Two Resected Cases of Gastric Cancer Arizing from the Gastric Tube Following Esophageal Cancer Surgery

Yoshihiro Kagawa, Wataru Takiyama, Toshiaki Saeki, Shigemitsu Takashima, Kouichi Manadai*

Department of Clinical Research, Surgery & Pathology*, National Shikoku Cancer Center Hospital

Recent advanced treatment for esophageal cancer may contribute to the prolongation of survival for esophageal cancer patients. On the other hand, a second cancer on the stomach used as a reconstructive organ occasionally has been found. We performed gastrectomy and intra-thoracic esophago-jejunostomy in two patients who had esophagectomy with reconstructive surgery using a portion of the stomach. The first case was a 65-year-old patient who had esophagectomy for type 3 esophageal cancer located on the lower esophagus. After esophagectomy, on the stomach, a giant ulcer with malignant appearance was observed by endoscopy, and histological examination of the biopsy specimen revealed poorly differentiated adenocarcinoma. Clinically, the patient was diagnosed with primary gastric cancer. The second case was a 50-year-old patient treated with esophagectomy. Five and a half years after surgery, the patient underwent routine endoscopic examination and diagnosed with gastric cancer on the gastric tube. The major problem in surgery for these patients was removal of the reconstructive esophagus from the retro-mediastinum, since the adhesion was extremely tight. Howerver, surgery was successful, suggesting that surgery for gastric cancer on the reconstructive esophagus might be recommended. Japan has been reported to have one of the highest incidences of double cancer in both the esophagus and stomach. Intensive follow-up for esophageal cancer patients may be necessary for the early detection of second cancer on the stomach and for improvement of the prognosis.

Key words
esophageal cancer, carcinoma of the reconstructed gastric tube, rote of the reconstruction for a esophageal cancer

Reprint requests
Yoshihiro Kagawa Department of Surgery, National Shikoku Cancer Center Hospital
13 Horinouchi, Matsuyama, 790 JAPAN

Accepted
October 11, 1995

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