Resection of carcinoma in the cervical esophagus following prior removal of a thoracic esophageal carcinoma — A case report—

  • Toshiro Konishi
  • Ken-ichi Mafune
  • Toru Hirata
  • Masakazu Takagi
  • Yoshio Ushirokoji
  • Yasuo Idezuki
  • Kiyonori Harii
  • Masao Asai
Case Reports


We report herein, a rare case of a patient who, having undergone resection of a thoracic esophageal cancer, underwent removal of a cervical esophageal cancer, for which a free jejunal graft with microvascular anastomoses was utilized. The tumor in the cervical esophagus had originated from a second primary squamous cell cancer, which had occurred synchronously but had unfortunately escaped detection before the first operation. Due to the high incidence of other multicentric neoplasma or metastatic skip lesions accompanying esophageal carcinoma, careful evaluation during preoperative examinations in order to avoid overlooking another lesion, especially in the cervical portion of the esophagus is imperative.

Key words

free jejunal graft multiple esophageal carcinoma post thoracic esophagectomy cervical esophageal carcinoma 


  1. 1.
    Kato, H, Iizuka, T, Watanabe, H, Terui, S, Ono I, Ebihara, S, Harii, K. Reconstruction of the esophagus by microvascular surgery. Jpn J Clin Oncol 1984; 14: 379–384.PubMedGoogle Scholar
  2. 2.
    Nishihira T, Hirayama K, Kasai M. Esophageal replacement using free intestinal grafts in patients with carcinoma involving both the cervical and thoracic esophagus. In: Siewert JR, Hölscher AH, eds. Diseases of the esophagus. Berlin: Springer-Verlag, 1988: 513–517.Google Scholar
  3. 3.
    Seidenberg B, Rosenak SS, Hurwitt ES, Som ML. Immediate Reconstruction of the cervical esophagus by a revascularized isolated, jejunal segment. Ann Surg 1959; 149: 162–171.PubMedGoogle Scholar
  4. 4.
    Nakayama K, Yamamoto K, Tamiya T, Makino H, Odaka M, Ohwada M, Takahashi H. Experience with free autografts of the bowel with a new venous anastomosis apparatus. Surgery 1964; 6: 796–802.Google Scholar
  5. 5.
    Wookey H. The surgical treatment of carcinoma of the pharynx and upper esophagus. Surg Gynecol Obstet 1942; 75: 499–506.Google Scholar
  6. 6.
    Harii K. Microvascular transfer of free skin flaps. In: Rob C, Smith R, eds. Operative surgery. London-Boston: Butterworth, 1980: 83–93.Google Scholar
  7. 7.
    Borst HG, Dragojevic D, Stegmann T, Hetzer R. Anastomotic leakage, stenosis, and reflux after esophageal replacement. World J Surg 1978; 2: 861–866.PubMedCrossRefGoogle Scholar
  8. 8.
    Wong J, Tam PC. Local recurrence after subtotal esophagectomy for cancer. In: Siewert JR, Hölscher AH eds. Diseases of the esophagus. Berlin: Springer-Verlag 1988: 490–493.Google Scholar
  9. 9.
    Warren S, Gates O. Multiple primary malignant tumors. Am J Cancer 1932; 16: 1358–1414.Google Scholar
  10. 10.
    Cahan WG, Castro EB, Rosen PP, Strong EW. Separate primary carcinomas of the esophagus and head and neck region, in the same patient. Cancer 1976; 37: 85–89.PubMedCrossRefGoogle Scholar
  11. 11.
    Fitzpatrick PJ, Tepperman BS, DeBoer G. Multiple primary squamous cell carcinomas in the upper digestive tract. Int Radiation Oncology Biol Phys 1984; 10: 2273–2279.CrossRefGoogle Scholar
  12. 12.
    Reboud E, Prodoura P, Fuentes P, Giudicelli R. Multicentric Esophageal Carcinoma: Yield of total endoscopy and vital staining. In: DeMeester TR, Skinner DB, eds. Esophageal disorders: Pathophysiology and therapy. New York: Raven press, 1985: 347–353.Google Scholar
  13. 13.
    Mandard AM, Marnay J, Gignoux M, Segol P, Blanc L, Ollivier JM, Borel B, Mandard JC. Cancer of the esophagus and associated lesions detailed pathologic study of 100 esophagectomy specimens. Hum Pathol 1984; 15: 660–669.PubMedGoogle Scholar
  14. 14.
    Kuwano H, Ohno S, Matsuda H, Mori M, Sugimachi K, Serial histologic evaluation of multiple primary squamous cell carcinomas of the esophagus. Cancer 1988; 61: 1635–1638.PubMedCrossRefGoogle Scholar
  15. 15.
    Tanaka O. Clinical and pathological analysis of esophageal carcinoma with a special reference to their intramural spreading characteristics. Nippon Kyoubugeka Gakkai Zasshi (J Jpn Ass Thorac Surg) 1979; 27: 1132–1144. (in Japanese with English Abst.)Google Scholar
  16. 16.
    Maeta M, Koga S, Shimizu, Inoue Y, Ishiguro M, Sawada T. Carcinogenic potential of the noncancerous epithelium in patients with oesophageal cancer. Br J Surg 1988; 75: 531–532.PubMedGoogle Scholar
  17. 17.
    Suckow EE, Yokoo H, Brock DR. Intraepithelial carcinoma concomitant with esophageal carcinoma. Cancer 1962; 15: 733–740.PubMedCrossRefGoogle Scholar
  18. 18.
    Ide H, Endo M. Clinical pathology of the esophageal tumor. 1 st ed. Tokyo: Igaku-Shoin, 1984; 27–29 (in Japanese).Google Scholar

Copyright information

© The Japan Surgical Society 1989

Authors and Affiliations

  • Toshiro Konishi
    • 1
  • Ken-ichi Mafune
    • 1
  • Toru Hirata
    • 1
  • Masakazu Takagi
    • 1
  • Yoshio Ushirokoji
    • 1
  • Yasuo Idezuki
    • 1
  • Kiyonori Harii
    • 2
  • Masao Asai
    • 3
  1. 1.The Second Department of Surgery, Faculty of MedicineUniversity of TokyoTokyoJapan
  2. 2.The Department of Plastic and Reconstructive Surgery, Facutly of MedicineUniversity of TokyoTokyoJapan
  3. 3.Department of Otolaryngolgy, Faculty of MedicineUniversity of TokyoTokyoJapan

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