A Case of Gastric Cancer with Intramural Metastasis to the Thoracic Esophagus

Tsukasa Takabayashi, Toshio Kanai, Motohito Nakagawa, Michio Sakata, Keigo Matsumoto, Takeshi Nakamura and Atsushi Suzuki

Department of Surgery, Hiratsuka City Hospital

Barium meal and endoscopic examinations were performed in a 64-year-old man with appetite loss and vomiting. An infiltrating ulcerative tumor of the upper and middle portions of the stomach and two elevated submucosal tumors, 30 and 10 mm in diameter, in the middle third of the esophagus were found. Biopsy specimens from both the gastric and esophageal tumors showed moderately differentiated adenocarcinomas. Under a diagnosis of gastric cancer with intramural metastasis to the esophagus, a total gastrectomy combined with splenectomy and caudal pancreatectomy was performed. An esophagectomy was omitted because metastasis to multiple lymph nodes, including the nodes around the abdominal aorta, was observed, indicating the systemic spread of the disease. Postoperative chemotherapy using mainly CDDP and 5FU, endoscopic mucosal resection of the esophageal lesions, and irradiation to the supraclavicular and mediastinal regions were effective and resulted in a relatively long survival period. The patient died of multiple organ metastases 34 months after the resection. Although rarely encountered, gastric cancer with intramural metastasis to the esophagus is usually diagnosed at an advanced stage. An operation strategy oriented to the patients'QOL and combined with chemotherapy and radiotherapy should be considered.

Key words
gastric cancer, intramural metastasis, metastatic esophageal tumor

Reprint requests
Tsukasa Takabayashi Department of Surgery, Hiratsuka City Hospital 1-19-1 Minamihara, Hiratsuka-city, 254-0065 JAPAN

Accepted
May 27, 2003

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