[Surgical treatment of esophageal cancer in post-subtotal gastrectomy patients].

Among the 1285 cases of esophageal cancer operated in our hospital during the interval 1985-1990, 11 had had subtotal gastrectomy earlier, with an incidence of 0.86%. Among these 11 cases, two had upper thoracic segment lesions which were resected and reconstructed by transverse and descending colon transplantation into the neck. Right postero-lateral thoracotomy, upper abdominal and left neck incisions were used. Nine patients had esophageal cancer in the middle and lower thoracic segment and 7 of them were operated by transplanting the remaining stomach with spleen and caudal portion of pancreas into the left thorax and esophago-gastrectomy with the remaining stomach. Exploratory thoracotomy only was done in the other 2 patients. No complication occurred. Billroth type II gastrectomy was found to be easier than Billroth type I to move the remaining stomach together with the spleen and pancreas up into the thorax and to anastomose supra-aortically. There was no direct cause-effect evidence between gastrectomy and the site of esophageal cancer. The purpose for gastrectomy (ulcer or cancer) and the type of gastrectomy (Billroth type I or II) were irrelevant to the subsequent development of esophageal cancer.