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Shintani H, Oura S, Makimoto S. Recurrence of Gastric Cancer in the Jejunum Close to the Anastomotic Site after Total Gastrectomy. Case Rep Oncol 2021; 14:767-771. [PMID: 34177528 PMCID: PMC8215971 DOI: 10.1159/000509998] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 07/03/2020] [Indexed: 01/10/2023] Open
Abstract
A 61-year-old man underwent total gastrectomy with esophago-jejunostomy for Borrmann type I gastric cancer. Postoperative intra-abdominal abscess made the patient unable to receive adjuvant chemotherapy. Only 23 weeks after operation, the patient developed melena and anemia, leading to the diagnosis of recurrence in the jejunum close to the anastomotic site. The patient received salvage resection of the recurrence. Pathological study showed that the tumor was composed of atypical cells similar to those of the primary gastric cancer. Normal jejunal mucosa was observed between the esophagus and the recurrent tumor. We judged that exfoliation of the gastric cancer cells caused the recurrence due to both the very short disease-free interval and pathological findings. Surgeons should pay attention to this type of recurrence especially for Borrmann type I gastric cancer. In addition to the adjuvant chemotherapy, gastric irrigation using distilled water during the operation seems to be a feasible measure to prevent this type of recurrence.
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Affiliation(s)
- Hiroshi Shintani
- Department of Surgery, Kishiwada Tokushukai Hospital, Kishiwada City, Japan
| | - Shoji Oura
- Department of Surgery, Kishiwada Tokushukai Hospital, Kishiwada City, Japan
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Lee JS, Lee JH, Kim J, Na HK, Ahn JY, Jung KW, Kim DH, Choi KD, Song HJ, Lee GH, Jung HY. Predictive Role of Endoscopic Surveillance after Total Gastrectomy with R0 Resection for Gastric Cancer. J Korean Med Sci 2021; 36:e88. [PMID: 33847079 PMCID: PMC8042482 DOI: 10.3346/jkms.2021.36.e88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/20/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Endoscopic surveillance after total gastrectomy (TG) for gastric cancer is routinely performed to detect tumor recurrence and postoperative adverse events. However, the reports on the clinical benefits of endoscopic surveillance are ambiguous. We investigated the clinical benefit of endoscopic surveillance after TG for gastric cancer. METHODS We analyzed 848 patients who underwent TG with R0 resection for gastric cancer between 2011 and 2012 (380 early gastric cancer and 468 advanced gastric cancer) and underwent regular postoperative surveillance with endoscopy and abdominopelvic computed tomography (CT) with contrast. RESULTS Median follow-up periods were 58 months for both endoscopy (range, 3-96) and abdominopelvic CT (range, 1-96). Tumor recurrence occurred in 167 patients (19.7%), of whom seven (4.2%) were locoregional recurrences in the peri-anastomotic area (n = 5) or regional gastric lymph nodes (n = 2). Whereas the peri-anastomotic recurrences were detected by both endoscopy and abdominopelvic CT, regional lymph node recurrences were only detected by abdominopelvic CT. Out of the 23 events of postoperative adverse events, the majority (87%) were detected by radiologic examinations; three events of benign strictures in the anastomotic site were detected only by endoscopy. CONCLUSION Endoscopic surveillance did not have a significant role in detecting locoregional tumor recurrence and postoperative adverse events after TG with R0 resection for gastric cancer. Routine endoscopic surveillance after TG may be considered optional and performed according to the capacities of each clinical setting.
