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Surveillance and treatment for second primary cancer in the gastric tube after radical esophagectomy

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Abstract

Background

Recent improvement in the survival of patients after esophagectomy for esophageal cancer has led to increasing occurrence of second primary cancer in the pulled-up stomach as gastric tube cancer (GTC). However, a treatment strategy for GTC including surveillance has not been established. The aims of this study are to clarify the incidence and clinicopathological characteristics of GTC and to assess the treatment results of endoscopic resection.

Methods

Twenty-five patients with 29 GTC lesions treated between 1989 and 2007 were analyzed retrospectively.

Results

The median interval between esophagectomy and GTC detection was 86 months, and the 10-year cumulative incidence rate of GTC was 8.6%. Of 18 asymptomatic GTCs, 17 lesions (94.4%) were detected by periodic endoscopy and 15 (88.2%) of them were treated endoscopically. Of all 29 GTCs, endoscopic submucosal dissection (ESD) was performed in 10 GTCs with a completely curative resection rate of 90%, which was significantly higher than that of 7 GTCs treated with endoscopic mucosal resection (EMR) (14.3%, P = 0.004). In these 17 GTCs, no cancer recurrence developed during a median follow-up period of 24 months, and the 3-year survival rate was 80.8%.

Conclusions

For patients after esophagectomy with gastric pull-up, long-term follow-up including periodic endoscopy is necessary to detect a potentially curable GTC. ESD is a feasible and safe procedure for GTC, with oncologically favorable features.

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Disclosures

Drs. Takeo Bamba, Shin-ichi Kosugi, Manabu Takeuchi, Masaaki Kobayashi, Tatsuo Kanda, Atsushi Matsuki, and Katsuyoshi Hatakeyama have no conflicts of interest to disclose. No financial support by commercial relationship was provided for this study.

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Authors and Affiliations

  1. Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuou-ku, Niigata City, 951-8510, Japan

    Takeo Bamba, Shin-ichi Kosugi, Tatsuo Kanda, Atsushi Matsuki & Katsuyoshi Hatakeyama

  2. Department of Endoscopy, Niigata University Medical and Dental Hospital, Niigata City, Japan

    Manabu Takeuchi, Masaaki Kobayashi & Atsushi Matsuki

  3. Division of Gastroenterology and Hepatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata City , Japan

    Manabu Takeuchi & Masaaki Kobayashi

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  1. Takeo Bamba
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  2. Shin-ichi Kosugi
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  3. Manabu Takeuchi
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  4. Masaaki Kobayashi
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  5. Tatsuo Kanda
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  6. Atsushi Matsuki
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  7. Katsuyoshi Hatakeyama
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Correspondence to Tatsuo Kanda.

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Bamba, T., Kosugi, Si., Takeuchi, M. et al. Surveillance and treatment for second primary cancer in the gastric tube after radical esophagectomy. Surg Endosc 24, 1310–1317 (2010). https://doi.org/10.1007/s00464-009-0766-y

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  • DOI: https://doi.org/10.1007/s00464-009-0766-y

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