Kan T, Shimada Y, Kanda Y, Yasuchika K, Imamura M
First Department of Surgery, Kyoto University, Japan.
Nihon Geka Hokan. 1995 Sep 1;64(5):123-7.
A case of adenocarcinoma developed in the reconstructed gastric tube after esophagectomy was reported. The patient was 66 years old man and he had received subtotal esophagectomy for the carcinoma of the esophagus 11 years previously. The follow-up examination of upper GI series revealed an ulcerative lesion in the lower part of the gastric tube and endoscopic biopsy showed adenocarcinoma. The partial resection of the lower gastric tube with mediansternotomy was performed because of limiting the invasion of the carcinoma. Pathological examination showed that poorly differentiated adenocarcinoma with signet ring cells had invaded muscularis propria. The postoperative course was uneventful and he is well without any recurrence 6 months after the operation. A double carcinoma, such as esophageal cancer concomitant gastric cancer is not rare, but a carcinoma of the gastric tube which was substituted for the esophagus is rare. Recently, the incidence of carcinoma of the gastric tube is increasing due to the increasingly long-term survival rate of patients who had esophageal carcinoma. In order to ensure the early detection of a second carcinoma which can minimalize damage from curative resections, follow up examinations should be conducted with the utmost diligence.
报告了1例食管癌切除术后重建胃管发生腺癌的病例。患者为66岁男性,11年前因食管癌接受了食管次全切除术。上消化道造影的随访检查显示胃管下部有溃疡性病变,内镜活检显示为腺癌。由于限制癌的浸润,行胸骨正中切开术对胃管下部进行了部分切除。病理检查显示,伴有印戒细胞的低分化腺癌已侵犯固有肌层。术后病程顺利,术后6个月情况良好,无任何复发。双癌,如食管癌合并胃癌并不少见,但替代食管的胃管癌却很罕见。近年来,由于食管癌患者的长期生存率不断提高,胃管癌的发病率正在上升。为了确保能早期发现可将根治性切除的损害降至最低的第二种癌症,应极其勤勉地进行随访检查。