Brown Kevin C, Esnaola Gabriela, Boffa Dan, Morton John M
Department of Surgery, Yale School of Medicine, 330 Cedar Street, PO Box 208062, New Haven, CT 06510, United States.
J Surg Case Rep. 2023 Sep 24;2023(9):rjad518. doi: 10.1093/jscr/rjad518. eCollection 2023 Sep.
Gastroesophageal malignancy after sleeve gastrectomy is rare. A 70-year-old male with a BMI of 46 underwent laparoscopic sleeve gastrectomy with normal endoscopy. By 10 months postop, the patient had reduced BMI to 30.5. Eleven months postop, he presented with emesis and endoscopy showed severe stenosis at the gastroesophageal junction with EUS showing a circumferential mass. Patient had adenocarcinoma of the distal esophagus HER 3+ and MMR proficient, clinical T2N1. He underwent esophageal stent placement followed by FOLFOX switched to carboplatin-Taxol with radiation therapy complicated by a localized perforation requiring antibiotics. After PET scan of esophageal mass indicated response, he underwent an open distal esophagectomy, total gastrectomy with Roux-en-Y esophagojejunostomy, and placement of feeding tube. Pathology revealed poorly differentiated invasive adenocarcinoma with negative margins. In the USA, this represents only the second adenocarcinoma following a sleeve gastrectomy and the first in a non-immune compromised patient.
袖状胃切除术后发生胃食管恶性肿瘤的情况较为罕见。一名70岁男性，体重指数（BMI）为46，接受了腹腔镜袖状胃切除术，术前内镜检查正常。术后10个月，患者的BMI降至30.5。术后11个月，他出现呕吐症状，内镜检查显示胃食管交界处严重狭窄，超声内镜显示有一个环形肿物。患者患有远端食管腺癌，HER 3阳性且错配修复功能正常，临床分期为T2N1。他先接受了食管支架置入术，随后接受FOLFOX方案化疗，之后改为卡铂-紫杉醇化疗并联合放射治疗，期间出现局部穿孔，需要使用抗生素。在PET扫描显示食管肿物有反应后，他接受了开放性远端食管切除术、全胃切除术及Roux-en-Y食管空肠吻合术，并放置了饲管。病理检查显示为低分化浸润性腺癌，切缘阴性。在美国，这是第二例袖状胃切除术后发生的腺癌，也是第一例发生在非免疫功能低下患者身上的病例。
