Incidence of Esophageal Carcinomas After Surgery for Achalasia: Usefulness of Long-Term and Periodic Follow-up

Abstract

Case seriesPatients: Male, 48 • Male, 60 • Male, 63 • Male, 69 • Male, 68 • Female, 63Final Diagnosis: Esophageal cancerSymptoms: NoneMedication: —Clinical Procedure: —Specialty: OncologyObjective:Rare diseaseBackground:Patients with esophageal achalasia are considered to be a high-risk group for esophageal carcinoma, and it has been reported that this cancer often arises at a long interval after surgery for achalasia. However, it is unclear whether esophageal carcinoma is frequent when achalasia has been treated successfully and the patient is without dysphagia. In this study, we reviewed patients with esophageal carcinoma who were detected by regular follow-up after surgical treatment of achalasia.Case Report:Esophageal cancer was detected by periodic upper GI endoscopy in 6 patients. Most of them had early cancers that were treated by endoscopic resection. All 6 patients had undergone surgery for achalasia and the outcome had been rated as excellent or good. Annual follow-up endoscopy was done and the average duration of follow-up until cancer was seen after surgery was 14.3 years (range: 5 to 40 years). Five patients had early cancer. Four cases had multiple lesions.Conclusions:In conclusion, surgery for achalasia usually improves passage symptoms, but esophageal cancer still arises in some cases and the number of tumors occurring many years later is not negligible. Accordingly, long-term endoscopic follow-up is needed for detection of malignancy at an early stage.

Endoscopic submucosal dissection of a squamous cell carcinoma of the esophagus developing in the area of a previous Heller’s myotomy for achalasia

“…To our knowledge, this is the first case of ESD for an early esophageal cancer in the area of a previous Heller's myotomy. ESD has been shown to be a safe and effective procedure for early esophageal cancer [5], even in a previously treated achalasia patient [3]. Previous myotomy should not be considered a contraindication to an ESD procedure in such patients, but a prophylactic stent can be placed to reduce the risk of complications.…”

“…A few reports have described early esophageal cancer associated with achalasia that has been resected by endoscopy [3,4]. Here we report a case of endoscopic submucosal dissection (ESD) for a squamous cell carcinoma that developed in the area of a previous Heller's myotomy.…”

Carcinoma de esôfago em pacientes com acalasia: revisão sistemática e metanálise

“…Foram selecionados 42 artigos para análise qualitativa (Jaccottet e Cruchaud, 1956;Camara-Lopes, 1961;Barrett, 1964;Belsey, 1966;Just-Viera et al, 1967;Lortat-Jacob et al, 1969;Pierce et al, 1970;Wychulis et al, 1971;Ribet e Laget, 1972a;Ribet e Laget, 1972b;Brandalise et al, 1974;Carter e Brewer, 1975;Hankins e McLaughlin, 1975;Grosdidier et al, 1977;Jimenez et al, 1979;Norton et al, 1980;Pinotti et al, 1980;Viard et al, 1980;Corti et al, 1981;Chuong et al, 1984;Adeyemo et al, 1987;Bardini et al, 1990;Peracchia et al, 1991;Aggestrup et al, 1992;Meijssen et al, 1992;Arber et al, 1993;Streitz et al, 1995;Di Simone et al, 1996;Herbella et al, 1999;Brücher et al, 2001;Liu et al, 2004;Csendes et al, 2006;Ruffato et al, 2006;Henry et al, 2007;Eckardt et al, 2008;Zaninotto et al, 2008;Leeuwenburgh et al, 2010;Zendehdel et al, 2011;Leeuwenburgh et al, 2013;Gossage et al, 2014;…”

“…(DP 9,5) anos para CEC (Belsey, 1966;Hankins e McLaughlin, 1975;Jimenez et al, 1979;Bardini et al, 1990;Peracchia et al, 1991;Streitz et al, 1995;Di Simone et al, 1996;Brücher et al, 2001;Liu et al, 2004;Csendes et al, 2006;Ruffato et al, 2006;Eckardt et al, 2008;Zaninotto et al, 2008;Gossage et al, 2014;Ota et al, 2016) e 12 (DP 4,9) anos para AE (Di Ruffato et al, 2006;Leeuwenburgh et al, 2013).…”

“…Pacientes que apresentaram diagnóstico simultâneo de acalasia e câncer foram excluídos para garantir que acalasia não é secundária a câncer (pseudoacalasia). Nesse subgrupo, a prevalência de carcinoma foi de 21 casos a cada 1000 pacientes com acalasia (IC 95% 14, 33; n=7997) (Wychulis et al, 1971;Chuong et al, 1984;Adeyemo et al, 1987;Peracchia et al, 1991;Aggestrup et al, 1992;Meijssen et al, 1992;Arber et al, 1993;Di Simone et al, 1996;Herbella et al, 1999;Brücher et al, 2001;Liu et al, 2004;Csendes et al, 2006;Ruffato et al, 2006;Eckardt et al, 2008;Zaninotto et al, 2008;Leeuwenburgh et al, 2010;Gossage et al, 2014;Ota et al, 2016).…”