - Efstratia Mpaili
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens 11527, Greece
| | - Natasha Hasemaki
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens 11527, Greece
| | - Anargyros Bakopoulos
- Third Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens 12462, Greece
| | - Dimitrios Filippou
- Department of Anatomy and Surgical Anatomy, National and Kapodistrian University of Athens, Medical School, Athens 11527, Greece
| | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens 11527, Greece
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Pyloroantrectomy and Pedunculated Short Gastric-Tube Interposition in Esophageal Carcinoma Patients Associated With Early Gastric Adenocarcinoma. Int Surg 2019. [DOI: 10.9738/intsurg-d-16-00011.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Gastric carcinoma is one of the most common secondary malignancies in esophageal cancer patients. We herein report our surgical procedure for esophageal reconstruction in esophageal cancer patients associated with synchronous or metachronous early gastric adenocarcinoma. Gastric adenocarcinoma was removed by pyloroantrectomy with preservation of the right gastroepiploic artery and vein, and a pedunculated short gastric tube was used as an esophageal substitute in a Roux-en-Y fashion. Surgical data of 6 esophageal cancer patients who underwent this type of surgery between 1993 and 2012 were analyzed. Three patients had synchronous early gastric carcinoma and the remaining 3 patients had metachronous early gastric adenocarcinoma. The gastric tube was easily pulled up to the neck and no problems occurred during this procedure. Postoperative complications, including leakage of esophagogastrostomy, acute respiratory failure, and diffuse peritonitis, were observed in 3 patients. No patients suffered from necrosis of the gastric tube. Although 3 patients died of other diseases, gastric cancer recurrence has not been observed to date. Despite the need for precaution to ensure technical safety, pyloroantrectomy and esophageal reconstruction using a pedunculated short gastric-tube are oncologically feasible as a potential curative surgery for esophageal cancer patients with early gastric adenocarcinoma.
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Huguenin JFL, Azevedo VVZD, Almeida HIB, Oliveira IMD, Pinto CE. Synchronous esophageal squamous cell carcinoma and gastric adenocarcinoma. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2013; 26:246-7. [PMID: 24190388 DOI: 10.1590/s0102-67202013000300019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Han JS, Choi SR, Jang JS, Roh MH, Kim DC, Ryu SH, Woo SM, Hsing CT. A Case of Synchronous Esophagus and Stomach Cancer Successfully Treated by Combined Chemotherapy. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2012; 60:113-8. [DOI: 10.4166/kjg.2012.60.2.113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Ji Sun Han
- Department of Gastroenterology, Dong-A University College of Medicine, Busan, Korea
| | - Seok Reyol Choi
- Department of Gastroenterology, Dong-A University College of Medicine, Busan, Korea
| | - Jin Seok Jang
- Department of Gastroenterology, Dong-A University College of Medicine, Busan, Korea
| | - Myung Hwan Roh
- Department of Gastroenterology, Dong-A University College of Medicine, Busan, Korea
| | - Dae Cheol Kim
- Department of Pathology, Dong-A University College of Medicine, Busan, Korea
| | - Seung Hee Ryu
- Department of Gastroenterology, Dong-A University College of Medicine, Busan, Korea
| | - Su Mi Woo
- Department of Gastroenterology, Dong-A University College of Medicine, Busan, Korea
| | - Chien Ter Hsing
- Department of Gastroenterology, Dong-A University College of Medicine, Busan, Korea
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Kanda T, Sato Y, Yajima K, Kosugi SI, Matsuki A, Ishikawa T, Bamba T, Umezu H, Suzuki T, Hatakeyama K. Pedunculated gastric tube interposition in an esophageal cancer patient with prepyloric adenocarcinoma. World J Gastrointest Oncol 2011; 3:75-8. [PMID: 21603033 PMCID: PMC3098435 DOI: 10.4251/wjgo.v3.i5.75] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2010] [Revised: 04/26/2011] [Accepted: 05/03/2011] [Indexed: 02/05/2023] Open
Abstract
Gastric carcinoma is one of the malignancies that are most frequently associated with esophageal carcinoma. We describe herein our device for advanced esophageal cancer associated with early gastric cancer in the antrum. A 57-year-old man presenting with dysphagia and upper abdominal pain was admitted to our hospital. Preoperative examinations revealed locally advanced squamous cell carcinoma (SCC) of the middle thoracic esophagus (T3N0M0 Stage IIA) and mucosal signet-ring cell carcinoma of the gastric antrum (T1N0M0 Stage IA). Although the gastric tumor appeared to be an intramucosal carcinoma, its margin was obscure, so endoscopic en-bloc resection was considered inadequate. We chose surgical resection of the gastric tumor as well as the esophageal SCC after neoadjuvant chemotherapy with 5-fluorouracil and cisplatin for advanced esophageal cancer. Following transthoracic esophagectomy with three-field lymph node dissection, the gastric carcinoma was removed by gastric antrectomy, which preserved the right gastroepiploic vessels, and a pedunculated short gastric tube was used as the esophageal substitute. Twenty-eight months after the surgery, the patient is well with no evidence of cancer recurrence. Because it minimizes surgical stress and organ sacrifice, gastric tube interposition is a potentially useful technique for esophageal cancer associated with localized early gastric cancer.
