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Agrawal R, Yang J, Ali S, Ghoulam E, Mutneja H, Bhurwal A, Boulay B, Villa EC. Safety and Efficacy of Endoscopic Submucosal Dissection in the Management of Gastric Tube Cancers After Esophagectomy: A Systematic Review. Cureus 2023; 15:e40526. [PMID: 37461759 PMCID: PMC10350321 DOI: 10.7759/cureus.40526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2023] [Indexed: 07/20/2023] Open
Abstract
Esophagectomy is the proposed standard of care for resectable primary esophageal cancers and recurrent lesions in the reconstructed gastric tube (GT); however, it carries significant morbidity and mortality. Endoscopic submucosal dissection (ESD) has established its role in the management of primary esophageal cancers with growing evidence of its safety in resecting recurrent primary lesions in GT. Our study aims to evaluate the safety and efficacy of ESD in the management of recurrent, localized primary esophageal cancers in GT. We searched PubMed, CENTRAL, EMBASE, Scopus, and clinical trial registries from inception to March 2023 for articles evaluating the safety and efficacy of ESD in the management of recurrent cancerous lesions in GT. Our primary outcome was the en bloc resection rate. Secondary outcomes were curative resection rate, complete resection rate, intra-procedural complication rate, post-procedure complication rate, and five-year survival rate. Seven studies with a total of 165 patients undergoing 192 ESDs were included in the review. The pooled en bloc resection rate was 92.5% (95% CI: 87.7-95.6), which was reported in all seven studies. Pooled complete resection rate was 78.9% (95% CI: 64.5-88.5) per three studies, pooled curative resection rate was 73.9% (95% CI: 63.5-82.2) per four studies, and pooled intra-procedural complication rate was 10.2% (95% CI: 1.5-46.3), which was reported in four studies. Only three studies reported a five-year survival rate that was 65.5% (95% CI: 56.0-73.9). ESD is safe and efficacious in the management of GT cancer after esophagectomy.
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Affiliation(s)
- Rohit Agrawal
- Gastroenterology and Hepatology, University of Illinois at Chicago, Chicago, USA
| | - James Yang
- Internal Medicine, University of Illinois at Chicago, Chicago, USA
| | - Saeed Ali
- Gastroenterology and Hepatology, University of Illinois at Chicago, Chicago, USA
| | - Elie Ghoulam
- Gastroenterology and Hepatology, University of Illinois at Chicago, Chicago, USA
| | - Hemant Mutneja
- Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - Abhishek Bhurwal
- Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, USA
| | - Brian Boulay
- Gastroenterology and Hepatology, University of Illinois at Chicago, Chicago, USA
| | - Edward C Villa
- Gastroenterology and Hepatology, NorthShore University Health System, Evanston, USA
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2
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Toyoshima Y, Narumiya K, Kudo K, Egawa H, Hosoda K. Comparative analysis of the outcomes of gastrectomy vs. endoscopic mucosal resection or endoscopic submucosal dissection for the treatment of gastric tube cancer after esophagectomy. Glob Health Med 2023; 5:40-46. [PMID: 36865898 PMCID: PMC9974229 DOI: 10.35772/ghm.2022.01059] [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: 09/12/2022] [Revised: 11/25/2022] [Accepted: 12/27/2022] [Indexed: 01/15/2023]
Abstract
This study investigated the clinical characteristics of patients with gastric tube cancer following esophagectomy at our hospital, and to examine the outcomes of gastrectomy versus endoscopic submucosal dissection. Of 49 patients who underwent treatment for gastric tube cancer that developed 1 year or more after esophagectomy, 30 patients underwent subsequent gastrectomy (Group A), and 19 patients underwent endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) (Group B). The characteristics and outcomes of these two groups were compared. The interval between esophagectomy and diagnosis of gastric tube cancer ranged from 1 to 30 years. The most common location was the lesser curvature of the lower gastric tube. When the cancer was detected early, EMR or ESD was performed, and the cancer did not recur. In advanced tumors, gastrectomy was performed but the gastric tube was difficult to approach and lymph node dissection was difficult; two patients died as a result of the gastrectomy. In Group A, recurrence occurred most often as axillary lymph node, bone, or liver metastases; in Group B, no recurrence or metastases were observed. In addition to recurrence and metastasis, gastric tube cancer is often observed after esophagectomy. The present findings highlight the importance of early detection of gastric tube cancer after esophagectomy and that the EMR and ESD procedures are safe and have significantly fewer complications compared with gastrectomy. Follow-up examinations should be scheduled with consideration given to the most frequent sites of gastric tube cancer occurrence and the time elapsed since esophagectomy.
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Affiliation(s)
| | - Kosuke Narumiya
- Address correspondence to:Kosuke Narumiya, Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawata-cho, Shinjuku-ku, Tokyo 162-8666, Japan. E-mail:
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3
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Khorobrykh T, Ivashov I, Spartak A, Babayan J, Andriyanov A, Pavlov P. Gastric Conduit Cancer following Ivor-Lewis Esophagectomy for Esophageal Adenocarcinoma: A Case Report and Literature Review. Case Rep Oncol 2023; 16:1196-1202. [PMID: 37900806 PMCID: PMC10601730 DOI: 10.1159/000531637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/19/2023] [Indexed: 10/31/2023] Open
Abstract
The incidence of gastric cancer associated with esophageal cancer is notably high. In recent years, there has been an increase in patients with gastric conduit cancers due to early detection and radical treatment of esophageal cancer, leading to prolonged survival of the patients. Metachronous gastric cancer following esophagectomy sometimes can pose a clinical challenge for surgeons, while gastric tube reconstruction is a well-established procedure accompanying esophagectomy, treating gastric cancer within the gastric tube can be difficult in contrast. Surgical treatment of gastric tube cancers is often complex and life-threatening. Early detection of gastric tube cancer is crucial for improving prognosis as it allows for less invasive surgical interventions. However, no specific guidelines for detecting gastric tube cancer have been established. In this report, we present a case of gastric tube cancer in a patient that had Ivor-Lewis surgery 20 years ago for preinvasive adenocarcinoma of the thoracic esophagus against the background of Barrett's esophagus. Recommendations for earlier and more accurate diagnosis and treatment of this pathology are discussed.
