Kitabayashi K, Nakano Y, Saito H, Ueno K I, Kita I, Takashima S, Kurose N, Nojima T
Department of Surgery II, Kanazawa Medical University, Ishikawa, Japan.
Surg Today. 2001;31(8):670-4. doi: 10.1007/s005950170067.
The effect of gastrectomy on the subsequent development of esophageal cancer was investigated, focusing on its multicentric occurrence. We retrospectively evaluated 28 patients who underwent subtotal esophagectomy for intrathoracic esophageal cancer between 1985 and 1999. They were divided into two groups according to whether or not they had previously undergone a gastrectomy: group 1, comprising 7 patients who had undergone gastrectomy and group 2, comprising 21 patients who had not. Clinical profiles of the patients were obtained from the medical records and the whole resected esophagus was histopathologically examined. The interval between gastrectomy and esophagectomy in group 1 was significantly shorter in the patients who had undergone gastrectomy for gastric cancer than in those who had undergone gastrectomy for a peptic ulcer, and also in the patients for whom anastomosis had been performed by Billroth I compared with Billroth II. The patients in group 1 were significantly younger than those in group 2. The multiple occurrence of esophageal cancer was found in 4 of 5 patients (80%) in group 1, and in 2 of 18 patients (11%) in group 2, with significantly higher frequency being seen in group 1. More than two coexisting cancer lesions apart from the primary tumor were detected in all four patients. Histological examination of all the coexisting cancer lesions showed well-differentiated squamous cell carcinoma confined within the superficial mucosal layer. No significant differences were noted in the location of the coexisting lesions between the oral and anal side of the primary tumors. Squamous dysplasia was randomly observed, especially around the cancer lesions. These findings suggest that gastrectomy precipitated subsequent chronic gastroesophageal reflux which in turn induced the development of squamous dysplasia and carcinoma at multiple locations in the esophagus.
研究了胃切除术对随后食管癌发生的影响，重点关注其多中心发生情况。我们回顾性评估了1985年至1999年间因胸段食管癌接受次全食管切除术的28例患者。根据他们之前是否接受过胃切除术将其分为两组：第1组，包括7例接受过胃切除术的患者；第2组，包括21例未接受过胃切除术的患者。从病历中获取患者的临床资料，并对整个切除的食管进行组织病理学检查。第1组中因胃癌接受胃切除术的患者，其胃切除术与食管切除术之间的间隔时间明显短于因消化性溃疡接受胃切除术的患者，并且与采用毕Ⅰ式吻合的患者相比，采用毕Ⅱ式吻合的患者也是如此。第1组患者明显比第2组患者年轻。第1组5例患者中有4例（80%）发现食管癌多灶发生，第2组18例患者中有2例（11%），第1组的发生率明显更高。在所有4例患者中均检测到除原发性肿瘤外还有两个以上并存的癌灶。对所有并存癌灶的组织学检查显示为局限于浅表黏膜层的高分化鳞状细胞癌。在原发性肿瘤的口侧和肛侧之间，并存病变的位置未发现明显差异。随机观察到鳞状上皮发育异常，尤其是在癌灶周围。这些发现表明，胃切除术促使随后发生慢性胃食管反流，进而导致食管多处发生鳞状上皮发育异常和癌。