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Affiliation(s)
- Tatsuo Kanda
- Tatsuo Kanda, Yu Sato, Kazuhito Yajima, Shin-ichi Kosugi, Atsushi Matsuki, Takashi Ishikawa, Takeo Bamba, Katsuyoshi Hatakeyama, Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata City 951-8510, Japan
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Park YK, Kim DY, Joo JK, Kim JC, Koh YS, Ryu SY, Kim YJ, Kim SK. Clinicopathological features of gastric carcinoma patients with other primary carcinomas. Langenbecks Arch Surg 2004; 390:300-5. [PMID: 15599757 DOI: 10.1007/s00423-004-0525-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2004] [Accepted: 09/21/2004] [Indexed: 02/06/2023]
Abstract
BACKGROUND Multiple primary carcinomas are increasingly being found because of the development of diagnostic techniques and the increasing incidence of early stage carcinoma. The purpose of this study was to determine the prevalence and clinicopathological features of gastric carcinoma patients with other primary carcinomas. METHODS There were 65 (incidence 2.6%) gastric carcinoma patients with other primary carcinomas compared with 2,444 patients with gastric carcinoma alone. RESULTS Associated primary carcinomas were often found in the gastrointestinal (GI) tract, especially in the colon (33.8%). In patients with gastric carcinoma only, poorly differentiated adenocarcinoma was the most common (43.2%), followed by moderately and well-differentiated adenocarcinoma. Similarly, poorly differentiated adenocarcinoma (33.8%) was also the prevalent histological type in gastric carcinoma patients with other primary carcinomas, although its incidence was lower. The stage of gastric carcinoma did not differ between the two groups. The estimated 5-year survival rate was 51.6% for patients with gastric carcinoma alone, and 50.7% for those with other primary carcinomas; the difference was not significant (P=0.82). CONCLUSION Gastric carcinoma should be treated aggressively, since the prognosis of gastric carcinoma patients treated for other primary carcinomas is not poorer than that of patients treated for gastric carcinoma alone.
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Affiliation(s)
- Young Kyu Park
- Division of Gastroenterologic Surgery, Department of Surgery, Chonnam National University Medical School, 8, Hakdong, Dongku, Gwangju, 501-757, South Korea
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Kyriazanos ID, Tachibana M, Yoshimura H, Kinugasa S, Dhar DK, Nagasue N. Impact of splenectomy on the early outcome after oesophagectomy for squamous cell carcinoma of the oesophagus. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2002; 28:113-9. [PMID: 11884045 DOI: 10.1053/ejso.2001.1235] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AIM Operative procedures for oesophageal malignancies are becoming more extensive and may result in fatal complications. Splenectomy compromises the immune system and can lead to increased susceptibility to infections. The aim of the present study was to report the early outcome of patients who underwent oesophagectomy and simultaneous splenectomy due to oesophageal squamous cell carcinoma (SCC). METHODS Pre-operative risks and post-operative morbidity and mortality in 135 patients who had undergone extensive oesophagectomy without simultaneous splenectomy for SCC of the thoracic oesophagus were compared with those of 14 patients who had undergone oesophagectomy associated with splenectomy. RESULTS Post-operative pneumonia, intra-abdominal abscess, post-operative sepsis and anastonotic leakage were significantly increased when splenectomy was added to the original operation. The incidence of in-hospital death was significantly higher among splenectomized than non-splenectomized patients (35.7% vs 8.1%, P<0.01). Pulmonary complications and leakage were the main causes of death. Multivariate analysis recognized splenectomy as an independent prognostic factor for in-hospital death following transthoracic oesophagectomy for SCC. CONCLUSION The addition of splenectomy to transthoracic oesophagectomy for oesophageal carcinoma can be a fatal combination. Preservation of the spleen should be the primary intention. In circumstances that necessitate splenectomy precautions should be taken to prevent post-operative infectious complications.
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Affiliation(s)
- I D Kyriazanos
- Second Department of Surgery, Shimane Medical University, Izumo, 693 8501, Japan.