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Affiliation(s)
- Tatyana Khorobrykh
- Department of Faculty Surgery No. 2, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Ivan Ivashov
- Department of Faculty Surgery No. 2, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Alexey Spartak
- Department of Faculty Surgery No. 2, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Juliet Babayan
- Department of Faculty Surgery No. 2, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Andrey Andriyanov
- Department of Faculty Surgery No. 2, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Pavel Pavlov
- Department of Surgery, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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4
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Inokuchi Y, Watanabe M, Hayashi K, Kaneta Y, Furuta M, Machida N, Maeda S. Feasibility, efficacy, and cautionary note of endoscopic resection for gastric tube cancer after esophagectomy. Surg Endosc 2022; 36:8096-8106. [PMID: 35604483 PMCID: PMC9613559 DOI: 10.1007/s00464-022-09240-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 04/02/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Gastric tube cancer (GTC), whose usual histology is adenocarcinoma, occurs frequently as a result of improved survival after esophagectomy. Whether endoscopic resection (ER) for GTC is safe and suitable and guidelines for treatment and follow-up remains unclear. METHODS Patients with GTC who underwent ER at Kanagawa Cancer Center Hospital between 1997 and 2020 were studied retrospectively to evaluate clinical characteristics and short- and long-term outcomes. RESULTS Twenty-two consecutive patients with 43 lesions were treated in 42 sessions of ER. Lesions were discovered at a median of 9.0 (0-21.8) years after esophageal surgery. Nine (40.9%) patients had multiple lesions at the time of the initial ER session. However, six (54.5%) of the 11 co-existing lesions were overlooked. The location of the middle third was an estimated risk factor for overlooking (p = 0.028). In endoscopic submucosal dissection (ESD) cases, the en bloc dissection rate was as high as 97.1%, and the rates of bleeding, perforation, and aspiration pneumonitis were 17.6%, 0%, and 2.9%, respectively. The bleeding rate was relatively higher than that in usual gastric ESD. Twelve patients (54.5%) experienced synchronous and/or metachronous multiple GTCs during their life span. Thirteen (61.9%) patients died during the median follow-up period of 5.9 (0.7-15.5) years. One patient (7.7%) died of GTC recurrence, 15.4 years after the initial non-curative ER date; 3 (23.1%) patients died of esophageal cancer recurrence, and 3 (23.1%) died of other organ malignancies. The 5-year overall survival rate was 85.0%, and the 5-year disease-specific survival rate was 100%. CONCLUSIONS ER is feasible for GTCs. However, the rate of bleeding was high in ESD cases. Life-long endoscopic screening of metachronous lesions is desirable. Care should be taken not to overlook lesions in the middle third of the gastric tube. Early detection of esophageal cancer recurrence and other organ malignancies may improve prognosis.
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Affiliation(s)
- Yasuhiro Inokuchi
- Department of Gastroenterology, Kanagawa Cancer Center, 2-3-2 Asahi-ku, Nakao, Yokohama, Kanagawa, 241-8515, Japan.
| | - Mamoru Watanabe
- Department of Gastroenterology, Kanagawa Cancer Center, 2-3-2 Asahi-ku, Nakao, Yokohama, Kanagawa, 241-8515, Japan
| | - Kei Hayashi
- Department of Gastroenterology, Kanagawa Cancer Center, 2-3-2 Asahi-ku, Nakao, Yokohama, Kanagawa, 241-8515, Japan
| | - Yoshihiro Kaneta
- Department of Gastroenterology, Kanagawa Cancer Center, 2-3-2 Asahi-ku, Nakao, Yokohama, Kanagawa, 241-8515, Japan
| | - Mitsuhiro Furuta
- Department of Gastroenterology, Kanagawa Cancer Center, 2-3-2 Asahi-ku, Nakao, Yokohama, Kanagawa, 241-8515, Japan
| | - Nozomu Machida
- Department of Gastroenterology, Kanagawa Cancer Center, 2-3-2 Asahi-ku, Nakao, Yokohama, Kanagawa, 241-8515, Japan
| | - Shin Maeda
- Department of Gastroenterology, Yokohama City University, Yokohama, Kanagawa, 236-0004, Japan
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Tajima K, Shimada H, Nishi T, Kamei Y, Koyanagi K, Makuuchi H. Distal gastric tube resection with preservation of the right gastroepiploic artery for gastric tube cancer: a case report. Surg Case Rep 2021; 7:266. [PMID: 34928456 PMCID: PMC8688639 DOI: 10.1186/s40792-021-01340-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 12/04/2021] [Indexed: 11/10/2022] Open
Abstract
Background The incidence of gastric tube cancer is increasing because of improved survival rates in patients with esophageal cancer treated by esophagectomy. Total resection of the gastric tube is expected to be highly curative, but it is associated with a higher risk of severe postoperative complications. Herein we report a case of early gastric tube cancer that was successfully treated by distal gastric tube resection with preservation of the right gastroepiploic artery (RGEA). Case presentation An 82-year-old man was diagnosed as having gastric tube cancer, B-12-O, Type 0-IIc, T1b, N0, M0, cStage IA (Japanese Classification of Gastric Carcinoma). Upper gastrointestinal endoscopy showed a Type 0-IIc lesion measuring 30 mm in length in the lower part of the gastric tube, and histopathological examination of biopsy specimens revealed the features of poorly differentiated adenocarcinoma. The primary lesion could not be identified by computed tomography, and there was no obvious lymph node metastasis or distant metastasis. Considering that total resection of the gastric tube would have been highly invasive and that the gastric tube cancer was at a relatively early stage, we performed distal gastric tube resection with preservation of the RGEA. The postoperative course was uneventful, and the patient was discharged on postoperative day 12. There has been no recurrence during the 17 months of follow-up. Conclusion We successfully treated a patient with gastric tube cancer by distal gastric tube resection with preservation of the RGEA. This treatment strategy may be acceptable for patients with early gastric tube cancer without lymph node metastasis, considering the balance between the surgical invasiveness and curability of the tumor.
