Abstract
Abstract Background The prolonged survival of patients receiving surgery for esophageal cancer has led to an increased incidence of adenocarcinoma arising in the gastric tube used for reconstruction (gastric tube cancer). The incidence of gastric tube cancer after esophagectomy has been reported to be 1.3–6.3% in Japan. Patients with early stage gastric tube cancer can be treated by endoscopic resection, however patients with advanced gastric tube cancer need to undergo the resection of the gastric tube. Methods A total of 497 patients underwent esophagectomy with gastric tube reconstruction between 2001 and 2015 at our institution. During the same period, gastric tube cancer was detected in seven patients including three by endoscopic submucosal dissection (ESD) and three by surgery. We investigated the clinicopathological study of these seven patient with gastric tube cancer. Results The incidence of gastric tube cancer was 1.4% (7/497) at our hospital. Average age was 73 years old (range, 62–84). Six patients were men and one was women. Average interval from esophagectomy to initial treatment was 78.3 ± 61.0 (months). Among seven patients with gastic tube cancer, three were treated by ESD and 3 underwent surgery. One patient went to a palliative therapy. All seven patient with gastric tube cancer, who didn’t have specific complains, were detected by regular upper gastrointestinal endoscopy. We observed a very high proportion of patients with H. pylori infection (at least five patients among seven). Conclusion ESD for gastric tube cancer after esophagectomy is a technically difficult procedure because of the limited working space and unusual fluid-pooling area in the reconstructed gastrictube as well as the presence of severe gastric fibrosis with staples under the suture line. A highly skilled endoscopist can perform the procedure successfully. An operative technique for the resection of gastric tube cancer by means of lifting the anterior chest wall and video scope-assisted surgery enabled the resection of gastric tube without performing a sternotomy. Disclosure All authors have declared no conflicts of interest.
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