Two Cases of Distal Gastrectomy for Gastric Cancers after Direct Surgical Intervention for Esophageal Varices: Case Report

Yuuki Takeuchi, Masahiro Suenaga, Jyunichi Tobinaga, Toyohiko Uchida, Hiroki Hayakawa, Masashi Uchimura, Osamu Teshigawara and Naohiro Nomura

Surgical Service, Nagoya Memorial Hospital

We encountered two cases of liver cirrhosis requiring distal gastrectomy for gastric cancers after terminal esophagoproximal gastrectomy (TEPG) with extensive devascuralization and splenectomy for esophageal varices. One patient was a 61-year-old woman who had undergone TEPG for esophageal varices 17 years before and was detected to have early gastric cancer in the lower third of the stomach by gastrointestinal endoscopic examination (0-IIa+IIc, T1N0M0 Stage IA). The other patient was a 71-year-woman who had undergone TEPG for esophageal varices two years before and was detected to have gastric cancer in the middle third of the stomach (3, T2N0M0 Stage IB). In both cases, we successfully performed distal gastrectomy and lymph node dissection without operative complications probably because of the preservation of sufficient blood supply to the remaining stomach as indicated by preoperative angiography. Both cases are alive five years and more after their operation without any evidence of recurrence of the gastric cancer. This surgical procedure may be recommended for liver cirrhosis patients with gastric cancer developing after TEPG in order to decrease the operative mortality and morbidity.

Key words
gastric cancer, liver cirrhosis with portal hypertension, after direct surgical intervention for esophageal varices

Reprint requests
Yuuki Takeuchi Surgical Service, Nagoya Memorial Hospital 4-305 Hirabari, Tenpaku-ku, Nagoya, 468-0011 JAPAN

Accepted
September 20, 2000

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