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Affiliation(s)
- Kohei Tajima
- Department of Gastroenterological Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Hideo Shimada
- Department of Surgery, Tokai University Oiso Hospital, 21-1 Gakkyou, Nakagun, Oiso, Kanagawa, 259-0198, Japan
| | - Takayuki Nishi
- Department of Surgery, Tokai University Oiso Hospital, 21-1 Gakkyou, Nakagun, Oiso, Kanagawa, 259-0198, Japan
| | - Yutaro Kamei
- Department of Surgery, Tokai University Oiso Hospital, 21-1 Gakkyou, Nakagun, Oiso, Kanagawa, 259-0198, Japan
| | - Kazuo Koyanagi
- Department of Gastroenterological Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan.
| | - Hiroyasu Makuuchi
- Department of Gastroenterological Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
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Yura M, Koyanagi K, Adachi K, Hara A, Hayashi K, Tajima Y, Kaneko Y, Fujisaki H, Hirata A, Takano K, Hongo K, Yo K, Yoneyama K, Dehari R, Nakagawa M. Distal gastric tube resection with vascular preservation for gastric tube cancer: A case report and review of literature. World J Gastrointest Surg 2020; 12:397-406. [PMID: 33024514 PMCID: PMC7520569 DOI: 10.4240/wjgs.v12.i9.397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/01/2020] [Accepted: 08/31/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Survival rates in patients with esophageal cancer undergoing esophagectomy have improved, but the prevalence of gastric tube cancer (GTC) has also increased. Total resection of the gastric tube with lymph node dissection is considered a radical treatment, but GTC surgery is more invasive and involves a higher risk of severe complications or death, particularly in elderly patients. CASE SUMMARY We report an elderly patient with early GTC that had invaded the duodenum who was successfully treated with resection of the distal gastric tube and Roux-en-Y (R-Y) reconstruction. The tumor was a type 0-IIc lesion with ulcer scars surrounding the pyloric ring. Endoscopic submucosal resection was not indicated because the primary lesion was submucosally invasive, was undifferentiated type, surrounded the pyloric ring, and had invaded the duodenum. Resection of distal gastric tube with R-Y reconstruction was safely performed, with preservation of the right gastroepiploic artery (RGEA) and right gastric artery (RGA). CONCLUSION Distal resection of the gastric tube with preservation of the RGEA and RGA is a good treatment option for elderly patients with cT1bN0 GTC in the lower part of the gastric tube.
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Affiliation(s)
- Masahiro Yura
- Department of Surgery, Hiratsuka City Hospital, Kanagawa 2540065, Japan
| | - Kazuo Koyanagi
- Department of Gastroenterological Surgery, Tokai University School of Medicine, Isehara 2591193, Japan
| | - Kiyohiko Adachi
- Department of Surgery, Hiratsuka City Hospital, Kanagawa 2540065, Japan
| | - Asuka Hara
- Department of Surgery, Hiratsuka City Hospital, Kanagawa 2540065, Japan
| | - Keita Hayashi
- Department of Surgery, Hiratsuka City Hospital, Kanagawa 2540065, Japan
| | - Yuki Tajima
- Department of Surgery, Hiratsuka City Hospital, Kanagawa 2540065, Japan
| | - Yasushi Kaneko
- Department of Surgery, Hiratsuka City Hospital, Kanagawa 2540065, Japan
| | - Hiroto Fujisaki
- Department of Surgery, Hiratsuka City Hospital, Kanagawa 2540065, Japan
| | - Akira Hirata
- Department of Surgery, Hiratsuka City Hospital, Kanagawa 2540065, Japan
| | - Kiminori Takano
- Department of Surgery, Hiratsuka City Hospital, Kanagawa 2540065, Japan
| | - Kumiko Hongo
- Department of Surgery, Hiratsuka City Hospital, Kanagawa 2540065, Japan
| | - Kikuo Yo
- Department of Surgery, Hiratsuka City Hospital, Kanagawa 2540065, Japan
| | - Kimiyasu Yoneyama
- Department of Surgery, Hiratsuka City Hospital, Kanagawa 2540065, Japan
| | - Reiko Dehari
- Department of Surgical Pathology, Hiratsuka City Hospital, Kanagawa 2540065, Japan
| | - Motohito Nakagawa
- Department of Surgery, Hiratsuka City Hospital, Kanagawa 2540065, Japan
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Hirayama Y, Fujisaki J, Yoshimizu S, Horiuchi Y, Yoshio T, Ishiyama A, Hirasawa T, Imamura Y, Mine S, Watanabe M, Tsuchida T. Efficacy and safety of endoscopic resection for gastric tube cancer after surgical resection of esophageal squamous cell carcinoma. Esophagus 2019; 16:194-200. [PMID: 30600485 DOI: 10.1007/s10388-018-00653-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 12/10/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Gastric tube cancers (GTCs) are found frequently, even as the surgical outcomes of esophageal cancer improve. Diagnosing and treating early gastric tube cancer endoscopically has therefore become very important. AIMS This study aimed to evaluate the clinical characteristics and outcomes of endoscopic resection for GTC. METHODS We analyzed 29 patients (33 lesions) with metachronous GTC who underwent endoscopic resection from April 2005 to August 2016 and evaluated their clinical characteristics and the short-term outcomes of endoscopic resection. RESULTS All of the cases were identified by periodic examinations. The lesions were found a median of 6.5 years after surgery (range 9 months-19 years), with six lesions found more than 10 years later. Among the total of 33 lesions, 28 resulted in curative resections (85%), and five were non-curative resections because of lymphovascular invasion, submucosal deep invasion, histological type, and size. None had received additional treatment or had a local recurrence thus far. Regarding the complications, delayed perforation occurred in a case (3%) and precordial skin burn occurred in four cases (12%). CONCLUSION The safety and efficacy of endoscopic resection for gastric tube cancer were evaluated. Additionally, it is important to continue annual endoscopy even 5 years or more after esophageal surgery.
