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Metachronous carcinoma of the gastric tube following tumour-associated oesophagectomy

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Abstract

Introduction

The prognosis of oesophageal carcinoma has improved during the last years. Thereby, the increasing survival has led to increasing occurrence of secondary gastric tube carcinoma (gastric conduit cancer, GTC) following oesophageal tumour resection.

Material and patients

A literature review (EMBASE, PubMed), spanning the years 2000 to 2020, identified 342 patients worldwide with a GTC following tumour-related oesophagectomy, of which 306 patients could be included for further analysis.

Results

The median age of 306 patients with GTC was 66.4 (39–80) years. 91.2% of patients (n = 279) were male. The median interval between oesophagectomy and GTC was 60.3 (4–236) months. 73.8% of patients (n = 226) were diagnosed as early cancer (EGC, T1) and 26.2% as advanced carcinoma (AGC, > T2; n = 80). Primary oesophagectomy was performed in 97.4% of patients (N = 298) for squamous cell carcinoma. AEG I carcinoma was present in only 5 patients (1.6%). In contrast, 99% (n = 303) of the GTC were found to be adenocarcinomas. One hundred eighty patients (58.8%) could be treated by endoscopic resection (ER). R0 resection was achieved in 82.8% (n = 149). The complication rate was 13.3% (n = 24) and the 30-day mortality 1.1% (n = 2) for ER. Eighty-three patients (27.1%) were treated surgically. These included 13 wedge resections, 25 partial resections and 45 total gastric graft resections with predominantly colon interposition. The R0 rate was 98.8% (n = 82). The postoperative morbidity was 24.1% (n = 20); the 90-day mortality was 6% (n = 5). In 43 patients (14%), palliative chemotherapy or radiotherapy or best supportive care took place.

Summary

GTC diagnosed early in the EGC stage can be safely managed with ER. In cases of advanced GTC, surgical resection can be a potentially curative approach. Survival times of up to 120 months have been described after intervention for GTC.

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Authors and Affiliations

  1. Department of General and Visceral Surgery, Klinikum Suedstadt Rostock, Suedring 81, 18059, Rostock, Germany

    Kaja Ludwig & Njanja Enz

  2. Institute for Pathology, Klinikum Suedstadt Rostock, Suedring 81, 18059, Rostock, Germany

    Hans Kreutzer

  3. Department for Internal Medicine A, F.-Sauerbruchstr, University Hospital Greifswald, 17475, Greifswald, Germany

    Tilman Pickartz

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  1. Kaja Ludwig
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  2. Njanja Enz
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  3. Hans Kreutzer
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Correspondence to Kaja Ludwig.

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This article does not contain studies with human participants performed by any of the authors. Only one own patient was included in the collected data. This involved participant was treated in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. A informed consent (ICMJE) was obtained.

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Ludwig, K., Enz, N., Kreutzer, H. et al. Metachronous carcinoma of the gastric tube following tumour-associated oesophagectomy. Langenbecks Arch Surg 406, 2263–2272 (2021). https://doi.org/10.1007/s00423-021-02316-4

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  • DOI: https://doi.org/10.1007/s00423-021-02316-4

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