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Efficacy of preserving the residual stomach in esophageal cancer patients with previous gastrectomy

General Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Objective

There is no consensus concerning whether the residual stomach should be preserved after esophagectomy for thoracic esophageal cancer patients with previous distal or segmental gastrectomy. The purpose of this retrospective study was to assess the efficacy of preserving the residual stomach after esophagectomy in patients with previous gastrectomy.

Methods

Between 2000 and 2015, 45 consecutive thoracic esophageal cancer patients with previous distal or segmental gastrectomy underwent esophagectomy followed by colon reconstruction. Patients were assigned to two groups according to how the residual stomach was treated (preservation group, n = 11; resection group, n = 34). We compared surgical outcomes and alterations of nutrition status, including the skeletal muscle area, between the two groups. In addition, we investigated the distribution of abdominal lymph node metastases in the resection group.

Results

Operative time and blood loss tended to be lower in the preservation group compared to the resection group. However, the difference did not reach statistical significance. The rate of patients decreasing skeletal muscle area after surgery was significantly higher in the resection group (88% vs 50%, P = 0.03). There were no patients with metastatic abdominal lymph nodes when the previous gastrectomy had been performed for gastric cancer and the esophageal cancer was located at the upper or middle esophagus in the resection group.

Conclusions

Preservation of the residual stomach after esophagectomy in esophageal cancer patients with previous gastrectomy may influence the postoperative nutrition status and can be selectively approved.

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References

  1. Zeng F, He B, Wang Y, Xue Y, Cong W. Combined thoracoscopic and laparoscopic minimally invasive esophagectomy. J Thorac Dis. 2014;6:152–5.

    PubMed  PubMed Central  Google Scholar 

  2. Doki Y, Okada K, Miyata H, Yamasaki M, Fujiwara Y, Takiguchi S, et al. Long-term and short-term evaluation of esophageal reconstruction using the colon or the jejunum in esophageal cancer patients after gastrectomy. Dis Esophagus. 2008;21:132–8.

    Article  CAS  PubMed  Google Scholar 

  3. Wada H, Doki Y, Nishioka K, Ishikawa O, Kabuto T, Yano M, et al. Clinical outcome of esophageal cancer patients with history of gastrectomy. J Surg Oncol. 2005;89:67–74.

    Article  PubMed  Google Scholar 

  4. Bartels H, Thorban S, Siewert JR. Anterior versus posterior reconstruction after transhiatal oesophagectomy: A randomized controlled trial. Br J Surg. 1993;80:1141–4.

    Article  CAS  PubMed  Google Scholar 

  5. Kato H, Tachimori Y, Watanabe H. Surgical treatment for thoracic esophageal carcinoma in patients after gastrectomy. J Surg Oncol. 1992;51:94–9.

    Article  CAS  PubMed  Google Scholar 

  6. Noguchi Y, Imada T, Abe S, Tamura S, Ymamoto Y, Amano T, et al. Lymphatic flow of the remnant stomach. Nihon Geka Gakkai zasshi. 1988;89:852–62.

    CAS  PubMed  Google Scholar 

  7. Shimada H, Fukagawa T, Haga Y, Oba K. Does postoperative morbidity worsen the oncological outcome after radical surgery for gastrointestinal cancers? A systematic review of the literature. Ann Gastroenterol Surg. 2017;1:11–23.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Nakashima Y, Saeki H, Nakanishi R, Sugiyama M, Kurashige J, Oki E, et al. Assessment of sarcopenia as a predictor of poor outcomes after esophagectomy in elderly patients with esophageal cancer. Ann Surg. 2018;267:1100–4.

    Article  PubMed  Google Scholar 

  9. Tanaka Y, Yoshida K, Suetsugu T, Imai T, Matsuhashi N, Yamaguchi K. Recent advancements in esophageal cancer treatment in Japan. Ann Gastroenterol Surg. 2018;2:253–65.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Sobin LH, Gospodarowicz MK, Wittekind C. UICC international Union Against Cancer. TNM classification of malignant tumors. 7th ed. New York: Wiley-Blackwell; 2009.