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Affiliation(s)
- Yoshie Hirayama
- The Cancer Institute Hospital of JFCR, 3-8-31 Ariake, Koto, Tokyo, 135-8550, Japan.
| | - Junko Fujisaki
- The Cancer Institute Hospital of JFCR, 3-8-31 Ariake, Koto, Tokyo, 135-8550, Japan
| | - Shoichi Yoshimizu
- The Cancer Institute Hospital of JFCR, 3-8-31 Ariake, Koto, Tokyo, 135-8550, Japan
| | - Yusuke Horiuchi
- The Cancer Institute Hospital of JFCR, 3-8-31 Ariake, Koto, Tokyo, 135-8550, Japan
| | - Toshiyuki Yoshio
- The Cancer Institute Hospital of JFCR, 3-8-31 Ariake, Koto, Tokyo, 135-8550, Japan
| | - Akiyoshi Ishiyama
- The Cancer Institute Hospital of JFCR, 3-8-31 Ariake, Koto, Tokyo, 135-8550, Japan
| | - Toshiaki Hirasawa
- The Cancer Institute Hospital of JFCR, 3-8-31 Ariake, Koto, Tokyo, 135-8550, Japan
| | - Yu Imamura
- The Cancer Institute Hospital of JFCR, 3-8-31 Ariake, Koto, Tokyo, 135-8550, Japan
| | - Shinji Mine
- The Cancer Institute Hospital of JFCR, 3-8-31 Ariake, Koto, Tokyo, 135-8550, Japan
| | - Masayuki Watanabe
- The Cancer Institute Hospital of JFCR, 3-8-31 Ariake, Koto, Tokyo, 135-8550, Japan
| | - Tomohiro Tsuchida
- The Cancer Institute Hospital of JFCR, 3-8-31 Ariake, Koto, Tokyo, 135-8550, Japan
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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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9
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Shirakawa Y, Noma K, Maeda N, Ninomiya T, Tanabe S, Kikuchi S, Kuroda S, Nishizaki M, Kagawa S, Kawahara Y, Okada H, Fujiwara T. Clinical characteristics and management of gastric tube cancer after esophagectomy. Esophagus 2018; 15:180-189. [PMID: 29951985 DOI: 10.1007/s10388-018-0611-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 03/23/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND Gastric cancer is the second most common malignancy, overlapping with thoracic esophageal cancer (TEC). Among them, metachronous gastric tube cancers after TEC surgery have been increasing. The aims of this study were to examine the clinicopathological factors and treatment outcomes of gastric tube cancer (GTC) after TEC surgery. METHODS Thirty-three GTCs in 30 cases after TEC treated between 1997 and 2016 were investigated retrospectively. RESULTS Most cases were males. The median interval from TEC surgery to GTC occurrence was 57 (6.5-107.5) months. Almost 2/3 lesions occurred in the lower third of the gastric tube (21/33); 29 lesions (in 26 cases) were superficial cancers, and 4 lesions were advanced cancers. Twenty-two lesions of superficial cancer were differentiated type, and the remaining seven lesions were undifferentiated type. Treatment for superficial cancer had previously been performed with partial gastric tube resection (10 lesions), and the number of cases undergoing endoscopic submucosal dissection (ESD) had increased recently (19 lesions). Most cases with superficial cancer survived without relapse. Four lesions of advanced cancer were found after a relatively long interval following TEC surgery. Most lesions of advanced cancer were scirrhous, undifferentiated type, and they died due to GTC. CONCLUSION GTCs may occur late in the postoperative course following TEC surgery. If they are discovered at an early stage, these lesions can be cured with ESD. Long-term periodic endoscopic examinations after TEC surgery are important.
