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Management and outcomes of resectable gastric conduit cancer: a retrospective comparative study of 51 cases

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Abstract

Purpose

Although gastric conduit cancer (GCC) arising after esophagectomy is increasingly being reported, therapeutic strategies for resectable GCC have yet to be optimized. We investigated clinicopathological features of patients undergoing endoscopic versus more invasive surgical treatments for GCC and compared their outcomes.

Methods

Fifty-one patients, who had a history of esophagectomy with gastric conduit reconstruction for esophageal cancer and underwent resection for metachronous GCC, were identified. Their characteristics and outcomes were retrospectively reviewed.

Results

There were 48 males and three females, ranging in age from 46–86 years. Twelve patients underwent surgery for GCC (group S) and 39 underwent only endoscopic resection (group E). The most common cause of death was pneumonia (10/51, 19.6%). Neither overall survival nor cumulative incidence of pneumonia-caused death differed significantly between the two groups (P = 0.60, 0.84, respectively). In group S, partial gastrectomy was performed in four cases and total gastrectomy in seven. Partial resections, including three antrectomy without sternotomy or intrathoracic procedures, were completed with significantly shorter operative durations than total resections (median 208 vs 513 min, P = 0.012). GCC recurrence was experienced in two cases: one undergoing open approach partial resection of the corpus and the other thoracoscopic total gastrectomy.

Conclusion

Even compared with endoscopic treatment, outcomes following surgery for GCC appeared to be acceptable. Open approach total gastric gastrectomy could be the most radical modality, while other less invasive alternatives, e.g., antrectomy, are also an option. Clinicians may select a treatment strategy balancing radicality and patient status, reflecting tolerance to invasive procedures.

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Abbreviations

EC:

Esophageal cancer

GCC:

Gastric conduit cancer

ESD:

Endoscopic submucosal dissection

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan

    Masayuki Urabe, Shusuke Haruta, Akikazu Yago, Yu Ohkura, Tsuyoshi Tanaka, Masaki Ueno & Harushi Udagawa

  2. Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan

    Masami Tanaka & Shu Hoteya

  3. Okinaka Memorial Institute for Medical Research, Tokyo, Japan

    Yu Ohkura, Shu Hoteya, Masaki Ueno & Harushi Udagawa

Authors
  1. Masayuki Urabe
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  2. Shusuke Haruta
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  3. Masami Tanaka
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  4. Akikazu Yago
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  5. Yu Ohkura
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  6. Tsuyoshi Tanaka
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  7. Shu Hoteya
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  8. Masaki Ueno
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  9. Harushi Udagawa
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Contributions

Study conception and design: M. Urabe, S. Haruta, and M. Ueno; acquisition of data: all authors; analysis and interpretation of data: M. Urabe and S. Haruta; drafting of manuscript: all authors; critical revision of manuscript: S. Hoteya, M. Ueno, and H. Udagawa

Corresponding author

Correspondence to Masayuki Urabe.

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Disclosures of ethical statements

The institutional review board of Toranomon Hospital approved the research protocol.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were 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.

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Urabe, M., Haruta, S., Tanaka, M. et al. Management and outcomes of resectable gastric conduit cancer: a retrospective comparative study of 51 cases. Langenbecks Arch Surg 406, 1433–1441 (2021). https://doi.org/10.1007/s00423-020-02053-0

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  • DOI: https://doi.org/10.1007/s00423-020-02053-0

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