    Google Scholar 

  11. Watanabe M, Mine S, Nishida K, Kurogochi T, Okamura A, Imamura Y. Reconstruction after esophagectomy for esophageal cancer patients with a history of gastrectomy. Gen Thorac Cardiovasc Surg. 2016;64:457–63.

    Article  PubMed  Google Scholar 

  12. Yoshizumi T, Shirabe K, Nakagawara H, Harimoto N, Toshima T, Yamashita Y, et al. Skeletal muscle area correlates with body surface area in healthy adults. Hepatol Res. 2014;44:313–8.

    Article  PubMed  Google Scholar 

  13. Takubo K, Makuuchi H, Fujita H, et al. Japanese classification of esophageal cancer, tenth edition: Part I. Esophagus-Tokyo. 2009;6:1–25.

    Article  Google Scholar 

  14. Roka S, Rath T, Jakesz R, Wenzl E. Treatment and reconstruction after disconnection of the failed cervical esophagogastric anastomosis. Dis Esophagus. 2003;16:130–4.

    Article  CAS  PubMed  Google Scholar 

  15. Davis PA, Law S, Wong J. Colonic interposition after esophagectomy for cancer. Arch Surg. 2003;138:303–8.

    Article  PubMed  Google Scholar 

  16. Cense HA, Visser MR, van Sandick JW, de Boer AG, Lamme B, Obertop H, et al. Quality of life after colon interposition by necessity for esophageal cancer replacement. J Surg Oncol. 2004;88:32–8.

    Article  PubMed  Google Scholar 

  17. Jun W, Wei W, Weibing W, Jing X, Fuxi Z, Xiaoxiang X, et al. Clinical outcome of using gastric remnant or jejunum or colon conduit in surgery for esophageal carcinoma with previous gastrectomy. J Surg Oncol. 2017;115:729–37.

    Article  PubMed  Google Scholar 

  18. Cummings DE, Weigle DS, Frayo RS, Breen PA, Ma MK, Dellinger EP, et al. Plasma ghrelin levels after diet-induced weight loss or gastric bypass surgery. N Eng J Med. 2002;346:1623–30.

    Article  Google Scholar 

  19. Li HH, Zhang QZ, Xu L, Hu JW. Clinical outcome of esophageal cancer after distal gastrectomy: a prospective study. Int J Surg. 2008;6:129–35.

    Article  CAS  PubMed  Google Scholar 

  20. Dionigi G, Dionigi R, Rovera F, Boni L, Carcano G. Reconstruction after esophagectomy in patients with [partial] gastric resection. Case report and review of the literature of the use of remnant stomach. Int Semin Surg Oncol. 2006;3:10.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Xie SP, Fan GH, Kang GJ, Geng Q, Huang J, Cheng BC. Esophageal reconstruction with remnant stomach: A case report and review of literature. World J Gastroenterol. 2013;19:3169–72.

    Article  PubMed  PubMed Central  Google Scholar 

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Correspondence to Kazuo Koyanagi.

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All authors have no financial or other relations that could lead to a conflict of interest.

Ethical statement

This work followed the guidelines set forth in the Helsinki Declaration of 1975, as revised in 2000, concerning Human and Animal Rights. This article does not contain human or animal subjects performed by any authors. This was a retrospective study approved by the institutional review board of the National Cancer Center Hospital.

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Nakanishi, K., Daiko, H., Kato, F. et al. Efficacy of preserving the residual stomach in esophageal cancer patients with previous gastrectomy. Gen Thorac Cardiovasc Surg 67, 470–478 (2019). https://doi.org/10.1007/s11748-019-01070-1

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  • DOI: https://doi.org/10.1007/s11748-019-01070-1

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