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Affiliation(s)
- Yasuhiro Shirakawa
- Department of Gastroenterological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikatacho, Kita-ku, Okayama, 700-8558, Japan.
| | - Kazuhiro Noma
- Department of Gastroenterological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikatacho, Kita-ku, Okayama, 700-8558, Japan
| | - Naoaki Maeda
- Department of Gastroenterological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikatacho, Kita-ku, Okayama, 700-8558, Japan
| | - Takayuki Ninomiya
- Department of Gastroenterological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikatacho, Kita-ku, Okayama, 700-8558, Japan
| | - Shunsuke Tanabe
- Department of Gastroenterological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikatacho, Kita-ku, Okayama, 700-8558, Japan
| | - Satoru Kikuchi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikatacho, Kita-ku, Okayama, 700-8558, Japan
| | - Shinji Kuroda
- Department of Gastroenterological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikatacho, Kita-ku, Okayama, 700-8558, Japan
| | - Masahiko Nishizaki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikatacho, Kita-ku, Okayama, 700-8558, Japan
| | - Shunsuke Kagawa
- Department of Gastroenterological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikatacho, Kita-ku, Okayama, 700-8558, Japan
| | - Yoshiro Kawahara
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Hiroyuki Okada
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Toshiyoshi Fujiwara
- Department of Gastroenterological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikatacho, Kita-ku, Okayama, 700-8558, Japan
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10
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Resection of the Gastric Tube Reconstructed through the Retrosternal Route without Sternotomy. Case Rep Surg 2017; 2017:5862871. [PMID: 28299227 PMCID: PMC5337371 DOI: 10.1155/2017/5862871] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 01/30/2017] [Indexed: 01/04/2023] Open
Abstract
With advances of combined modality therapy, prognoses in esophageal cancer have been improving. After resection of esophageal cancer, the development of gastric tube cancer is a risk. While such cancer in an early stage can be cured endoscopically, total gastric tube resection is indicated in advanced stages. A 68-year-old man underwent subtotal esophagectomy reconstructed with a gastric tube through the retrosternal route. Gastric cancer was found one and a half years postoperatively. The gastric tube was resected without sternotomy. This is the first report of a patient undergoing resection of the gastric tube reconstructed through the retrosternal route without sternotomy.
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Tawaraya S, Jin M, Matsuhashi T, Suzuki Y, Sawaguchi M, Watanabe N, Onochi K, Koizumi S, Hatakeyama N, Ohba R, Mashima H, Ohnishi H. Advanced feasibility of endoscopic submucosal dissection for the treatment of gastric tube cancer after esophagectomy. Gastrointest Endosc 2014; 79:525-30. [PMID: 24246794 DOI: 10.1016/j.gie.2013.10.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 10/02/2013] [Indexed: 02/08/2023]
Affiliation(s)
- Shin Tawaraya
- Department of Gastroenterology, Akita University Graduate School of Medicine, Akita City, Akita, Japan
| | - Mario Jin
- Department of Gastroenterology, Akita University Graduate School of Medicine, Akita City, Akita, Japan
| | - Tamotsu Matsuhashi
- Department of Gastroenterology, Akita University Graduate School of Medicine, Akita City, Akita, Japan
| | - Yusato Suzuki
- Department of Gastroenterology, Akita University Graduate School of Medicine, Akita City, Akita, Japan
| | - Masayuki Sawaguchi
- Department of Gastroenterology, Akita University Graduate School of Medicine, Akita City, Akita, Japan
| | - Noboru Watanabe
- Department of Gastroenterology, Akita University Graduate School of Medicine, Akita City, Akita, Japan
| | - Kengo Onochi
- Department of Gastroenterology, Akita University Graduate School of Medicine, Akita City, Akita, Japan
| | - Shigeto Koizumi
- Department of Gastroenterology, Akita University Graduate School of Medicine, Akita City, Akita, Japan
| | - Natsumi Hatakeyama
- Department of Gastroenterology, Akita University Graduate School of Medicine, Akita City, Akita, Japan
| | - Reina Ohba
- Department of Gastroenterology, Akita University Graduate School of Medicine, Akita City, Akita, Japan
| | - Hirosato Mashima
- Department of Gastroenterology, Akita University Graduate School of Medicine, Akita City, Akita, Japan
| | - Hirohide Ohnishi
- Department of Gastroenterology, Akita University Graduate School of Medicine, Akita City, Akita, Japan
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12
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Nonaka S, Oda I, Sato C, Abe S, Suzuki H, Yoshinaga S, Hokamura N, Igaki H, Tachimori Y, Taniguchi H, Kushima R, Saito Y. Endoscopic submucosal dissection for gastric tube cancer after esophagectomy. Gastrointest Endosc 2014; 79:260-70. [PMID: 24060521 DOI: 10.1016/j.gie.2013.07.059] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 07/30/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND 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. OBJECTIVE To assess the feasibility and effectiveness of endoscopic submucosal dissection (ESD) for GTC. DESIGN Retrospective study. SETTING National Cancer Center Hospital, Tokyo, Japan. PATIENTS We investigated patients with GTC after esophagectomy undergoing ESD from 1998 to 2011. INTERVENTION ESD MAIN OUTCOME MEASUREMENTS Patient characteristics, endoscopic findings, technical results, histopathology including curability and Helicobacter pylori gastritis, and long-term outcomes. RESULTS 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). LIMITATION Single-center retrospective study. CONCLUSIONS ESD for GTC was feasible and effective for curative patients; however, long-term outcomes for non-curative patients were less satisfactory.
