, Volume 15, Issue 3, pp 180–189 | Cite as

Clinical characteristics and management of gastric tube cancer after esophagectomy

  • Yasuhiro ShirakawaEmail author
  • Kazuhiro Noma
  • Naoaki Maeda
  • Takayuki Ninomiya
  • Shunsuke Tanabe
  • Satoru Kikuchi
  • Shinji Kuroda
  • Masahiko Nishizaki
  • Shunsuke Kagawa
  • Yoshiro Kawahara
  • Hiroyuki Okada
  • Toshiyoshi Fujiwara
Original Article



Gastric cancer is the second most common malignancy, overlapping with thoracic esophageal cancer (TEC). Among them, metachronous gastric tube cancers after TEC surgery have been increasing. The aims of this study were to examine the clinicopathological factors and treatment outcomes of gastric tube cancer (GTC) after TEC surgery.


Thirty-three GTCs in 30 cases after TEC treated between 1997 and 2016 were investigated retrospectively.


Most cases were males. The median interval from TEC surgery to GTC occurrence was 57 (6.5–107.5) months. Almost 2/3 lesions occurred in the lower third of the gastric tube (21/33); 29 lesions (in 26 cases) were superficial cancers, and 4 lesions were advanced cancers. Twenty-two lesions of superficial cancer were differentiated type, and the remaining seven lesions were undifferentiated type. Treatment for superficial cancer had previously been performed with partial gastric tube resection (10 lesions), and the number of cases undergoing endoscopic submucosal dissection (ESD) had increased recently (19 lesions). Most cases with superficial cancer survived without relapse. Four lesions of advanced cancer were found after a relatively long interval following TEC surgery. Most lesions of advanced cancer were scirrhous, undifferentiated type, and they died due to GTC.


GTCs may occur late in the postoperative course following TEC surgery. If they are discovered at an early stage, these lesions can be cured with ESD. Long-term periodic endoscopic examinations after TEC surgery are important.


Gastric tube cancer Esophagectomy Endoscopic submucosal dissection 


Compliance with ethical standards

Ethical Statement

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions.

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent or substitute for it was obtained from all patients for being included in the study.


