Surveillance and treatment for second primary cancer in the gastric tube after radical esophagectomy
- 189 Downloads
Recent improvement in the survival of patients after esophagectomy for esophageal cancer has led to increasing occurrence of second primary cancer in the pulled-up stomach as gastric tube cancer (GTC). However, a treatment strategy for GTC including surveillance has not been established. The aims of this study are to clarify the incidence and clinicopathological characteristics of GTC and to assess the treatment results of endoscopic resection.
Twenty-five patients with 29 GTC lesions treated between 1989 and 2007 were analyzed retrospectively.
The median interval between esophagectomy and GTC detection was 86 months, and the 10-year cumulative incidence rate of GTC was 8.6%. Of 18 asymptomatic GTCs, 17 lesions (94.4%) were detected by periodic endoscopy and 15 (88.2%) of them were treated endoscopically. Of all 29 GTCs, endoscopic submucosal dissection (ESD) was performed in 10 GTCs with a completely curative resection rate of 90%, which was significantly higher than that of 7 GTCs treated with endoscopic mucosal resection (EMR) (14.3%, P = 0.004). In these 17 GTCs, no cancer recurrence developed during a median follow-up period of 24 months, and the 3-year survival rate was 80.8%.
For patients after esophagectomy with gastric pull-up, long-term follow-up including periodic endoscopy is necessary to detect a potentially curable GTC. ESD is a feasible and safe procedure for GTC, with oncologically favorable features.
KeywordsGastric tube Endoscopic submucosal dissection Endoscopic surveillance
Drs. Takeo Bamba, Shin-ichi Kosugi, Manabu Takeuchi, Masaaki Kobayashi, Tatsuo Kanda, Atsushi Matsuki, and Katsuyoshi Hatakeyama have no conflicts of interest to disclose. No financial support by commercial relationship was provided for this study.
- 8.Kuwabara S, Nishimaki T, Kanda T, Nakagawa S, Suzuki T, Hatakeyama K (2002) Second primary cancer developing in the reconstructed gastric tube after esophagectomy for esophageal cancer: clinicopathological analyses of 14 cases. Acta Med Biol 50:91–96Google Scholar
- 11.Sobin LH, Wittekind CH (2002) TNM classification of malignant tumors, 6th edn. Wiley, New YorkGoogle Scholar
- 13.Japan Esophageal Society (2008) Japanese classification of esophageal cancer, 10th edn. Kanehara, TokyoGoogle Scholar
- 15.Japanese Gastric Cancer Association (2004) Treatment guideline for gastric cancer in Japan (in Japanese), 2nd edn. Kanehara, TokyoGoogle Scholar
- 17.Oyama T, Kikuchi Y, Shimaya S, Tomori A, Hotta K, Miyata Y, Yamada S (2002) Endoscopic mucosal resection using a hooking knife (hooking EMR). Stomach Intest 37:1155–1161Google Scholar