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Affiliation(s)
- Satoru Nonaka
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Ichiro Oda
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Chiko Sato
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan; Pathology Division, National Cancer Center Hospital, Tokyo, Japan
| | - Seiichiro Abe
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Haruhisa Suzuki
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | | | - Nobukazu Hokamura
- Esophageal Surgery Division, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroyasu Igaki
- Esophageal Surgery Division, National Cancer Center Hospital, Tokyo, Japan
| | - Yuji Tachimori
- Esophageal Surgery Division, National Cancer Center Hospital, Tokyo, Japan
| | | | - Ryoji Kushima
- Pathology Division, National Cancer Center Hospital, Tokyo, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
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13
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Ho C, Tong DKH, Tsang JS, Law SYK. Post-esophagectomy gastric conduit cancers: treatment experiences and literature review. Dis Esophagus 2013; 27:141-5. [PMID: 23551754 DOI: 10.1111/dote.12070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Esophagectomy remains the mainstay of treatment for esophageal cancer. The stomach is the commonest organ used to restore intestinal continuity after esophagectomy. Metachronous gastric cancer in the gastric conduit after esophagectomy is rare; the etiology remains unclear. Possible risk factors include Helicobacter pylori infection, biliary or pancreatic reflux and prior radiotherapy. Prognosis of these patients remains poor. Treatment of this particular entity poses unique challenges to the surgeon and oncologist. Early diagnosis by endoscopy may allow endoscopic excision such as endoscopic mucosal resection or endoscopic submucosal dissection. In more advanced cancers, surgery is difficult, reconstruction is complicated, and further radiation may not be feasible because of previous neoadjuvant therapy. In this report, four patients who developed gastric conduit cancers are presented. They were treated with either surgery alone or combined with chemoradiotherapy. All four patients were still alive after at least 21 months, with three patients currently still alive (21-48 months). The literature is also reviewed, in particular addressing the incidence, possible underlying causes, prognosis and options of treatment for this specific clinical scenario.
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Affiliation(s)
- C Ho
- Department of Surgery, Kwong Wah Hospital
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14
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Jabłoński S, Piskorz L, Wawrzycki M. Gastric tube resection due to metachronic cancer and a recurrence in anastomosis after Ivor-Lewis esophagectomy--case report. World J Surg Oncol 2012; 10:83. [PMID: 22591456 PMCID: PMC3407740 DOI: 10.1186/1477-7819-10-83] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2011] [Accepted: 05/16/2012] [Indexed: 12/26/2022] Open
Abstract
Gastric tube after esophagectomy can be the site of local recurrence or the development of second primary tumor which implies poor prognosis. The study presents an extremely rare case of a patient after Ivor-Lewis esophagectomy for squamous cell carcinoma, in whom there was detected local recurrence in the anastomosis associated with metachronous primary tumor in gastric tube. Esophageal reresection with the upper part of the stomach was performed. Left colonic segment supplied by middle colic vessels transposed through retrosternal route was used as new esophageal substitute.
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Affiliation(s)
- Sławomir Jabłoński
- Department of Thoracic Surgery, General and Oncological Surgery, Medical University of Lodz, 113 Żeromskiego St,, 90-547, Łódź, Poland.
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15
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Saito T, Yano M, Motoori M, Kishi K, Fujiwara Y, Shingai T, Noura S, Ohue M, Ohigashi H, Ishikawa O. Subtotal gastrectomy for gastric tube cancer after esophagectomy: a safe procedure preserving the proximal part of gastric tube based on intraoperative ICG blood flow evaluation. J Surg Oncol 2012; 106:107-10. [PMID: 22331794 DOI: 10.1002/jso.23050] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2011] [Accepted: 01/04/2012] [Indexed: 12/13/2022]
Abstract
Recent improvements in the survival of patients after esophagectomy have led to an increase in the occurrence of gastric tube cancer (GTC). Total resection of the gastric tube with lymphadenectomy is a standard and reliable treatment for GTC, but problems may arise during or after surgery, such as laryngeal nerve injury, reduced selection of organs for reconstruction, and impaired swallowing function. We recently performed a less invasive procedure, subtotal gastrectomy with preservation of the upper region of the gastric tube, in two patients. In these patients, blood supply to the gastric tube was evaluated by indocyanine green fluorescence imaging. Blood flow was confirmed as passing from the remnant esophagus to the upper region of the gastric tube through the esophago-gastric anastomotic site by indocyanine green fluorescence imaging. Therefore, we resected the gastric tube while preserving the upper region of the gastric tube. There was no necrosis of the remnant gastric tube or anastomotic leakage postoperatively, and postoperative swallowing and eating functions were quite good in both patients. In summary, subtotal gastrectomy as a treatment for GTC is potentially safe, curative, and beneficial for the patient's quality of life.
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Affiliation(s)
- Takuro Saito
- Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
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16
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Yoon YS, Kim HK, Choi YS, Kim K, Kim J, Shim YM. Primary gastric cancer in an oesophageal gastric graft after oesophagectomy. Eur J Cardiothorac Surg 2011; 40:1181-4. [PMID: 21868245 DOI: 10.1016/j.ejcts.2011.02.061] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Revised: 02/10/2011] [Accepted: 02/28/2011] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Recent advances in surgical treatment of oesophageal cancer have improved the prognosis of early, locally advanced oesophageal cancer. Primary cancer from oesophageal graft is rare, but has been detected in long-term survivor. We analyzed data from patients who developed primary gastric cancer in an oesophageal graft to evaluate strategies of treatment and their outcomes. METHODS We retrospectively reviewed data from patients who developed primary gastric cancer in oesophageal graft at Samsung Medical Center between September 1994 and December 2009. The clinico-pathologic features and prognoses were investigated. Long-term survival rate was determined by Kaplan-Meier analysis. RESULTS Ten primary gastric graft cancers (five early gastric cancer (EGC), five advanced gastric cancer (AGC)) were diagnosed. The mean age was 69.0 (range 59.6-74.6). Initial operation was Ivor-Lewis transthoracic oesophagectomy in eight cases and three-field lymphadenectomy in two. The median period to detection of the primary gastric graft cancer after oesophagectomy was 50 (9-102) months. Seven gastric graft cancers were diagnosed by regular endoscopic examination. EGCs were treated with ESD in two cases, partial resection of stomach in one, and oesophagocolojejunostomy in three, including one patient who underwent the operation after ESD. AGCs were treated with chemotherapy in one case, supportive care in one, and oesophagocolojejunostomy in three. There was no adjuvant chemotherapy used in any case. The median follow-up period after second operation was 14 months (range 1-97). Six patients survived during this period. Three of the five AGC patients died. The estimated 5-year survival rate of our cases was 70%. CONCLUSIONS In areas of high prevalence of stomach cancer, regular endoscopic examinations of oesophageal gastric grafts may help in the early detection of primary gastric graft cancer. Reoperation with a colon graft is a potential treatment option for primary gastric graft cancer.
