A 69-year-old man with jaundice was diagnosed with cancer of the ampulla of Vater by endoscopic retrograde cholangiopancreatography and abdominal computed tomography. A screening gastrointestinal endoscopy showed middle thoracic esophageal cancer and early gastric cancer on the anterior wall of the lower gastric body. We chose a two-stage operation for synchronous triple primary cancer of the esophagus, stomach, and ampulla of Vater, in order to safely perform the curative resection of these three cancers. The first-stage operation consisted of a right transthoracic subtotal esophagectomy with mediastinal and cervical lymph node dissection, an external esophagostomy in the neck, and a gastrostomy. Thirty-five days after the first surgery, a total gastrectomy with regional lymph node dissection, and a pancreatoduodenectomy with Child’s reconstruction were performed as the second-stage surgery. Esophageal reconstruction was achieved using the ileocolon via the percutaneous route without vascular anastomosis.
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Conflict of interest
Masahide Fukaya and the coauthors have no conflicts of interest to declare.
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Fukaya, M., Abe, T., Yokoyama, Y. et al. Two-stage operation for synchronous triple primary cancer of the esophagus, stomach, and ampulla of Vater: report of a case. Surg Today 44, 967–971 (2014). https://doi.org/10.1007/s00595-013-0549-x