Five cases of early gastric cancer in the reconstructed gastric tube after radical resection for esophageal cancer

We report seven early gastric cancers in five patients, which arose in the reconstructed gastric tube after radical resection for esophageal cancer. Four of them occurred in the middle gastric tube and three in the distal gastric tube. Three of 5 cases were reconstructed via the retromediastinal route and two via the presternal route. They all were diagnosed by follow-up endoscopy from 8 months to 5 years after esophagectomy. All of them were treated surgically with partial resection of the gastric tube because they were suspected to have invaded the submucosal layer or large enough to be treated with endoscopic mucosal resection (EMR). Histologically, six of seven were diagnosed as well differentiated adenocarcinoma and one as signet ring cell carcinoma. Although one of them died for reasons other than cancer itself, the others are alive and well without any recurrence. Recently, gastric tube cancer after esophagectomy has been increasingly reported to be accompanied with prolongation of survival of esophageal cancer patients. Total or partial gastrectomy is proposed for surgical treatment of gastric tube cancer, but the operating procedure is complicated and invasive, especially in the case of gastric tube reconstructed via the retromediastinal route. Total gastrectomy is much more invasive because it needs re-reconstruction with other organs. Therefore, it is important to detect the lesion in early stages so as to treat it with minimally invasive surgery such as EMR or partial resection. Hence intensive follow up with endoscopy is necessary after resection of esophageal cancer.     

Gastric-carcinoma developing in the reconstructed gastric tube following esophagectomy - analysis of 58 cases

Fifty-eight Japanese patients with secondary adenocarcinoma, which developed in the reconstructed gastric tube after esophagectomy for carcinoma of the esophagus, were reviewed from 20 case reports published over a period of twenty years. Following esophagectomy the gastric tube was replaced through the antesternal route in 32 patients (55.2%), through the retrosternal route in 19 (32.7%) and through the intrathoracic route in 7 (12.1%). Regarding the initial diagnosis of the secondary carcinoma, 28 patients (48.3%) had a self-palpable tumor in the anterior chest, 10 patients (17.2%) had a feeling of dysphagia, and two (3.4%) experienced epigastralgia. In eighteen patients (31.1%), the secondary carcinoma was detected incidentally at follow-up examinations, including two autopsied cases. The interval between esophagectomy and the detection of the secondary carcinoma in the gastric tube ranged from 7 to 255 months (mean 72.4 +/- 54.2 months). In 31 patients (53.4%) the secondary carcinoma was detected more than 5 years after esophagectomy. The mean survival period was 81.2 +/- 54.3 months with a range from 21 to 227 months after esophagectomy. These results thus emphasise the significance of lifetime check-ups for the reconstructed gastric tube, especially when the stomach is used as substitution for the esophagus.     

A case of long-term survival after resection of aortic arch for locally advanced non-small cell lung cancer with induction chemotherapy

Our patient was a 57-year-old male with a history of esophageal cancer. He was referred to our hospital for squamous cell lung carcinoma(SCC). Chest computed tomography identified a mass in the left lung field, which was suspected to be invading the reconstructed gastric tube, left subclavian artery, common carotid artery, and distal aortic arch. He was diagnosed as primary pulmonary squamous cell carcinoma(SCC)because six years had already passed since a previous surgery for early esophageal cancer. He received three courses of induction chemotherapy including S-1/CDDP. We evaluated the therapy as a partial response. He underwent an extended resection of distal aortic arch and left subclavian artery with left upper lobectomy, and those vessels were reconstructed using prosthetic grafts. Pathological findings showed the tumor as a well differentiated SCC of pT4N0M0 at stage III A, with a residual tumor on the reconstructed gastric tube, even though the effect of induction chemotherapy was Ef2. He received three courses of S-1/CDDP after surgery. The patient has been well without recurrence for 31 months after surgery.     

Gastric tube reconstruction prevented esophageal reflux after proximal gastrectomy

Although the standard operation for early cancer of gastric cardia is proximal gastrectomy followed by jejunal interposition, we recently reported a simple and useful technique for proximal gastrectomy with gastric tube reconstruction. The operative procedures included resection of the proximal two-thirds of the stomach, followed by anastomosis between the esophagus and gastric tube, using a circular stapler (Proximate ILS 25; Ethicon, Cincinnati, OH, USA). The gastric tube was about 20 cm long and 4 cm wide. The patient a 76-year-old man had no reflux symptoms such as heartburn, retrosternal pain, and regurgitation. Endoscopy showed no evidence of reflux esophagitis, including mucosal redness, erosion, and ulceration. Ambulatory 24-h pH monitoring indicated that the pH of the lower esophagus was between 6 and 8 when the patient was upright and between 5 and 7 when he was in the supine position. There were nine reflux episodes during the day, and no reflux episode while he was asleep. The duration of each reflux episode was less than 1 min, and the total reflux time was 1 min in the 12-h day (0.1%). These data indicate that reconstruction by gastric tube may prevent esophageal reflux in patients who have undergone proximal gastrectomy for early cancer of the gastric cardia. Received for publication on Apr. 27, 1998; accepted on Aug. 19, 1998     

