Mesojejunal lymph node metastasis in esophageal cancer following total gastrectomy.
We report on a case of thoracic esophageal cancer following total gastrectomy (rho-Roux-en-Y reconstruction) with metastasis to the mesojejunal lymph nodes. Subtotal esophagectomy with reconstruction using pedicled colon and dissection of two lymph node fields was performed. During the operation, we found three lymph nodes showing metastasis at the rho-Roux loop of the mesentery, and resected the rho-Roux loop. The route of the lymphatic drainage to the abdomen from the thoracic tumor seemed to have been changed by the prior gastrectomy. Based on the pathological findings, the case was diagnosed with T2N4M0, Stage IVa. We did not confirm that the distant metastases skipped the mesojejunal lymph nodes preoperatively; the distant metastases were detected accidentally by lymphoscintigraphy using technetium-99m tin colloid. We believe this case highlights the need for detailed examinations in esophageal cancer patients who have had prior gastrectomy.
Ono
Takashi
T
Department of Surgery, Akita University School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan.
Motoyama
Satoru
S
Saito
Reijiro
R
Okuyama
Manabu
M
Imano
Hiroshi
H
Ogawa
Jun-ichi
J
D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D003106:Colon / Q000637:transplantation; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy; D017809:Fatal Outcome; D005743:Gastrectomy; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging*; D008297:Male; D009367:Neoplasm Staging; D011877:Radionuclide Imaging; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery; D017556:Technetium Compounds; D017971:Tin Compounds
D017556:Technetium Compounds; D017971:Tin Compounds; C033493:technetium Tc 99m tin colloid