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Gu YM, Che GW, Chen LQ. Severe Gastric Conduit Engorgement after Esophagectomy. Ann Thorac Surg 2022; 114:e231. [PMID: 35032451 DOI: 10.1016/j.athoracsur.2021.12.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 11/27/2021] [Accepted: 12/12/2021] [Indexed: 02/08/2023]
Affiliation(s)
- Yi-Min Gu
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Guo-Wei Che
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Long-Qi Chen
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China.
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Ludwig K, Enz N, Kreutzer H, Pickartz T. Metachronous carcinoma of the gastric tube following tumour-associated oesophagectomy. Langenbecks Arch Surg 2021; 406:2263-2272. [PMID: 34491431 DOI: 10.1007/s00423-021-02316-4] [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: 03/15/2021] [Accepted: 08/23/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The prognosis of oesophageal carcinoma has improved during the last years. Thereby, the increasing survival has led to increasing occurrence of secondary gastric tube carcinoma (gastric conduit cancer, GTC) following oesophageal tumour resection. MATERIAL AND PATIENTS A literature review (EMBASE, PubMed), spanning the years 2000 to 2020, identified 342 patients worldwide with a GTC following tumour-related oesophagectomy, of which 306 patients could be included for further analysis. RESULTS The median age of 306 patients with GTC was 66.4 (39-80) years. 91.2% of patients (n = 279) were male. The median interval between oesophagectomy and GTC was 60.3 (4-236) months. 73.8% of patients (n = 226) were diagnosed as early cancer (EGC, T1) and 26.2% as advanced carcinoma (AGC, > T2; n = 80). Primary oesophagectomy was performed in 97.4% of patients (N = 298) for squamous cell carcinoma. AEG I carcinoma was present in only 5 patients (1.6%). In contrast, 99% (n = 303) of the GTC were found to be adenocarcinomas. One hundred eighty patients (58.8%) could be treated by endoscopic resection (ER). R0 resection was achieved in 82.8% (n = 149). The complication rate was 13.3% (n = 24) and the 30-day mortality 1.1% (n = 2) for ER. Eighty-three patients (27.1%) were treated surgically. These included 13 wedge resections, 25 partial resections and 45 total gastric graft resections with predominantly colon interposition. The R0 rate was 98.8% (n = 82). The postoperative morbidity was 24.1% (n = 20); the 90-day mortality was 6% (n = 5). In 43 patients (14%), palliative chemotherapy or radiotherapy or best supportive care took place. GTC diagnosed early in the EGC stage can be safely managed with ER. In cases of advanced GTC, surgical resection can be a potentially curative approach. Survival times of up to 120 months have been described after intervention for GTC.
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Affiliation(s)
- Kaja Ludwig
- Department of General and Visceral Surgery, Klinikum Suedstadt Rostock, Suedring 81, 18059, Rostock, Germany.
| | - Njanja Enz
- Department of General and Visceral Surgery, Klinikum Suedstadt Rostock, Suedring 81, 18059, Rostock, Germany
| | - Hans Kreutzer
- Institute for Pathology, Klinikum Suedstadt Rostock, Suedring 81, 18059, Rostock, Germany
| | - Tilman Pickartz
- Department for Internal Medicine A, F.-Sauerbruchstr, University Hospital Greifswald, 17475, Greifswald, Germany
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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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Gentile D, Riva P, Da Roit A, Basato S, Marano S, Castoro C. Gastric tube cancer after esophagectomy for cancer: a systematic review. Dis Esophagus 2019; 32:5492605. [PMID: 31111880 DOI: 10.1093/dote/doz049] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Gastric conduit used for reconstruction after esophagectomy for cancer has the potential to develop a metachronous neoplasm known as gastric tube cancer (GTC). The aim of this study was to review literature and evaluate outcomes and possible treatment strategies for GTC. A comprehensive systematic literature search was conducted using PubMed, EMBASE, Scopus, and the Cochrane Library Central Register of Controlled Trials. No restriction was set for the type of publication, number, age, or sex of the patients. The search was limited to articles in English. Characteristics of esophageal cancer (EC) and its treatment and GTC and its treatment were analyzed. A total of 28 studies were analyzed, 12 retrospective analyses and 16 case reports, involving 229 patients with 250 GTCs in total. The majority of ECs (88.2%) were squamous cell carcinomas. In 120 patients (52.4%) a posterior mediastinal reconstructive route was used when esophagectomy was performed. The mean interval between esophagectomy and diagnosis of GTC was 55.8 months, with a median interval of 56.8 months (4-236 months). One hundred and twenty-four GTCs (49.6%) were located in the lower part of the gastric tube. One hundred and forty patients were endoscopically treated. Eighty-five patients underwent surgery. Thirty-six total gastrectomies with lymphadenectomy with colon or jejunal interposition were performed. Forty-three subtotal gastrectomies and 6 wedge resections were performed. The main reported postoperative complications were anastomotic leak, vocal cord palsy, and respiratory failure. Twenty-five patients were treated with palliative chemotherapy. Three-year survival rates were 69.3% for endoscopically treated patients, 58.8% for surgically resected patients, and 4% for patients who underwent palliative treatment. The feasibility of endoscopic resections in patients diagnosed with superficial GTC has been reported. Surgical treatment represented the preferred treatment method in operable patients with locally invasive tumor. Patients treated with conservative therapy have a scarce prognosis. The development of GTC should be taken into consideration during the extended follow-up of patients undergoing esophagectomy for cancer. Total gastrectomy plus lymphadenectomy should be considered the preferred treatment modality in operable patients with locally invasive tumor, when endoscopy is contraindicated. Long-term yearly endoscopic follow-up is recommended.
