A Case of Distal Gastrectomy for Posterior Mediastinal Gastric Tube Cancer after Radical Operation for Esophageal Cancer : Literature Review in Japan

Abstract Background Gastric conduit used for reconstruction after esophagectomy for esophageal cancer (EC) has the potential to develop a metachronous cancer known as gastric tube cancer (GTC). The aim of our study was to review literature and evaluate outcomes and possible treatment strategies for GTC. Methods A comprehensive systematic literature search was conducted using PubMed. No restriction was set for type of publication, number, age and sex of patients. Study language was limited to English. Characteristics of EC and its treatment and GTC and its treatment were analyzed. Results A total of 26 studies were analyzed, 10 retrospective analysis and 16 case reports, involving 170 patients, 17 patients (10%) were affected by multifocal GTC. 143 ECs (84,1%) were squamous cell carcinomas. In 95 patients (55,9%) a posterior-mediastinal reconstructive route was used at the time of esophagectomy for EC. Mean interval between esophagectomy and diagnosis of GTC was 67,18 months (4–236 months). 184 GTCs were metachronous lesions (98,4%). 164 GTCs were adenocarcinomas (98,2%). 84 GTCs were located in the lower part of the gastric tube. 88 patients were endoscopically treated. 63 patients underwent surgery. 30 total gastrectomies + limphoadenectomy with colon or jejunal interposition were performed. 27 subtotal gastrectomies and 6 wedge resections were performed. Main reported post-operative complications were: anastomotic leak, vocal cord palsy and respiratory failure. 19 patients were treated with chemoradiotherapy and palliative care. 68,2% of endoscopically treated patients, 63,5% of surgically resected patients and 5,2% of patients who underwent chemoradiotherapy were alive at a mean follow-up of 25,5 months. Feasibility of endoscopic resections in patients diagnosed with superficial GTC has been established. Surgical treatment represents the preferred treatment modality in operable patients with locally invasive tumor. Patients treated with conservative therapy have a scarce prognosis. Conclusion Yearly endoscopic follow-up is of paramount importance in patients who underwent esophagectomy for EC with gastric tube reconstruction. At least, a 10-year endoscopic surveillance is recommended. Disclosure All authors have declared no conflicts of interest.

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Treating Gastric Tube Cancer With Distal Gastrectomy Preserving the Gastroepiploic Artery

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2004.11.011 ◽

2006 ◽

Vol 81 (2) ◽

pp. 751-753 ◽

Cited By ~ 12

Author(s):

Satoru Motoyama ◽

Reijiro Saito ◽

Manabu Okuyama ◽

Kiyotomi Maruyama ◽

Jun-ichi Ogawa

Keyword(s):

Gastric Tube ◽

Distal Gastrectomy ◽

Gastroepiploic Artery ◽

Gastric Tube Cancer

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Cancer of the gastric tube reconstructed through the posterior mediastinal route after radical surgery for esophageal cancer

The Japanese Journal of Thoracic and Cardiovascular Surgery ◽

10.1007/bf02913915 ◽

2001 ◽

Vol 49 (7) ◽

pp. 466-469 ◽

Cited By ~ 19

Author(s):

Hiroyuki Suzuki ◽

Michihiko Kitamura ◽

Raijiro Saito ◽

Satoru Motoyama ◽

Jun-ichi Ogawa

Keyword(s):

Esophageal Cancer ◽

Gastric Tube ◽

Radical Surgery ◽

Posterior Mediastinal ◽

Posterior Mediastinal Route

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A CASE OF CARCINOMA DEVELOPED IN THE RECONSTRUCTED GASTRIC TUBE AFTER RADICAL OPERATION FOR ESOPHAGEAL CANCER

The journal of the Japanese Practical Surgeon Society ◽

10.3919/ringe1963.55.1201 ◽

1994 ◽

Vol 55 (5) ◽

pp. 1201-1205

Author(s):

Shoichiro KOIKE ◽

Wataru ADACHI ◽

Masaru KOBAYASHI ◽

Hideo MIYAMOTO ◽

Takai KURODA ◽

...

Keyword(s):

Esophageal Cancer ◽

Gastric Tube ◽

Radical Operation

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Resection of the Gastric Tube Reconstructed through the Retrosternal Route without Sternotomy

Case Reports in Surgery ◽

10.1155/2017/5862871 ◽

2017 ◽

Vol 2017 ◽

pp. 1-4

Author(s):

Masahiro Kimura ◽

Yasuyuki Shibata ◽

Kotaro Mizuno ◽

Hironori Tanaka ◽

Motoki Hato ◽

...