Long-term survival after perforation of advanced gastric cancer: Case report and review of the literature

Although the standard operation for early cancer of gastric cardia is proximal gastrectomy followed by jejunal interposition, we recently reported a simple and useful technique for proximal gastrectomy with gastric tube reconstruction. The operative procedures included resection of the proximal two-thirds of the stomach, followed by anastomosis between the esophagus and gastric tube, using a circular stapler (Proximate ILS 25; Ethicon, Cincinnati, OH, USA). The gastric tube was about 20 cm long and 4 cm wide. The patient a 76-year-old man had no reflux symptoms such as heartburn, retrosternal pain, and regurgitation. Endoscopy showed no evidence of reflux esophagitis, including mucosal redness, erosion, and ulceration. Ambulatory 24-h pH monitoring indicated that the pH of the lower esophagus was between 6 and 8 when the patient was upright and between 5 and 7 when he was in the supine position. There were nine reflux episodes during the day, and no reflux episode while he was asleep. The duration of each reflux episode was less than 1 min, and the total reflux time was 1 min in the 12-h day (0.1%). These data indicate that reconstruction by gastric tube may prevent esophageal reflux in patients who have undergone proximal gastrectomy for early cancer of the gastric cardia. Received for publication on Jan. 14, 1998; accepted on Apr. 1, 1998     

Clinicopathologic study of esophageal cancer associated with simultaneous metastatic lesions in the stomach

Between 1965 and 1985, 89 Japanese patients with esophageal squamous cell carcinoma underwent esophagectomy. In five of them (5.6%), a simultaneous metastatic lesion from the esophageal cancer was detected within the stomach in the resected specimens. Preoperative diagnosis of the gastric lesions had been made in none of the five patients because of an obstruction that was due to esophageal cancer. All gastric lesions were located at the gastric cardia, close to the esophagocardial junction, with a mean distance of 6.9 +/- 2.0 cm from the primary esophageal lesions. Provision of a gastric tube that contains metastatic lesions, for reconstruction of a new alimentary tract after esophagectomy, must be avoided. In cases of inadequate preoperative gastric examination, gastric lesions should be searched for intraoperatively, not only by serosal inspection and palpation, but also by mucosal inspection and palpation after partial proximal gastrectomy.     

S-1 chemotherapy for cancer of the gastric tube used for esophageal reconstruction following surgery for esophageal cancer

We used S-1 chemotherapy to treat 5 patients with cancer of the gastric tube used for esophageal reconstruction through the posterior mediastinal route following surgery for esophageal cancer. The response rate was 40%, the median survival 15 months, and 3 patients still survive. In those 3 patients, the gastric tube cancer was at a resectable stage, but the patients elected to have chemotherapy instead. One patient has survived 21 months after responding completely to 2 cycles of combined chemotherapy with S-1 and cisplatin. Another has survived 15 months after partially respondingto S-1 chemotherapy. And the third has survived 46 months after endoscopic treatment, radiation therapy and S-1 chemotherapy. S-1 chemotherapy thus appears to be an effective treatment for cancer of the gastric tube after surgery for esophageal cancer.     

食管癌穿孔外科治疗的临床分析

背景与目的:食管癌穿孔往往发生在癌肿进展期,易并发胸内感染,病情危重。保守疗法包括食管旷置、肠内或静脉营养支持以及内镜下放置支架,但是这些方法既不能消除癌肿又难以控制胸内感染,近期死亡率高。本研究分析外科治疗食管癌穿孔的手术方法及围手术期治疗特点。方法:对41例食管癌穿孔患者(其中穿入右肺19例,穿入纵隔17例,穿入气管5例)进行手术治疗。开胸手术39例,其中右胸三切口术式16例,分期手术23例,经胸骨后间隙胃或结肠代食管35例,经食管床胃代食管4例。2例只做胃造瘘姑息手术治疗。结果:36例患者获得手术成功,康复期能经口腔进食保证营养,生活自理,术后随访3～72个月,其中生存3个月2例,6～12个月31例,24个月2例,72个月1例,手术后死亡2例,2例胃造瘘姑息手术者和1例术后吻合口气管瘘再通者自动出院后1个月内死亡。结论:手术治疗食管癌穿孔成功恢复消化道的连续性,明显延长了患者的生存期,提高了生活质量;手术径路以右胸三切口术式(胸骨后胃或结肠代食管)或分期手术为佳。     

