Second primary carcinoma in the gastric tube constructed as an esophageal substitute after esophagectomy
Second primary carcinoma in the gastric tube constructed as an esophageal substitute after esophagectomy
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DOI：
10.1016/s1072-7515(02)01135-3
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发表时间：
2002-05-01
影响因子：
5.2
通讯作者：
Nakanishi, Y
中科院分区：
文献类型：
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作者：
Sugiura, T;Kato, H;Nakanishi, Y
背景技术背景：食管癌的预后已得到改善，但沿着这种改善，人们越来越担心食管切除术后胃内构建的管道中发生第二原发癌，特别是胃癌。研究设计：回顾性分析1968年9月至2000年10月间收治的26例食管癌患者中的31例胃管癌。结果：10例患者行手术切除。7例行胃切除加区域淋巴结清扫术，3例行胃部分切除不加淋巴结清扫术。6例患者在胃切除术后发生漏，其中3例死于多器官功能衰竭。胃切除术后仅1例无病存活。在过去的7年中，15例患者的20个病变已经通过内镜粘膜切除术（EMR）进行了治疗。其中3例因肿瘤大量侵犯粘膜下而需再次手术。EMR时发生1例并发症，经保守治疗成功。所有接受EMR治疗的患者均存活，在中位随访期27.5个月内无局部或远处转移。在那些最初接受手术切除并被诊断为不可手术的患者中，所有10名患者都没有接受定期检查并有一些症状。相比之下，15例患者进行EMR，所有20个病变被发现每年的后续行动，在没有症状的内镜检查。结论：EMR胃管癌是安全的，并发症少，相反，胃管手术切除，这给病人带来了沉重的负担，并具有较高的发病率和死亡率。建议食管癌切除术后通过每年一次的内镜检查早期发现肿瘤，以获得良好的预后。
BACKGROUND: The prognosis of esophageal carcinoma has improved, but along with this improvement, concern has increased about the occurrence of second primary carcinoma, especially gastric carcinoma, in tubes constructed from the stomach after esophagectomy. We describe our experience in the diagnosis and treatment of gastric tube carcinoma.STUDY DESIGN: We retrospectively examined 31 cases of gastric tube carcinoma; these cases occurred in 26 patients who received esophagectomy between September 1968 and October 2000.RESULTS: Surgical resection was performed in 10 patients. Gastrectomy with regional lymph node dissection was performed in 7 patients and partial resection of the stomach without lymph node dissection in 3 patients. In 6 patients leak-age was encountered after gastrectomy; 3 of these patients died of multiple organ failure. Only one of the gastrectomy patients is alive without disease. Over the past 7 years, 15 patients with 20 lesions have been treated by endoscopic mucosal resection (EMR). Three of these patients required additional operation because of massive submucosal invasion by the tumor. One complication occurred at EMR, but it was successfully treated by conservative therapy. All patients treated by EMR alone were alive with neither local nor distant metastasis during a median followup period of 27.5 months. Of those patients who received surgical resection initially and were diagnosed as inoperable, all 10 had not received periodic checkups and had some symptoms. In contrast, of 15 patients who underwent EMR, all 20 lesions were found by annual follow,up endoscopic examination in the absence of symptoms.CONCLUSIONS: EMR for gastric tube carcinoma is safe and has few complications, in contrast to surgical resection of the gastric tube, which places a severe burden on the patient and has high morbidity and mortality. Early detection of the tumor by annual endoscopic examination is recommended for achieving good outcomes in gastric tube carcinoma after esophagectomy.