Surveillance and treatment for second primary cancer in the gastric tube after radical esophagectomy.
BACKGROUND
Recent improvement in the survival of patients after esophagectomy for esophageal cancer has led to increasing occurrence of second primary cancer in the pulled-up stomach as gastric tube cancer (GTC). However, a treatment strategy for GTC including surveillance has not been established. The aims of this study are to clarify the incidence and clinicopathological characteristics of GTC and to assess the treatment results of endoscopic resection.


METHODS
Twenty-five patients with 29 GTC lesions treated between 1989 and 2007 were analyzed retrospectively.


RESULTS
The median interval between esophagectomy and GTC detection was 86 months, and the 10-year cumulative incidence rate of GTC was 8.6%. Of 18 asymptomatic GTCs, 17 lesions (94.4%) were detected by periodic endoscopy and 15 (88.2%) of them were treated endoscopically. Of all 29 GTCs, endoscopic submucosal dissection (ESD) was performed in 10 GTCs with a completely curative resection rate of 90%, which was significantly higher than that of 7 GTCs treated with endoscopic mucosal resection (EMR) (14.3%, P = 0.004). In these 17 GTCs, no cancer recurrence developed during a median follow-up period of 24 months, and the 3-year survival rate was 80.8%.


CONCLUSIONS
For patients after esophagectomy with gastric pull-up, long-term follow-up including periodic endoscopy is necessary to detect a potentially curable GTC. ESD is a feasible and safe procedure for GTC, with oncologically favorable features.
Bamba
Takeo
T
Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuou-ku, Niigata City 951-8510, Japan. banba@med.niigata-u.ac.jp
Kosugi
Shin-ichi
S
Takeuchi
Manabu
M
Kobayashi
Masaaki
M
Kanda
Tatsuo
T
Matsuki
Atsushi
A
Hatakeyama
Katsuyoshi
K
D000368:Aged; D016099:Endoscopy, Gastrointestinal; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D011159:Population Surveillance / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D015996:Survival Rate / Q000639:trends