Pedunculated gastric tube interposition in an esophageal cancer patient with prepyloric adenocarcinoma

Gastric carcinoma is one of the malignancies that are most frequently associated with esophageal carcinoma.We describe herein our device for advanced esophageal cancer associated with early gastric cancer in the antrum.A 57-year-old man presenting with dysphagia and upper abdominal pain was admitted to our hospital.Preoperative examinations revealed locally advanced squamous cell carcinoma (SCC) of the middle thoracic esophagus (T3N0M0 Stage ⅡA) and mucosal signetring cell carcinoma of the gastric antrum (T1N0M0 Stage ⅠA).Although the gastric tumor appeared to be an intramucosal carcinoma,its margin was obscure,so endoscopic en-bloc resection was considered inadequate.We chose surgical resection of the gastric tumor as well as the esophageal SCC after neoadjuvant chemotherapy with 5-fluorouracil and cisplatin for advanced esophageal cancer.Following transthoracic esophagectomy with three-field lymph node dissection,the gastric carcinoma was removed by gastric antrectomy,which preserved the right gastroepiploic vessels,and a pedunculated short gastric tube was used as the esophageal substitute.Twenty-eight months after the surgery,the patient is well with no evidence of cancer recurrence.Because it minimizes surgical stress and organ sacrifice,gastric tube interposition is a potentially useful technique for esophageal cancer associated with localized early gastric cancer.     

Surgical treatment of concurrent cancer of the esophagus and stomach

Out of a total of 250 resections for carcinoma of the esophagus done in our department between 1965 and 1983, there were 11 patients with a concurrent esophageal cancer, nine being gastric cancer and seven of them early gastric cancer. In these nine, four underwent resection of the esophagus and lesser curvature of the stomach with gastric tube reconstruction. Two of the four patients are alive 10 and 3 yr postoperatively. We hold the view that detailed preoperative gastric examination is most important to plan the surgical repair and that the small gastric tube may serve as a substitute by resecting the lesser curvature of the stomach in cases of early proximal gastric cancer.     

Prospective study of “early” gastric cancer

In order to elucidate the natural history of early gastric cancer, we followed up non-concurrently certain patients who had been diagnosed endoscopically as having “early” gastric cancer and who had histological evidence of cancer by biopsy, but on whom surgical resection had been delayed or had not been conducted. At the Center for Adult Diseases, Osaka, 56 cases were eligible for this study. Out of these, 27 cases progressed to advanced cancer and 16 remained at the early stage during the follow-up period (6-88 months, mean: 29 months). The remaining 13 cases had had neither surgical resection nor examinations. The survivorship function for the duration of “early” gastric cancer was estimated by the life-table method of Kaplan and Meier. The median of the duration was estimated as 37 months. The 5-year survival rate of the 34 cases on whom surgical resection had not been conducted was estimated as 64.5%. These results suggest that early diagnosis and early treatment may lead to a reduction of mortality from stomach cancer.     

17例早期贲门腺癌患者的自然生存状况追踪分析

背景与目的:未经治疗的晚期贲门腺癌患者的生存时间为8～9个月.本研究目的是观察未进行任何治疗的早期胃贲门腺癌的自然发展史.方法:1987年在食管癌高发现场,对细胞学诊断为鳞状细胞重度增生的851例进行了内镜复查,同时检查了贲门区粘膜,经活检病理确诊为贲门腺癌者共43例.包括晚期癌12例,早期癌31例.其中17例早期患者虽经多次劝说,仍因不同原因拒绝治疗,随诊观察14年,直至全部患者死亡.结果:随诊14年,17例早期贲门癌患者中,12例死于贲门腺癌,另外5例死于非癌疾病;生存5年以上者13例,5年自然生存率为76.47%(13/17),10年自然生存率为23.53%(4/17).结论:早期贲门癌发展到晚期是一个漫长的演进过程.这对早期诊断和选择治疗时机很有帮助.同时,如要精确评估早期癌治疗效果,宜充分考虑其自然史的因素.     

