Esophageal cancer in patients with a history of distal gastrectomy.
OBJECTIVE
There is an association between a history of distal gastrectomy and the development of esophageal cancer. Surgical treatment of esophageal cancer in patients with a history of gastrectomy is more complicated but will not result in increased mortality in an experienced center.


METHODS
Case-control study.


METHODS
Tertiary care center for the treatment of esophageal cancer.


METHODS
Forty patients with a history of gastrectomy and 1266 patients with intact stomachs who underwent esophagectomy for cancer.


METHODS
Patients' demographic characteristics, tumor characteristics, operative morbidity, mortality, and long-term survival.


RESULTS
There were more squamous tumors located in the lower third of the esophagus in those who had a history of gastrectomy compared with those with intact stomachs (16 [41%] of 40 patients vs 318 [25%] of 1266 patients; P=.04). This difference was more pronounced after Billroth I vs Billroth II gastrectomy (8 [73%] of 11 patients vs 8 [29%] of 28 patients; P=.03). Twenty-four patients (60%) in the gastrectomy group and 738 (58%) in the nongastrectomy group underwent surgical resection (P=.87). The operative time (300 [160-465] vs 220 [90-520] minutes; P<.001) was longer and more blood loss (1000 [300-2500] vs 700 [150-7000] mL;P<.001) was encountered for esophagectomy after previous gastrectomy (data are given as median [range]). A colon interposition was the substitute conduit of choice in the gastrectomy group (20 [83%] of 24 patients), and the stomach was the preferred loop in those with intact stomachs (729 [99%] of 738 patients). Postoperative complication rates were similar. In-hospital mortality rates also did not differ for those with a history of gastrectomy vs those without such a history (12% for both,P>.99). Median survival after resection was 13.8 and 12.5 months for patients who did and did not undergo prior gastrectomy, respectively (P=.62).


CONCLUSIONS
A history of gastrectomy (especially the Billroth I type) is associated with more lower-third squamous cell esophageal carcinomas. Surgical resections in patients with such a history were more complicated but resulted in similar outcomes.
Alexandrou
Andreas
A
Division of Esophageal Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, China.
Davis
Peter A
PA
Law
Simon
S
Whooley
Brian P
BP
Murthy
Sudish C
SC
Wong
John
J
D000230:Adenocarcinoma / Q000209:etiology / Q000601:surgery; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D002277:Carcinoma / Q000209:etiology / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000209:etiology* / Q000601:surgery; D016022:Case-Control Studies; D004938:Esophageal Neoplasms / Q000209:etiology* / Q000601:surgery; D016629:Esophagectomy; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D006801:Humans; D007421:Intestine, Small / Q000601:surgery; D008297:Male; D008875:Middle Aged; D013270:Stomach / Q000601:surgery*