Metachronous cancer of gastroplasty after esophagectomy

Abstract

We reviewed two cases of adenocarcinoma of the gastric tube used for reconstruction after esophagectomy for cancer. The first case gastric cancer was detected during follow-up by endoscopic examination. Total resection of the gastric tube and reconstruction by Roux-en-Y was performed each time. The patient was alive and disease-free 1 year after surgery. In the second case the tumor was revealed via thoracic pain. Chemotherapy, using carboplatin-5-fluorouracil, was performed because of lung metastasis but the patient died 1 year later. The incidence of gastric tube cancer after esophagectomy has recently increased in conjunction with the lengthening of survival of esophageal cancer patients. The clinical symptoms related to tumors are associated with short-term survival, whereas the cancers detected by routine endoscopy screening have occasional long-term survival. Gastrectomy is proposed for surgical treatment but the operating procedure is complex with a high morbidity rate. Lesions detected at an early stage could be treated by minimally invasive surgery such as endoscopic mucosal resection.

Use of Positron Emission Tomography in Surgery Follow-Up of Esophageal Cancer

“…Endoscopic examination is appropriate only for the detection of local recurrence or metachronous cancer of the gastroplasty that could be cured by minimal surgery. 18 Since CT is a morphological-based investigation tool, it is now wellknown to be suboptimal in the diagnosis of nodal involvement, since nodal size is not an accurate parameter for predicting involvement. It is also suboptimal for the differentiation between posttreatment fibrosis and recurrence.…”

Post-esophagectomy gastric conduit cancers: treatment experiences and literature review

“…Patients with esophageal cancer are predisposed to other tumors of the aerodigestive tract with an incidence of 8–12% . Adenocarcinoma of the gastric conduit used for reconstruction after esophagectomy is reported in 0.2–3.5% of patients …”

Gastric tube resection due to metachronic cancer and a recurrence in anastomosis after Ivor-Lewis esophagectomy – case report

“…We cannot exclude that due to esophageal stenosis, the secondary gastric tumor was not detected in our patient in the first endoscopy. Gastric metachronous carcinomas which are diagnosed on the basis of clinical symptoms have poor prognosis, whereas those detected early in the course of endoscopic screening have much better prognosis, particularly if they are related only to the mucosa [9,10]. Synchronous primary gastric cancers in patients with esophageal carcinoma diagnosed before esophagectomy should be treated in the same way as primary cancer [4,10].…”