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Affiliation(s)
- Damiano Gentile
- Department of Upper Gastro-Intestinal Surgery, Humanitas Research Hospital, Milan, Italy
| | - Pietro Riva
- Department of Upper Gastro-Intestinal Surgery, Humanitas Research Hospital, Milan, Italy
| | - Anna Da Roit
- Department of Upper Gastro-Intestinal Surgery, Humanitas Research Hospital, Milan, Italy
| | - Silvia Basato
- Department of Upper Gastro-Intestinal Surgery, Humanitas Research Hospital, Milan, Italy
| | - Salvatore Marano
- Department of Upper Gastro-Intestinal Surgery, Humanitas Research Hospital, Milan, Italy
| | - Carlo Castoro
- Department of Upper Gastro-Intestinal Surgery, Humanitas Research Hospital, Milan, Italy
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Incidence of food residue interfering with postoperative endoscopic examination for gastric pull-up after esophagectomy. Esophagus 2016. [DOI: 10.1007/s10388-015-0516-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Usami S, Motoyama S, Matsuhashi T, Jin M, Maruyama K, Sato Y, Yoshino K, Nakatsu T, Saito H, Minamiya Y, Saito R, Ohnishi H, Ogawa J. Outcomes of endoscopic and surgical resection for a second primary cancer in the residual cervical esophagus after thoracic esophagectomy. Dis Esophagus 2012; 25:228-34. [PMID: 21895851 DOI: 10.1111/j.1442-2050.2011.01239.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Patients who have received subtotal esophagectomy for thoracic esophageal cancer must be closely monitored for second primary malignancies. The purpose of this study is to review and assess patients who developed a second primary esophageal cancer in the residual cervical esophagus. Between 1996 and 2010, 10 patients were diagnosed in our hospital with esophageal squamous cell cancer in the residual cervical esophagus after undergoing thoracic esophagectomy and were treated with endoscopic or surgical resection. Data from these patients were reviewed retrospectively. Seven of the 10 patients (70%) had multiple primary carcinoma lesions at the time of their esophagectomy. A second primary cancer in the residual cervical esophagus was detected in eight patients during follow-up endoscopic examinations while the patients were still asymptomatic. Seven of the patients underwent endoscopic resection for a superficial cancer. None of those patients experienced any complications, and all are currently alive and cancer-free. The remaining three patients underwent resection of the cervical esophagus with regional lymph node dissection. Two of those patients experienced severe complications; one subsequently died (hospital death) from pneumonia, 12 months after surgery, while the other died from recurrence of his cancer. The third patient is alive and cancer-free. Early detection of a second primary malignancy in the residual cervical esophagus followed by endoscopic resection is the best treatment strategy for patients who previously received subtotal esophagectomy for thoracic esophageal cancer. Surgical resection puts patients at high risk of mortality or morbidity.
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Affiliation(s)
- S Usami
- Department of Surgery, Akita University Graduate School of Medicine, Hondo, Akita, Japan.
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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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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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Atmani A, Topart P, Vandenbroucke F, Louzi A, Ferrand L, Lozac'h P. Metachronous cancer of gastroplasty after esophagectomy. Dis Esophagus 2006; 19:512-5. [PMID: 17069598 DOI: 10.1111/j.1442-2050.2006.00623.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We reviewed two cases of adenocarcinoma of the gastric tube used for reconstruction after esophagectomy for cancer. The first case gastric cancer was detected during follow-up by endoscopic examination. Total resection of the gastric tube and reconstruction by Roux-en-Y was performed each time. The patient was alive and disease-free 1 year after surgery. In the second case the tumor was revealed via thoracic pain. Chemotherapy, using carboplatin-5-fluorouracil, was performed because of lung metastasis but the patient died 1 year later. The incidence of gastric tube cancer after esophagectomy has recently increased in conjunction with the lengthening of survival of esophageal cancer patients. The clinical symptoms related to tumors are associated with short-term survival, whereas the cancers detected by routine endoscopy screening have occasional long-term survival. Gastrectomy is proposed for surgical treatment but the operating procedure is complex with a high morbidity rate. Lesions detected at an early stage could be treated by minimally invasive surgery such as endoscopic mucosal resection.
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Affiliation(s)
- A Atmani
- Service de Chirurgie Générale, Hôpital La Cavale Blanche, Brest. France.
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