2019年度广西上消化道癌机会性筛查结果分析

目的分析广西地区2019年度上消化道癌机会性筛查数据,为上消化道机会性筛查工作提供指导。方法回顾性分析从广西上消化道癌管理系统收集的2019年度(2019年7月1日—2020年6月30日)参加广西上消化道癌机会性筛查的临床病历资料。计算活检率,食管/胃肿瘤性病变检出率,食管癌/胃癌早诊率,并在不同性别组以及年龄组之间进行比较。结果共10357例受检者纳入上消化道癌机会性筛查,其中5897例进行活检组织病理学检查,食管、贲门、胃分别活检882例、178例、5392例,活检率分别为14.96%、3.02%、91.44%。共检出食管肿瘤性病变126例(1.22%),早期癌37例(29.37%);胃肿瘤性病变210例(2.03%),早期癌66例(31.43%);贲门肿瘤性病变19例(0.18%),早期癌4例(21.05%);胃及贲门肿瘤性病变229例(2.21%),胃及贲门早期癌70例(30.57%)。肿瘤性病变检出率在性别和年龄分组中比较,差异均有统计学意义(均P<0.001)。食管癌、胃癌早诊率在性别和年龄分组中比较,差异均无统计学意义(均P>0.05)。在80岁之前,食管、胃(包括贲门)肿瘤性病变的检出率均随年龄上升而上升(χ^(2)=46.716,P<0.001;χ^(2)=51.989,P<0.001)。结论2019年度广西上消化道癌机会性筛查检出率及早诊率均不高,需进一步提高人群的防癌意识,尤其是年龄≥40岁的男性人群。     

食管癌贲门癌切除及食管(管状胃)胃侧侧吻合术

目的探讨食管癌、贲门癌切除、食管(管状胃)胃侧侧吻合术的治疗效果及应用前景。方法共有32例患者行此手术。贲门癌6例、食管癌26例;其中胸下段9例,胸中段12例,胸上段5例。术中按肿瘤手术切除原则常规游离食管及近端胃,切除肿瘤。行主动脉弓下吻合9例,经食管床主动脉弓上吻合10例,左胸左颈两切口4例,右胸顶吻合3例,右胸颈腹三切口6例。22例患者应用管状胃代食管,10例患者应用全胃代食管。行食管胃端端吻合+侧侧吻合术15例;食管胃端侧吻合+侧侧吻合术10例;胸下段食管癌患者行食管管状胃全侧侧吻合术7例。结果本组病例术后分期分别为Ⅱa期9例,Ⅱb期11例,Ⅲ期12例。全部病例手术顺利,术后未出现吻合口瘘,术后2周复查上消化道钡透及胃镜检查均见吻合口通畅、无狭窄,术后随诊0.5～2年不等,均未见吻合口狭窄。结论食管癌、贲门癌切除食管(管状胃)胃侧侧吻合术可降低吻合口并发症尤其是狭窄的发生,值得临床推广。     

Aneuploidy of tumor cells in cases of gastric cancer with esophageal invasion: Another indicator of poor prognosis

The prognosis of patients with gastric cancer with esophageal invasion is extremely poor. To evaluate factors related to this poor prognosis, we analyzed 200 patients with gastric cancer located in the upper third of the stomach. These patients underwent gastrectomy and were divided into two groups in terms of the presence (E[+] group; n=62) or absence (E[-] group; n=138) of histological evidence of esophageal invasion. Even when apparently curative surgery was performed, the 5-year survival rate of patients with E[+] gastric cancer (45.8%) was significantly lower than of patients with E[-] gastric cancer (71.6%). In the E[+] group, the 5-year survival rate of patients who had tumors with infiltrative growth and DNA aneuploidy was only 10.0%. These patients had a high frequency of peritoneal metastasis at operation (5/16; 31.3%); even when apparently curative operations were performed, 50% of these patients died from peritoneal metastatic recurrence within 2 years after surgery. Gastric adenocarcinoma with esophageal invasion accompanied by infiltrative growth and DNA aneuploidy had a high potential for peritoneal metastasis. This combination is associated with the most pessimistic prognosis for patients with gastric cancer with esophageal invasion. © 1995 Wiley-Liss, Inc.     

