Diagnosis and treatment of metachronous gastric cancers after surgical treatment for esophageal squamous cell carcinoma.
OBJECTIVE
With the improvement of the outcome after esophagectomy for esophageal cancer, patients with metachronous gastric cancer (MGC) in the reconstructed thoracic stomach have been observed in clinical practice. This study is a report of experiences with MGC with an emphasis on clinical pictures and treatment results.


METHODS
Medical records were reviewed of 728 patients who underwent surgery for esophageal cancer at Samsung Medical Center between 1994 and 2004. MGC was defined as follows; (1) diagnosed more than 6 months after esophagectomy, (2) squamous cell carcinoma in histology of the surgically resected esophagus, (3) adenocarcinoma in histology of the stomach biopsy or surgical specimen. The clinicopathologic characteristics of MGC were evaluated.


RESULTS
Eight patients (1.1%) of 728 patients were diagnosed with MGC. All patients were male and had a history of active smoking and drinking. The median age at the time of diagnosis of MGC was 67.8 years old (range: 62-76). Three patients (37.5%) were asymptomatic. Two patients (25%) complained of epigastric pain and 3 patients (37.5%) complained of obstructive symptoms including regurgitation, aspiration, dysphagia, and vomiting. The median interval between diagnosis of MGC and esophagectomy was 37 months (range: 8-85). Three MGCs (37.5%) were detected by endoscopic examination but not by computed tomography (CT). Three patients (37.5%) received surgery and were alive without recurrence for 12, 18 and 63 months respectively. One patient (12.5%) received radiation therapy and was alive for 69 months. Four patients (50%) received no treatment because of follow-up loss in 2 patients (25%) and death within days of MGC diagnosis in 2 patients (25%).


CONCLUSIONS
Favorable outcomes can be obtained by active treatment in patients with MGC after esophagectomy. Regular endoscopic follow-up is important for early detection and more effective treatment of MGC, especially in areas where the incidence of gastric cancer is high.
Kim
Hoi Jin
HJ
Department of Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea.
Lee
Jun Haeng
JH
Moon
Tae Gun
TG
Lee
June Sang
JS
Kim
Young-Ho
YH
Chang
Dong Kyung
DK
Son
Hee Jung
HJ
Rhee
Poong-Lyul
PL
Kim
Jae J
JJ
Rhee
Jong-Chul
JC
Shim
Young Mog
YM
D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000175:diagnosis* / Q000628:therapy*; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000628:therapy*