A Case of Cancer in the Stomach Used for Posterior Mediastinal Reconstruction after Radical Operation for Esophageal Cancer

Kenichiro Fukuhara, Harushi Osugi, Nobuyasu Takada, Yoshihiko Nishimura, Takanobu Funai, Shigeru Ree, Shinichi Taguchi, Miyuki Fujita, Eiki Okuda and Hiroaki Kinoshita

Second Department of Surgery, Osaka City University Medical School

A case of gastric cancer that arose in the section of stomach, used for posterior mediastinal reconstruction after radical operation for esophageal cancer is reported. The patient was a 69-year-old man, who had undergone thoracoscopic esophagectomy and posterior mediastinal reconstruction using stomach for moderately differentiated squamous cell carcinoma, with submucosal invasion, but without lymph node metastasis, in the middle thoracic esophagus, in our department, in September 1995. In October 1997, endoscopy revealed a lesion at the curvature of the gastric antrum. No malignant cells were detected in the biopsy specimen. However, in January 1998, the lesion had changed to 0-II a+II c in appearance and proved to be moderately differenciated adenocarcinoma by endoscopic biopsy. Endoscopic ultrasonography revealed submucosal layer invasion with metastasis to the subpyloric lymph node. In April 1998, the stomach was resected totally by right thoracotomy with D2 lymph node dissection followed by reconstruction using a long section of pedicled jejunum through the posterior mediastinum. The lesion was diagnosed histologically as moderately differentiated adenocarcinoma, m, n0, ly0, v0, stage Ia. The postoperative course was uneventful except for transient palsy of the recurrent laryngeal nerve. Although resection of the stomach for use in posterior mediastinal reconstruction seemed to be a complicated approach because of possible severe adhesion developing, complete resection with lymph node dissection is essential to obtain a good out come for cancer originating in the stomach. Also the thoracoscopic procedure for the previous esophagectomy contributed to reduced pleural adhesion.

Key words
metachronous double cancer in the esophagus and stomach, cancer in the reconstructed gastric role, route of reconstruction

Reprint requests
Kenichiro Fukuhara Second Departmemt of Surgery, Osaka City University Medical School 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585 JAPAN

Accepted
February 24, 1999

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