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Affiliation(s)
- Yoo Sang Yoon
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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17
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Gastric cancer in the reconstructed gastric tube after radical esophagectomy: a single-center experience. Surg Today 2011; 41:966-9. [PMID: 21748613 DOI: 10.1007/s00595-010-4402-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Accepted: 07/20/2010] [Indexed: 12/19/2022]
Abstract
PURPOSE Metachronous gastric carcinoma arising in a gastric tube used for esophageal reconstruction has been occasionally encountered in long-term survivors of esophageal cancer. This study investigated 10 cases of gastric tube cancer in order to clarify the characteristics and the outcome of these patients. METHODS Four hundred and seventy-one patients underwent a radical esophagectomy at Kyushu University Hospital between 1989 and 2003. There were 10 cases of gastric tube cancer after an esophagectomy. RESULTS The interval between the esophagectomy and the development of the gastric tube cancer ranged from 1.1 to 7 years. There was no peak for the incidence of gastric tube cancer. In 6 of 10 cases of gastric tube cancer, endoscopic or surgical resection were performed for the treatment; however, chemotherapy was administered to the other 4 cases for several reasons. The prognosis of patients who underwent resection was better than that of the other patients. CONCLUSIONS Frequent endoscopic examinations are therefore important even several years after performing an esophagectomy, since the risk of gastric tube cancer is higher than the risk of a recurrence of esophageal cancer several years after an esophagectomy. Only an early diagnosis permits a less invasive and appropriate approach for the treatment of gastric tube cancer.
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18
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Bamba T, Kosugi SI, Takeuchi M, Kobayashi M, Kanda T, Matsuki A, Hatakeyama K. Surveillance and treatment for second primary cancer in the gastric tube after radical esophagectomy. Surg Endosc 2009; 24:1310-7. [PMID: 19997933 DOI: 10.1007/s00464-009-0766-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2009] [Accepted: 11/09/2009] [Indexed: 12/16/2022]
Abstract
BACKGROUND Recent improvement in the survival of patients after esophagectomy for esophageal cancer has led to increasing occurrence of second primary cancer in the pulled-up stomach as gastric tube cancer (GTC). However, a treatment strategy for GTC including surveillance has not been established. The aims of this study are to clarify the incidence and clinicopathological characteristics of GTC and to assess the treatment results of endoscopic resection. METHODS Twenty-five patients with 29 GTC lesions treated between 1989 and 2007 were analyzed retrospectively. RESULTS The median interval between esophagectomy and GTC detection was 86 months, and the 10-year cumulative incidence rate of GTC was 8.6%. Of 18 asymptomatic GTCs, 17 lesions (94.4%) were detected by periodic endoscopy and 15 (88.2%) of them were treated endoscopically. Of all 29 GTCs, endoscopic submucosal dissection (ESD) was performed in 10 GTCs with a completely curative resection rate of 90%, which was significantly higher than that of 7 GTCs treated with endoscopic mucosal resection (EMR) (14.3%, P = 0.004). In these 17 GTCs, no cancer recurrence developed during a median follow-up period of 24 months, and the 3-year survival rate was 80.8%. CONCLUSIONS For patients after esophagectomy with gastric pull-up, long-term follow-up including periodic endoscopy is necessary to detect a potentially curable GTC. ESD is a feasible and safe procedure for GTC, with oncologically favorable features.
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Affiliation(s)
- Takeo Bamba
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuou-ku, Niigata City 951-8510, Japan.
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19
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Abstract
BACKGROUND AND AIM Gastric tube cancer (GTC), defined as carcinoma arising in the reconstructed gastric tube after esophagectomy, has been increasingly reported, but its pathogenesis remains unclear. Therefore, the aim of this study was to examine clinically and pathologically 10 GTCs in six patients. METHODS In addition to examination of the clinicopathological features of GTCs, the adjacent gastric tube mucosa was also evaluated immunohistochemically using gastric foveolar markers (MUC5AC and human gastric mucin), pyloric gland markers (MUC6 and M-GGMC-1), and intestinal markers (MUC2 and CD10). RESULTS All patients were men and three patients had multiple GTCs. All GTCs were located on the middle to lower portion of the gastric tube. Nine GTCs had tubular and/or papillary adenocarcinoma components, and another was signet-ring cell carcinoma. Intestinal metaplasia was found in non-neoplastic mucosa adjacent to nine GTCs. Metaplastic goblet cells adjacent to five GTCs expressed both gastric and intestinal markers, which were similar to the corresponding GTC cells, indicating a close association between the GTCs and metaplastic goblet cells. The other three GTCs expressed only intestinal markers, which may support the suggestion that the intestinal phenotype is expressed later in cancerous development. CONCLUSION Pathogenesis of GTCs could be identical to that of ordinary gastric cancer. Cancerous multiplicity associated with esophageal cancer may also play a role in the development of GTCs.
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Affiliation(s)
- Hiroaki Takeo
- Japan Self Defense Forces Central Hospital, Tokyo, Japan.
