Shirakawa Yasuhiro, Noma Kazuhiro, Maeda Naoaki, Ninomiya Takayuki, Tanabe Shunsuke, Kikuchi Satoru, Kuroda Shinji, Nishizaki Masahiko, Kagawa Shunsuke, Kawahara Yoshiro, Okada Hiroyuki, Fujiwara Toshiyoshi
Department of Gastroenterological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikatacho, Kita-ku, Okayama, 700-8558, Japan.
Department of Gastroenterology and Hepatology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan.
Esophagus. 2018 Jul;15(3):180-189. doi: 10.1007/s10388-018-0611-2. Epub 2018 Mar 27.
Gastric cancer is the second most common malignancy, overlapping with thoracic esophageal cancer (TEC). Among them, metachronous gastric tube cancers after TEC surgery have been increasing. The aims of this study were to examine the clinicopathological factors and treatment outcomes of gastric tube cancer (GTC) after TEC surgery.
Thirty-three GTCs in 30 cases after TEC treated between 1997 and 2016 were investigated retrospectively.
Most cases were males. The median interval from TEC surgery to GTC occurrence was 57 (6.5-107.5) months. Almost 2/3 lesions occurred in the lower third of the gastric tube (21/33); 29 lesions (in 26 cases) were superficial cancers, and 4 lesions were advanced cancers. Twenty-two lesions of superficial cancer were differentiated type, and the remaining seven lesions were undifferentiated type. Treatment for superficial cancer had previously been performed with partial gastric tube resection (10 lesions), and the number of cases undergoing endoscopic submucosal dissection (ESD) had increased recently (19 lesions). Most cases with superficial cancer survived without relapse. Four lesions of advanced cancer were found after a relatively long interval following TEC surgery. Most lesions of advanced cancer were scirrhous, undifferentiated type, and they died due to GTC.
GTCs may occur late in the postoperative course following TEC surgery. If they are discovered at an early stage, these lesions can be cured with ESD. Long-term periodic endoscopic examinations after TEC surgery are important.
胃癌是第二常见的恶性肿瘤，与胸段食管癌（TEC）存在重叠。其中，TEC手术后异时性胃管癌的发生率一直在上升。本研究的目的是探讨TEC手术后胃管癌（GTC）的临床病理因素及治疗效果。
回顾性研究1997年至2016年间接受治疗的30例TEC术后的33例GTC。
大多数病例为男性。从TEC手术到GTC发生的中位间隔时间为57（6.5 - 107.5）个月。几乎2/3的病变发生在胃管的下三分之一处（21/33）；29个病变（26例）为浅表癌，4个病变为进展期癌。22个浅表癌病变为分化型，其余7个病变为未分化型。浅表癌的治疗以前采用部分胃管切除术（10个病变），最近接受内镜黏膜下剥离术（ESD）的病例数有所增加（19个病变）。大多数浅表癌病例存活且无复发。4个进展期癌病变在TEC手术后较长时间间隔后被发现。大多数进展期癌病变为硬癌、未分化型，患者因GTC死亡。
GTC可能在TEC手术后的病程后期发生。如果在早期发现，这些病变可通过ESD治愈。TEC手术后长期定期进行内镜检查很重要。
