Multiprimary Cancer Following Removal of Esophageal Cancer -Carcinogenic Factors and Treatment for Patients with Cancers in the Esophagus and Stomach or in the Esophagus and Oral Cavity or Neck-

Shunji Ikeuchi, Shingo Shima, Tetsuhiko Okamoto, Masaki Arimori*

Department of Surgery, Division of Clinical Research, The Second Tokyo National Hospital
*Department of Surgery, Kasumigaura National Hospital

We performed esophagectomy with reconstruction using the subtotal stomach in 252 of 382 esophageal cancer patients. There were 27 patients who underwent surgery on cancers in both the esophagus and other organs. After esophageal reconstruction, multiprimary cancers occurred in 9 male patients (3.6%) aged 59 on average, who were younger than patients not-operated on average 65. The cancer occurred in the gastric tube in 5 patients, oral cavity in 3, hypopharynx in 1, and colon in 1. Concerning carcinogenic factors, frequency of cigarettes and drinking alcohol was markedly higher in patients with multiprimary cancer than in those with esophageal cancer alone. Familial cancer accumulation was prevalent in patients with multiprimary cancers in the esophagus and stomach. Well-diferentiated adenocarcinoma was found in 60% of their resected stomach. The severity of atrophic gastritis in the resected stomach ranged moderate to severe. Thus, it was considered a possible precursor of gastric cancer. Some esophageal cancer patients showed the extremely low levels of serum pepsinogen PG I and a low PG I/II ratio preoperatively and postoperatively. This suggested that the esophageal cancer diathesis and esophagectomy induced chronic gastritis. Many patients with gastric tube cancer died of gastric cance. Endoscopy was useful in early diagnosis and treatment in one patient. Microsurgery was effective as a treatment of multiprimary cancers in the oral cavity and neck.

Key words
multiprimary cancer in the esophagus and other organ, chronic atrophic gastritis, serum pepsinogen

Reprint requests
Shunji Ikeuchi Department of Surgery, The Second Tokyo National Hospital
2-5-1 Higashigaoka, Meguro-ku, Tokyo, 152 JAPAN

Accepted
June 14, 1995

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