Complete response to chemoradiotherapy in a patient with synchronous double gastric and esophageal cancer

A 77-year-old man with early synchronous double primary gastric and esophageal cancer showed complete response (CR) to chemoradiotherapy (CRT) with fluorouracil (5-FU) and cis-diamminedichloroplatinum (CDDP) and 60 Gy total dose of radiation. Gastrointestinal endoscopy had revealed type IIc squamous cell carcinoma in the lower oesophagus and type IIc adenocarcinoma in the mid-stomach region. Synchronous double primary early-stage esophageal and gastric cancer was diagnosed. The patient's age and chronic obstructive pulmonary disease (COPD) contraindicated radical esophageal surgery. Therefore, we decided to first administer CRT with 5-FU and CDDP for the esophageal cancer, and subsequently perform partial gastrectomy for the gastric cancer. After the CRT, neither of the tumors recurred. CR to CRT for the esophageal cancer and CR to chemotherapy for the gastric cancer were achieved. CONCLUSION: CRT with 5-FU and CDDP can produce CR in cases of early esophageal and gastric cancer.     

中下段食管癌三种术式探讨

目的:探讨中下段食管癌三种术式的优缺点。方法:2000年1 月至2007年12月共300 例中下段食管癌患者分别采用左胸左颈切口手工吻合（G1 组）、左胸切口经食管床行左胸顶机械吻合（G2 组）、左胸切口经主动脉旁行左胸顶机械吻合（G3 组）三种手术方式（各100 例）,观察手术时间、术后胸液量、胃液引流总量、肠蠕动恢复时间、心律失常、术后吻合口瘘、术前及术后3 个月肺功能变化、术后3 个月进食梗阻及反流等指标。结果:三组均无手术死亡。术后病理示食管鳞癌289 例,小细胞癌4 例,类癌4 例,腺癌3 例。上、下切缘无癌残留。G1 组发生3 例吻合口瘘,经保守治疗治愈。G1 组手术时间比G2、G3 组长,费用较低,术后吻合口瘘发生率相对较高,术后3 个月吻合口狭窄发生率较低;G2 组与G1、G3 组相比术后胸液引流总量少,术后早期心律失常发生率相对较低,术后3 个月肺功能减退及食管反流症状较轻;三组术后胃液引流总量/肠蠕动恢复时间无差别。结论:中下段食管癌的三种术式各有优缺点,应该根据患者肿瘤位置高低、术前肺功能状况、经济条件以及术者的熟练程度等因素综合考虑选择合适的术式。在条件允许的情况下,选择左胸切口经食管床行左胸顶机械吻合具有一定优势。      

食管癌贲门癌术后早期胸内消化道瘘的外科治疗5 例报告

 目的　总结探讨食管癌贲门癌手术后早期发生消化道瘘(即72h 之内) 的治疗方法。方法　本组报告5 例早期发生胸内消化道瘘病历, 均采取二次剖胸探查, 重新吻合或瘘口处修补方法解决消化道瘘。结果　5 例中4 例治愈出院, 1 例术后并发呼吸衰竭死亡。结论　食管癌贲门癌手术后早期发生消化道瘘病 人应采用手术为应急措施。     

Bleomycin infusions combined with radiotherapy in the treatment of inoperable esophageal cancer

A combination of bleomycin, in a 12 h infusion, and radiotherapy was applied in 25 patients with untreated inoperable esophageal cancer. Bleomycin was administered 15 mg/m2 twice weekly, concurrently with irradiation (total dose 3600-4000 rad). Such combined treatment produced 3 complete remissions of the esophageal tumor, 10 partial remissions (response rate 52%--13/25), 3 stable disease cases, while in 9 cases the disease progressed in spite of therapy. The median duration of remissions was 8.7 months in complete responders, 6.0 months in partial responders, and 3.0 months in stable disease cases. Similarly, median survival was the longest in complete remission cases (10.3 months). Patients who did not respond to therapy had a median survival of only 2.8 months. Adverse treatment reactions were of a milder character, except retrosternal pain and burning caused by irradiation mucositis, which occurred in 80% of patients. The trial showed that the combination of bleomycin applied in the form of 12 h infusion and irradiation can produce remissions in 50% of inoperable esophageal cancer cases, i.e., a rate of remission which is similar to that achieved by irradiation and bleomycin applied in the form of rapid (push) i.v. injections.     

36例食管癌穿孔的手术治疗

目的：探讨手术治疗食管癌穿孔的理想手术方法及围术期治疗特点。方法：对36例食管癌穿孔（其中穿入右肺14例，穿入纵隔17例，穿入气管5例）患者进行手术治疗。开胸手术34例，其中右胸三切口术式16例，分期手术15例。34例中经胸骨后间隙胃或结肠代食管26例。结果：31例患者获得手术成功，手术死亡3例，术后随访3～72个月．其中生存7～12个月15例，24个月2例，72个月1例，疗效较为满意：结论：手术治疗食管癌穿孔效果较为明显．优于一般保守治疗。手术方式以右胸三切口术式（胸骨后胃或结肠代食管）或分期手术为佳。