Surgical treatment and prognosis of esophageal cancer after distal gastrectomy.
BACKGROUND
The purpose of the present study was to explore the clinicopathological characteristics and operative therapeutic efficacy of thoracic esophageal cancer after gastrectomy and compare with those without gastrectomy.


METHODS
From January 2000 to June 2007, 28 esophageal cancer patients with a history of distal gastrectomy underwent subtotal esophagectomy. Vascularized pedicle colonic conduit was most commonly used for esophageal substitution. Six hundred seventeen patients without a history of gastrectomy treated in the same period form the control group. After the operation, pathological characteristic, tumor staging, and survival statistics were analyzed.


RESULTS
Of those patients with esophageal cancer associated with gastric remnant, the majority were male. There was an average of 16.5 years for diagnosing esophageal cancer from the initial partial gastrectomy, 75% (21/28) of them were patients with Billroth I anastomosis. The proportion of lower-third tumors in patients after gastrectomy (12 of 28 patients, 43%) was significantly higher compared with that of the patients with intact stomachs (124 of 617 patients, 20%; P = 0.004). After surgical treatment, the overall 1-, 3-, and 5-year survival rates of gastrectomized and nongastrectomized patients were 100%, 35.00%, and 23.33% versus 98.93%, 59.42%, and 30.85% in stages I-II and 80.00%, 30.00%, and 0% versus 98.59%, 62.03%, and 21.03% in stages III-IV. The log rank test of equality of survival distribution for the gastrectomized vs nongastrectomized patients was not significant in stages I-II (P = 0.5692) but was significant in stages III-IV (P = 0.0166).


CONCLUSIONS
The patients with partial gastrectomy for more than 5 years, having upper gastrointestinal symptoms, should be considered having the risk of esophageal cancer associated with gastric remnant. For patients with a history of distal gastrectomy, a vascularized pedicle colonic conduit was most commonly used for esophageal substitution. Surgical efficacy was similar with the no-gastrectomy group in early stages I-II of esophageal cancer associated with gastric remnant but was lower compared with the no-gastrectomy group in stages III-IV. So, early diagnosis and an aggressive surgical approach may be crucial to achieve better outcomes for esophageal cancer patients with gastrectomy.
Wu
Lihui
L
Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai 200003, People's Republic of China. dr_wulihui@yahoo.com.cn
Xu
Zhifei
Z
Zhao
Xuewei
X
Li
Jianqiu
J
Sun
Yaochang
Y
D000230:Adenocarcinoma / Q000601:surgery; D004938:Esophageal Neoplasms / Q000401:mortality / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D005743:Gastrectomy; D018530:Gastric Stump; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000601:surgery; D010437:Peptic Ulcer / Q000601:surgery; D011183:Postoperative Complications; D011379:Prognosis; D013274:Stomach Neoplasms / Q000601:surgery; D015996:Survival Rate