A Case of Multiple Primary Cancers that underwent a Radical Resection of both Remnant Gastric Cancer and Hepatocelluar Carcinoma, after an Esopahagectomy with Reconstruction Using the Colon

Mikito Inokuchi, Noriaki Nakamura*, Keiji Kato, Kagami Nagai, Yasuaki Nakajima, Hiroyuki Yamada, Kazuyuki Kojima, Kenro Kawada, Tetsuro Nishikage and Tatsuyuki Kawano

Department of Esophagogastric Surgery and Department of Hepato-Pancreatic Biliary Surgery*, Tokyo Medical and Dental University

We report a case of a gastric cancer remnant previously involving an esophagectomy among multiple cancers of more than three organs. A 76-year-old-man who had undergone distal gastrectomy with Billroth-I reconstruction for gastric cancer at age 36, esophagectomy with reconstruction using the colon for multiple early esophageal cancers at 63, and a resection for left lung cancer at 74, was found at the last surgery in computed tomography (CT) to have two tumors in the left lateral hepatic segment. Follow-up CT showed them to be growing, and they were eventually diagnosed as hepatocellular carcinoma based on CT angiography. Endoscopy also detected a gastric cancer remnant of macroscopic type 0IIc, and a pathological type of poorly differentiated adenocarcinoma and signet-ring cell carcinoma. We radically resected the gastric remnant cancer and two hepatocellular carcinomas, preserving the left colic artery feeding the reconstructed colon and removing the gastric remnant together with the left lateral hepatic segment. After resection, we constructed an anastomosis between the reconstructed colon and the jejunum using the Roux-en-Y method.

Key words
gastric remnant cancer, hepatocellular carcinoma, esophageal cancer

Reprint requests
Mikito Inokuchi Department of Esophagogastric Surgery, Tokyo Medical and Dental University
1-5-45 Yushima, Bunkyo, 113-8519 JAPAN

Accepted
December 16, 2009

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