  1. 1.
    Poon RT, Law SY, Chu KM, et al. Multiple primary cancers in esophageal squamous cell carcinoma: incidence and implications. Ann Thorac Surg. 1998;65:1529–34.CrossRefPubMedGoogle Scholar
  2. 2.
    Nagasawa S, Onda M, Sasajima K, et al. Multiple primary malignant neoplasms in patients with esophageal cancer. Dis Esophagus. 2000;13:226–30.CrossRefPubMedGoogle Scholar
  3. 3.
    Kokawa A, Yamaguchi H, Tachimori Y, et al. Other primary cancers occurring after treatment of superficial oesophageal cancer. Br J Surg. 2001;88:439–43.CrossRefPubMedGoogle Scholar
  4. 4.
    Okamoto N, Ozawa S, Kitagawa Y, et al. Metachronous gastric carcinoma from a gastric tube after radical surgery for esophageal carcinoma. Ann Thorac Surg. 2004;77:1189–92.CrossRefPubMedGoogle Scholar
  5. 5.
    Mukasa M, Takedatsu H, Matsuo K, et al. Clinical characteristics and management of gastric tube cancer with endoscopic submucosal dissection. World J Gastroenterol. 2015;21:919–25.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Sugiura T, Kato H, Tachimori Y, et al. Second primary carcinoma in the gastric tube constructed as an esophageal substitute after esophagectomy. J Am Coll Surg. 2002;194:578–83.CrossRefPubMedGoogle Scholar
  7. 7.
    Ahn HS, Kim JW, Yoo MW, et al. Clinicopathological features and surgical outcomes of patients with remnant gastric cancer after a distal gastrectomy. Ann Surg Oncol. 2008;15:1632–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Shigemitsu K, Naomoto Y, Shirakawa Y, et al. Five cases of early gastric cancer in the reconstructed gastric tube after radical resection for esophageal cancer. Jpn J Clin Oncol. 2002;32:425–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer. 2017;20:1–19.CrossRefGoogle Scholar
  10. 10.
    Bamba T, Kosugi S, Takeuchi M, et al. Surveillance and treatment for second primary cancer in the gastric tube after radical esophagectomy. Surg Endosc. 2010;24:1310–7.CrossRefPubMedGoogle Scholar
  11. 11.
    Nonaka S, Oda I, Sato C, et al. Endoscopic submucosal dissection for gastric tube cancer after esophagectomy. Gastrointest Endosc. 2014;79:260–70.CrossRefPubMedGoogle Scholar
  12. 12.
    Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011;14:101–12.CrossRefGoogle Scholar
  13. 13.
    Shirakawa Y, Noma K, Koujima T, et al. Operative technique of antethoracic esophageal reconstruction with pedicled jejunal flap. Esophagus. 2015;15:57–64.CrossRefGoogle Scholar
  14. 14.
    Takenaka R, Kawahara Y, Okada H, et al. Endoscopic submucosal dissection for cancers of the remnant stomach after distal gastrectomy. Gastrointest Endosc. 2008;67:359–63.CrossRefPubMedGoogle Scholar
  15. 15.
    Imagawa A, Okada H, Kawahara Y, et al. Endoscopic submucosal dissection (ESD) for early gastric cancer: results and degrees of technical difficulty as well as success. Endoscopy. 2006;38:987–90.CrossRefPubMedGoogle Scholar
  16. 16.
    Japan Esophageal Society. Japanese classification of esophageal cancer, 11th edition: part I. Esophagus. 2017;14:1–36.CrossRefGoogle Scholar
  17. 17.
    Japan Esophageal Society. Japanese classification of esophageal cancer, 11th edition: part II and III. Esophagus. 2017;14:37–65.CrossRefGoogle Scholar
  18. 18.
    Sobin LH, Gospodarowicz MK, Wittekind CH. TNM classification of malignant tumors (UICC international union against cancer). 7th ed. Oxford: Wiley-Blackwell; 2009.Google Scholar
  19. 19.
    Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Warren S, Gates O. Multiple primary malignant tumors. A survey of the literature and a statistical study. Am J Cancer. 1932;16:1358–414.Google Scholar
  21. 21.
    Osumi W, Fujita Y, Hiramatsu M, et al. Endoscopic submucosal dissection allows less-invasive curative resection for gastric tube cancer after esophagectomy—a case series. Endoscopy. 2009;41:777–80.CrossRefPubMedGoogle Scholar
  22. 22.
    Suzuki H, Kitamura M, Saito R, et al. Cancer of the gastric tube reconstructed through the posterior mediastinal route after radical surgery for esophageal cancer. Jpn J Thorac Cardiovasc Surg. 2001;49:466–9.CrossRefPubMedGoogle Scholar
  23. 23.
    Kise Y, Kijima H, Shimada H, et al. Gastric tube cancer after esophagectomy for esophageal squamous cell cancer and its relevance to Helicobacter pylori. Hepatogastroenterology. 2003;50:408–11.PubMedGoogle Scholar
  24. 24.
    Dixon MF, Mapstone NP, Neville PM, et al. Bile reflux gastritis and intestinal metaplasia at the cardia. Gut. 2002;51:351–5.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© The Japan Esophageal Society and Springer Japan KK, part of Springer Nature 2018

Authors and Affiliations

  • Yasuhiro Shirakawa
    • 1
    Email author
  • Kazuhiro Noma
    • 1
  • Naoaki Maeda
    • 1
  • Takayuki Ninomiya
    • 1
  • Shunsuke Tanabe
    • 1
  • Satoru Kikuchi
    • 1
  • Shinji Kuroda
    • 1
  • Masahiko Nishizaki
    • 1
  • Shunsuke Kagawa
    • 1
  • Yoshiro Kawahara
    • 2
  • Hiroyuki Okada
    • 2
  • Toshiyoshi Fujiwara
    • 1
  1. 1.Department of Gastroenterological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayama UniversityOkayamaJapan
  2. 2.Department of Gastroenterology and Hepatology, Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayama UniversityOkayamaJapan

Personalised recommendations