Multicentric Occurrence of Esophageal Cancer After Gastrectomy: A Preliminary Report

Abstract

The effect of gastrectomy on the subsequent development of esophageal cancer was investigated, focusing on its multicentric occurrence. We retrospectively evaluated 28 patients who underwent subtotal esophagectomy for intrathoracic esophageal cancer between 1985 and 1999. They were divided into two groups according to whether or not they had previously undergone a gastrectomy: group 1, comprising 7 patients who had undergone gastrectomy and group 2, comprising 21 patients who had not. Clinical profiles of the patients were obtained from the medical records and the whole resected esophagus was histopathologically examined. The interval between gastrectomy and esophagectomy in group 1 was significantly shorter in the patients who had undergone gastrectomy for gastric cancer than in those who had undergone gastrectomy for a peptic ulcer, and also in the patients for whom anastomosis had been performed by Billroth I compared with Billroth II. The patients in group 1 were significantly younger than those in group 2. The multiple occurrence of esophageal cancer was found in 4 of 5 patients (80%) in group 1, and in 2 of 18 patients (11%) in group 2, with significantly higher frequency being seen in group 1. More than two coexisting cancer lesions apart from the primary tumor were detected in all four patients. Histological examination of all the coexisting cancer lesions showed well-differentiated squamous cell carcinoma confined within the superficial mucosal layer. No significant differences were noted in the location of the coexisting lesions between the oral and anal side of the primary tumors. Squamous dysplasia was randomly observed, especially around the cancer lesions. These findings suggest that gastrectomy precipitated subsequent chronic gastroesophageal reflux which in turn induced the development of squamous dysplasia and carcinoma at multiple locations in the esophagus.

Clinical outcome of esophageal cancer patients with history of gastrectomy

“…Thus, the surgical indication for esophageal cancer has recently been discussed more seriously with respect to its survival benefit [11,12]. There have been many studies concerning esophageal cancers after gastrectomy, which revealed some differences in the clinicopathological features in comparison with esophageal cancer without a history of gastrectomy, such as for sex [13], tumor location [2,5,13], and multiple cancers [14]. However, the survival benefit of surgical therapy for gastrectomized esophageal cancer patients has not been sufficiently discussed, probably because the number of patients in these studies was not adequate.…”

Surgical Treatment and Prognosis of Esophageal Cancer After Distal Gastrectomy

“…3 A history of abdominal surgery should not be considered a contraindication to surgery, although esophageal cancer associated with gastric remnants belong to an advanced stage, with a removal rate of 30-50%. 3,5 In our study, one of the strictly selected 28 cases was resected, which related to the case selection. More importantly, with the continuous improvement of auxiliary examination techniques-particularly with the universal application of fiber endoscopy-the early diagnosis of esophageal cancers associated with gastric remnants has become possible, thus increasing the removal rate.…”

“…For extended lymph node metastases, infiltration of adjacent organs, and low rate of early diagnosis, most patients with a history of distal gastrectomy are diagnosed with advanced esophageal cancer; so, their removal rate and survival rate (SR) were lower than in patients without such a history. 5 The reported 5-year overall SR ranged from 7% to 20%, but it was also reported that early detection of esophageal cancer after gastrectomy would lead to longterm SR. 6 This study determines if there is any difference in the clinicopathological features and clinical outcome of esophageal cancer in patients with a history of distal gastrectomy compared with those without such a history.…”

Esophageal Carcinoma in a Pregnant Woman Who Has Prior History of Gastric Cancer

“…Some authors reported that it is only incidental [5] , however some experimantal studies demonstrated that carcinogenetic effects of the reflux of gastroduodenal contents on the esophagus is frequently observed after gastrectomy [6,7] . Kitayabashi et al reported that gastrectomy may precipitate chronic gastroesophageal reflux and it can induce the development of squamous dysplasia and carcinoma [8] . This effect may be considered for our patient.…”