title: Diagnosis and treatment of metachronous gastric cancers after surgical treatment for esophageal squamous cell carcinoma.
abstract: 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.
authors.affiliation: Department of Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea.
authors.forename: Hoi Jin
authors.initials: HJ
authors.lastname: Kim
authors.forename: Jun Haeng
authors.initials: JH
authors.lastname: Lee
authors.forename: Tae Gun
authors.initials: TG
authors.lastname: Moon
authors.forename: June Sang
authors.initials: JS
authors.lastname: Lee
authors.forename: Young-Ho
authors.initials: YH
authors.lastname: Kim
authors.forename: Dong Kyung
authors.initials: DK
authors.lastname: Chang
authors.forename: Hee Jung
authors.initials: HJ
authors.lastname: Son
authors.forename: Poong-Lyul
authors.initials: PL
authors.lastname: Rhee
authors.forename: Jae J
authors.initials: JJ
authors.lastname: Kim
authors.forename: Jong-Chul
authors.initials: JC
authors.lastname: Rhee
authors.forename: Young Mog
authors.initials: YM
authors.lastname: Shim
mesh_terms: 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*