Keyword(s):

Gastric Cancer ◽

Esophageal Cancer ◽

Gastric Tube ◽

Early Stage ◽

Combined Modality Therapy ◽

First Report ◽

Gastric Tube Cancer ◽

Subtotal Esophagectomy ◽

Combined Modality ◽

Advanced Stages

With advances of combined modality therapy, prognoses in esophageal cancer have been improving. After resection of esophageal cancer, the development of gastric tube cancer is a risk. While such cancer in an early stage can be cured endoscopically, total gastric tube resection is indicated in advanced stages. A 68-year-old man underwent subtotal esophagectomy reconstructed with a gastric tube through the retrosternal route. Gastric cancer was found one and a half years postoperatively. The gastric tube was resected without sternotomy. This is the first report of a patient undergoing resection of the gastric tube reconstructed through the retrosternal route without sternotomy.

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Chylothorax after esophagectomy treated with inguinal intranodal lymphangiography and transvenous retrograde thoracic duct embolization

Clinical Journal of Gastroenterology ◽

10.1007/s12328-021-01429-z ◽

2021 ◽

Author(s):

Yuta Sato ◽

Yoshihiro Tanaka ◽

Takeharu Imai ◽

Hiroshi Kawada ◽

Naoki Okumura ◽

...

Keyword(s):

Esophageal Cancer ◽

Thoracic Duct ◽

Gastric Tube ◽

Treatment Options ◽

Effective Treatment Option ◽

Major Morbidity ◽

Posterior Mediastinal ◽

Posterior Mediastinal Route ◽

Intranodal Lymphangiography ◽

High Output

AbstractChylothorax after esophagectomy is a serious complication that is associated with major morbidity due to dehydration and malnutrition. Reoperation with ligation of the thoracic duct is considered for patients with high-output chyle leaks that have failed conservative management. In this report, we present the treatment options for chylothorax after esophagectomy: inguinal intranodal lymphangiography and transvenous retrograde thoracic duct embolization. A 74-year-old man with esophageal cancer had been operated with thoracoscopic esophagectomy. Six days after surgery, he presented with high-output chyle leaks. Conservative treatment did not result in a significant improvement. Inguinal intranodal lymphangiography and transvenous retrograde thoracic duct embolization were performed 13 days after surgery and were technically and clinically successful. Inguinal intranodal lymphangiography and transvenous retrograde thoracic duct embolization are an effective treatment option, especially for patients after esophagectomy with reconstruction performed via the posterior mediastinal route, without the potential for damage the gastric tube and omentum.

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Gastric tube cancer after esophagectomy for esophageal cancer: A single-center experience with meta-analysis of 145 cases.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e14573 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e14573-e14573

Author(s):

Geun Dong Lee ◽

Yong-Hee Kim ◽

Seung-Il Park ◽

Dong Kwan Kim ◽

Hyeong Ryul Kim

Keyword(s):

Esophageal Cancer ◽

Surgical Resection ◽

Endoscopic Resection ◽

Gastric Tube ◽

Palliative Treatment ◽

Meta Analysis ◽

Gastric Conduit ◽

Survival Duration ◽

Gastric Tube Cancer

e14573 Background: Gastric tube cancer (GTC) defined as carcinoma arising in the gastric conduit after esophagectomy, is often crucial in long-term survivors of esophageal cancer. The aim of this study was to determine the optimal approach to manage GTC. Methods: We reviewed data of 863 patients who underwent esophagectomy and reconstruction with the gastric conduit for esophageal cancer at Asan Medical Center from 1993 to 2011 and identified 28 cases of GTC. We also searched through the PubMed database and included additional 117 cases of GTC from 13 studies to conduct meta-analysis. Results: In our cases, the incidence rate of GTC was 3.2%. The median interval between esophagectomy and GTC detection was 3.1 (0.6-15.2) years. Twelve (42.9%) patients were asymptomatic and diagnosed by periodic endoscopy. The Most common histologic type of GTC was adenocarcinoma (57.1%) and fifteen (53.6%) were located on the lower third of gastric tube. Chemotherapy, total gastrectomy or palliative treatment was performed in 10, 5, 2 patients, respectively. Eleven (39.3%) patients refused the further treatment for GTC. Mean survival duration of 28 patients after the diagnosis of GTC was 29.1 months. In meta-analysis, The cumulative occurrence of 5, 8 years was 59.5%, 87.8%, respectively. Two-year survival rate of the patients who underwent endoscopic resection, surgical resection or palliative treatment was 100%, 61.6%, 5.2%, respectively. The patients who underwent endoscopic resection had a better prognosis than those who underwent surgical resection or those who received palliative treatment (p=0.047, p=0.000, respectively). Conclusions: After esophagectomy for esophageal cancer, patients had a constant risk of GTC occurrence up to 8 years approximately. The patients who diagnosed as advanced-state GTC had a poor prognosis. However, endoscopic resection as a minimally invasive treatment for early-GTC represented a feasible prognosis compared with those of operative resection or palliative treatment. Therefore, a long-term follow-up including detailed endoscopy is essential for the better outcomes in patients who underwent esophagectomy for esophageal cancer.

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