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Kokawa A, Yamaguchi H, Tachimori Y, Kato H, Watanabe H, Nakanishi Y. Other primary cancers occurring after treatment of superficial oesophageal cancer. Br J Surg 2001; 88:439-43. [PMID: 11260113 DOI: 10.1046/j.1365-2168.2001.01696.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Recent advances in endoscopic diagnosis and treatment have led to better prognosis for patients with superficial oesophageal cancer. The incidence of subsequent other primary cancer (SOPC) has become a new problem for patients who survive after treatment of superficial oesophageal cancer. METHODS Between 1966 and 1998, 368 patients with superficial oesophageal cancer, histologically confirmed as squamous cell carcinoma after resection, were reviewed for the presence of SOPC. RESULTS Among the 368 patients, 43 developed SOPC. The most frequent sites of SOPC were the stomach (11 patients) and hypopharynx (11). Subsequent cancers of the stomach and hypopharynx developed significantly more frequently in heavy smokers. The 5-year cumulative occurrence rate of subsequent cancers within the fields of endoscopy of the upper gastrointestinal tract (stomach, hypopharynx and residual oesophagus) was 15 per cent. CONCLUSION Gastric and hypopharyngeal cancers were frequently found after resection of superficial oesophageal cancer. A history of heavy smoking at the time of initial resection may be a risk factor. To make an early diagnosis of subsequent cancers, follow-up observation by upper gastrointestinal endoscopy is important after treatment of oesophageal cancer.
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Affiliation(s)
- A Kokawa
- Department of Gastrointestinal Oncology, National Cancer Centre Hospital, Tokyo, Japan
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Hamabe Y, Ikuta H, Nakamura Y, Kawasaki K, Yamamoto M. Clinicopathological features of esophageal cancer simultaneously associated with gastric cancer. J Surg Oncol 1998; 68:179-82. [PMID: 9701211 DOI: 10.1002/(sici)1096-9098(199807)68:3<179::aid-jso9>3.0.co;2-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND OBJECTIVES We usually use the stomach for esophageal substitution in the surgical treatment of esophageal cancer, although it is often associated with gastric cancer. In order to improve the likelihood of safe and curative surgery of esophageal cancer, we investigated the clinicopathological characteristics of synchronous esophageal and gastric cancer. METHODS Among 288 patients with primary esophageal cancer who had undergone esophageal resection, this cancer was associated with gastric cancer in 11 cases, and 1,416 gastric cancer patients operated on during the same period, were analyzed. The clinicopathological characteristics and surgical procedures of the 11 patients were compared with those of the other esophageal cancer patients and with those with the gastric cancer only. RESULTS There were significant differences between the synchronous double cancer and the gastric cancer only in sex (P < 0.01) and location of the gastric cancer (P < 0.05). All of the patients with the synchronous double cancer were men, and the incidence of patients with cardiac cancer was high. CONCLUSIONS Our findings suggest that, in cases of synchronous esophageal and gastric cancer, an adequate surgical procedure must be chosen in terms of the stage, location, and operative burden.
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Affiliation(s)
- Y Hamabe
- The First Department of Surgery, Kobe University School of Medicine, Japan
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Murata S, Kato H, Tamura H, Tachimori Y, Watanabe H, Yamaguchi H, Nakanishi Y. Second primary carcinoma in the residual cervical esophagus after thoracic esophagectomy: report of five cases. J Surg Oncol 1997; 66:130-3. [PMID: 9354170 DOI: 10.1002/(sici)1096-9098(199710)66:2<130::aid-jso11>3.0.co;2-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVES Development of second primary carcinomas after thoracic esophagectomy has become of much concern, because recently the prognosis of thoracic esophageal carcinoma after esophagectomy with extended lymph node dissection has been improving. We report our experience of diagnosing and treatment second primary carcinomas arising in the remaining esophagus after thoracic esophagectomy. METHODS Among 253 patients who underwent esophagectomy for thoracic esophageal carcinoma more than 2 years previously, second primary esophageal carcinomas developed in five (2.0%), and these five patients were examined. RESULTS All second primary carcinomas were found by endoscopy, and were diagnosed as superficial carcinoma (Tis or T1) of the residual cervical esophagus. One patient underwent laser irradiation, another endoscopic mucosal resection, two had surgical mucosectomy, and one segmental resection of the esophagus. After the second treatment, three patients were disease free for 37-38 months, one died of recurrent disease of the first carcinoma 36 months later, and one died of distant metastases of the second carcinoma 8 months later. There have been no local recurrences after treatments for the second primaries. CONCLUSIONS A variety of low-trauma treatments were employed for the second carcinomas because they were found at an early stage. Endoscopic follow-up is proposed to detect second lesions at an early stage.
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Affiliation(s)
- S Murata
- Department of Surgery, National Cancer Center Hospital and Research Institute, Tokyo, Japan
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