[Surgery for upper or middle thoracic esophageal carcinoma after gastrectomy].
OBJECTIVE
To evaluate the surgical treatment and technical key-points of upper or middle thoracic esophageal carcinoma in patients with history of gastrectomy.


METHODS
Eighty-six patients with upper or middle thoracic esophageal carcinoma after previous gastrectomy received surgical treatment between 1980 and 2004. Among them, tumor location was in middle thoracic esophagus in 50 patients, in upper thoracic esophagus in 31 and cervical esophagus in 5. Postoperative pathological staging was stage I in 16 patients, stage IIa in 62, stage IIb in 5 and stage III in 8. The interval between gastrectomy and the diagnosis of esophageal carcinoma ranged from 2 to 22 years. Surgical procedures included esophagectomy and reconstruction with nonreversed gastric tube in 2 patients and reversed gastric tube in 3. The esophagus was reconstructed with short segment of colon in 5 patients and long segment of colon in 74. Two cases underwent jejunostomy only.


RESULTS
Seventy-six patients (88%) were treated with curative intent. Seven patients (8%) received palliative surgery. Postoperative complication rate was 12% (10/86). One patient died of multiple organ dysfunction syndrome (MODS). Sixty-seven patients were followed up, the 1-, 3-, 5-year survival rates were 84% (56/67), 57% (38/67) and 22% (15/67), respectively.


CONCLUSIONS
Surgical treatment is the first choice for esophageal cancer patients after gastrectomy although the procedures are complicated. The surgery should be considered as a reliable therapeutic modality because of favorable patient prognosis. The replacement with colon is recommended for those patients.
Cheng
Bang-chang
BC
Department of Cardio-Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan 430060, China. xiajunml@yahoo.com
Xia
Jun
J
Mao
Zhi-fu
ZF
Huang
Jie
J
Wang
Zhi-wei
ZW
Wang
Tu-sheng
TS
Deng
Hong-ping
HP
D000328:Adult; D000368:Aged; D003106:Colon / Q000637:transplantation; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy; D004944:Esophagoplasty / Q000379:methods*; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012189:Retrospective Studies; D013270:Stomach / Q000601:surgery; D015996:Survival Rate; D014182:Transplantation, Autologous