A new surgical procedure for synchronous esophageal squamous cell carcinoma and gastric adenocarcinoma: Case report: three cases reports

Evaluation of a new surgical procedure for simultaneous resection of synchronous thoracic middle-lower segment esophageal and distal gastric cancers

Background

An increasing number of patients with synchronous esophageal cancer (EC) and gastric cancer (GC) have been diagnosed in recent years. Colon or jejunal interposition for esophageal reconstruction has been frequently performed. This study aimed to evaluate the technical feasibility of a new surgical procedure for patients with synchronous thoracic middle-lower segment EC and distal GC.

Methods

Between July 2012 and December 2021, 18 patients underwent simultaneous esophagectomy and distal gastrectomy, in which the tubular stomach was formed by greater curvature of proximal stomach, with the right gastroepiploic vessels used as the blood supply. Patient demographics and perioperative data were analyzed.

Results

All 18 patients were male, with a mean age of 64.9 years (range, 51-72 years). The mean ± standard deviation (SD) operative duration was 249.6±17.4 min (range, 195-275 min) and mean estimated blood loss was 200.0±86.6 mL (range, 100-400 mL). Ten (55.6%) patients recovered well without any complications, with a mean postoperative length of hospitalization of 9.2±2.6 days (range, 6-13 days). Overall, postoperative complications, defined as Clavien-Dindo grades I-V, occurred in eight (44.4%) patients, with anastomotic leakage in four (22.2%), and hydrothorax (11.1%), gastric retention (5.6%), pneumonia (5.6%), and jaundice (5.6%) occurring in two, one, one, and one patient(s), respectively. All patients who experienced complications recovered after treatment, except for one who died of anastomotic leakage.

Conclusions

The surgical procedure might be a new treatment option for selected patients with synchronous thoracic middle-lower segment EC and distal GC.

Reconstruction using the colon or jejunum in patients with synchronous advanced esophageal and gastric cancers: a retrospective study from a single institutional database

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.

Formation of the upper digestive tract by the ileum - right colon for patient with concurrent cancers of the esophagus and the stomach: A case report

Introduction and importance

A very rare case with presence of both esophageal and gastric cancers raised questions on how to perform optimal surgery for such cases. To date, reports on experimental surgery strategies for these rare cases remained sparse in the literatures.

Case presentation

A 61-year-old male patient having epigastric abdominal pain and swallowing difficulties for a month prior to the hospital. Esophagoscopy and gastroscopy results showed a 2-cm lesion in the esophagus, located around 25 cm away from the teeth arch; and a 2-cm ulcer lesion with high ridge line at the corner of the lesser curvature of stomach. Biopsy results revealed esophageal squamous epithelium carcinoma and poorly differentiated gastric adenocarcinoma. The surgery was esophago-gastrectomy with curettage of the lymph nodes and reconstruction of the upper gastrointestinal tract with the ileum – right colon in the left side of the neck.

Clinical discussion

We did not remain the stomach and performed thoracoscopic Ivor Lewis esophagectomy with chest anastomosis, as in previous studies to prevent cancer recurrence. Here, we performed a new surgical method of reconstruct the upper gastrointestinal tract by connecting the upper part of the esophagus at the neck, to the ileum – right colon.

Conclusions

This case could suggest an effective surgical strategy that the ileum - right colon was an organ to be used in replacing the upper gastrointestinal tract in cases of removing the entire stomach and thoracic esophagus, which could serve as a valuable reference for similar rare cases in the future.

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Papers on experimental surgery strategies for rare cases with presence of both esophageal and gastric cancers remained sparse in the literature.

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This study is the first case to introduce a novel surgical procedure using the ileum - right colon to reconstruct the upper gastrointestinal tract

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The presented case report demonstrated effective surgery of esophago-gastrectomy and reconstruction of the upper gastrointestinal tract by using the ileum – right colon.

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The case report could be served as a valuable reference for similar rare cases in the future.