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20
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Motoyama S, Saito R, Okuyama M, Maruyama K, Ogawa JI. Treating gastric tube cancer with distal gastrectomy preserving the gastroepiploic artery. Ann Thorac Surg 2006; 81:751-3. [PMID: 16427900 DOI: 10.1016/j.athoracsur.2004.11.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2004] [Revised: 11/01/2004] [Accepted: 11/10/2004] [Indexed: 12/13/2022]
Abstract
Total resection of the gastric tube with lymphadenectomy is standard and reliable treatment for gastric tube cancer. However the risk associated with totally removing a gastric tube previously reconstructed through the posterior mediastinal route is significant, given the need to lyse a significant number of adhesions in order to reach the mediastinum. As a less invasive procedure, we used distal gastrectomy to treat superficial gastric tube cancer in 2 patients. The distal gastric tube was mobilized and resected with preservation of the right gastroepiploic artery, and the Roux-en-Y gastrojejunostomy was used for reconstruction. This procedure was curative with less surgical stress.
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Affiliation(s)
- Satoru Motoyama
- Department of Surgery, Akita University School of Medicine, Akita, Japan.
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21
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Okamoto N, Ozawa S, Kitagawa Y, Shimizu Y, Kitajima M. Metachronous gastric carcinoma from a gastric tube after radical surgery for esophageal carcinoma. Ann Thorac Surg 2004; 77:1189-92. [PMID: 15063232 DOI: 10.1016/j.athoracsur.2003.09.071] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/05/2003] [Indexed: 12/17/2022]
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.
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Affiliation(s)
- Nobuhiko Okamoto
- Department of Surgery, School of Medicine, Keio University, Tokyo, Japan
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22
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Akita H, Doki Y, Ishikawa O, Takachi K, Miyashiro I, Sasaki Y, Ohigashi H, Murata K, Noura S, Yamada T, Eguchi H, Imaoka S. Total removal of the posterior mediastinal gastric conduit due to gastric cancer after esophagectomy. J Surg Oncol 2004; 85:204-8. [PMID: 14991878 DOI: 10.1002/jso.20017] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Total removal of the gastric conduit (TRGC) due to gastric cancer after esophagectomy often results in high operative morbidity and mortality rates, especially when done in the posterior mediastinum. This is one of the reasons for the retro-sternal or subcutaneous route being preferred for gastric conduit replacement in esophageal cancer operation. PATIENTS Five out of 680 post-operative esophageal cancer patients underwent TRGC via thoracotomy and laparotomy due to posterior mediastinal gastric conduit cancers. RESULTS In these patients, advanced gastric cancers were found at an average of 84 months (ranging 57-136 months) after esophageal cancer surgery and preoperative risk factors for TRGC were found in age, nutrition, and pulmonary function. The operative time for TRGC was long (average 670 min) but not associated with operative complications, while blood loss varied among patients, with one with the most operative blood loss dying after surgery due to pyothorax and renal failure. This case, and another early case subjected to TRGC first with thoracotomy then followed by laparotomy, showed more operative blood loss (10,895 and 3,260 ml) than the later three patients (2,370, 1,900, and 1,780 ml), who underwent laparotomy before thoracotomy with ligation of the blood supply of the gastric conduit and lysis of adhesion around gastric conduit in the lower mediastinum from the abdomen. CONCLUSION TRGC in the posterior mediastinum would be safer if operative manipulation were started from laparotomy in order to reduce operative blood loss. J. Surg. Oncol. 2004;85:204-208.
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Affiliation(s)
- Hirofumi Akita
- Department of Digestive Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
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Motoyama S, Saito R, Kitamura M, Ogawa JI. Outcomes of active operation during intensive followup for second primary malignancy after esophagectomy for thoracic squamous cell esophageal carcinoma. J Am Coll Surg 2003; 197:914-20. [PMID: 14644278 DOI: 10.1016/j.jamcollsurg.2003.07.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recent advances in the treatment of thoracic esophageal cancer have afforded it a better prognosis. As a consequence, increasing attention is being paid to the outcomes with postoperative monitoring for second primary malignancies after esophagectomy, but no recent study has focused on the longterm followup and outcomes in these patients. STUDY DESIGN In 1989, we began intensive prospective screening and surveillance designed to detect cancers of the head and neck, lung, stomach, residual esophagus, and colon/rectum after esophagectomy. Between 1989 and 2001, 365 patients underwent esophagectomy for thoracic squamous cell esophageal carcinoma in our department. Of those, 200 were followed up as part of this program. Excluded were patients in whom esophageal cancer recurred, patients with other prior or simultaneous malignancies, and patients who died within a year of operation. Clinicopathologic profiles and treatment outcomes were determined for 33 patients who developed a second primary malignancy after esophagectomy. RESULTS The interval between the primary esophageal cancer and the secondary carcinoma was 49 +/- 40 months (median, 48 months). The second primary malignancies were located in the stomach (30%), head and neck (24%), lung (24%), colon/rectum (9%), liver (6%), pancreas (3%), and blood (6%). Twenty-one patients (64%) were classified as stage 0, I, or II; 10 (30%) were stage III or IV. Overall, the 2-year, 3-year, and 5-year survival rates following diagnosis of a second primary malignancy were 58.0%, 58.0%, and 48.6%, respectively. Of the 19 patients (58%) in whom second primary malignancies were detected before symptoms developed, the 5-year survival rate was 70.7%, which was significantly greater than that among patients whose secondary malignancies were discovered after symptoms developed (17.1%). CONCLUSIONS Good outcomes in the treatment of second primary malignancies after esophagectomy for thoracic squamous cell esophageal carcinoma can be obtained with longterm, intensive followup and active surgical intervention for detected malignancies.
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Affiliation(s)
- Satoru Motoyama
- Second Department of Surgery, Akita University School of Medicine, Hondo, Akita City, Japan
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