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Affiliation(s)
- Jung Su Lee
- Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Division of Gastroenterology, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Jeong Hoon Lee
- Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Jinyoung Kim
- Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Kyong Na
- Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Yong Ahn
- Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kee Wook Jung
- Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Do Hoon Kim
- Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kee Don Choi
- Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho June Song
- Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gin Hyug Lee
- Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hwoon Yong Jung
- Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Yokoe T, Sato M, Yahagi M, Dogru M, Fujisaki H, Ogura M, Kawamata H, Asahara F, Takayama S, Harada H, Tanaka Y, Miyauchi J, Matsui J. Heterochronous Suture Line Recurrences in the Jejunal Pouch following Total Gastrectomy for Stage II Gastric Cancer: A Case Report and Literature Review. Case Rep Oncol 2020; 13:225-232. [PMID: 32308581 PMCID: PMC7154264 DOI: 10.1159/000505392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 12/10/2019] [Indexed: 11/19/2022] Open
Abstract
We report the case of a 65-year-old male who developed heterochronous local recurrences of gastric cancer in the jejunal pouch (J-pouch) four times after total gastrectomy. He underwent total gastrectomy, J-pouch, and Roux-en-Y reconstruction for stage II gastric cancer in 2005. Four local recurrences appeared on the esophago-jejunal anastomosis, the suture line within the pouch, the esophago-jejunal anastomosis, and the anastomosis between the jejunum and Y-loop, which were resected by partial excision or endoscopic submucosal dissection. Suture line recurrence of gastric cancer is rare. The common features for each recurrence included the surgically negative resection margins, observation of the same histopathological subtype, absence of remote metastasis or peritoneal seeding, and the recurrence on the anastomotic suture line, suggesting that the cause of recurrence was the implantation of exfoliated cancer cells probably in the suture line. However, there is no established procedure for preventing implantation recurrence currently, the effectiveness of lumen lavage is suggested.
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Affiliation(s)
- Takamichi Yokoe
- Department of Surgery, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Japan.,Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Michio Sato
- Department of Surgery, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Japan.,Department of Surgery, International Goodwill Hospital, Yokohama, Japan
| | - Masashi Yahagi
- Department of Surgery, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Japan
| | - Murat Dogru
- Department of Surgery, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Japan
| | - Hiroto Fujisaki
- Department of Surgery, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Japan
| | - Masaharu Ogura
- Department of Surgery, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Japan
| | - Hiroshi Kawamata
- Department of Surgery, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Japan
| | - Fumitaka Asahara
- Department of Surgery, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Japan
| | - Shin Takayama
- Department of Surgery, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Japan
| | - Hirohisa Harada
- Department of Surgery, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Japan
| | - Yoichi Tanaka
- Division of Surgical Pathology, Clinical Laboratory, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Japan
| | - Jun Miyauchi
- Department of Pathology and Laboratory Medicine, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Japan.,Department of Central Laboratory, Saitama Municipal Hospital, Saitama, Japan
| | - Junichi Matsui
- Department of Surgery, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Japan
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Huang H, Wang W, Chen Z, Jin JJ, Long ZW, Cai H, Liu XW, Zhou Y, Wang YN. Prognostic factors and survival in patients with gastric stump cancer. World J Gastroenterol 2015; 21:1865-1871. [PMID: 25684953 PMCID: PMC4323464 DOI: 10.3748/wjg.v21.i6.1865] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 09/12/2014] [Accepted: 10/15/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To elucidate the clinicopathological characteristics and prognostic factors of gastric stump cancer (GSC).
METHODS: The clinical data for 92 patients with GSC were collected at Fudan University Shanghai Cancer Center. The prognostic factors were analyzed with Cox proportional hazard models.
RESULTS: GSC tended to occur within 25 years following the primary surgery, when the initial disease is benign, whereas it primarily occurred within the first 15 years post-operation for gastric cancer. Patients with regular follow-up after primary surgery had a better survival rate. The multivariate Cox regression analysis revealed that Borrmann type I/II (HR = 3.165, 95%CI: 1.055-9.500, P = 0.040) and radical resection (HR = 1.780, 95%CI: 1.061-2.987, P = 0.029) were independent prognostic factors for GSC. The overall 1-, 3-, and 5-year survival rates of the 92 patients were 78.3%, 45.6% and 27.6%, respectively. The 1-, 3-, and 5-year survival rates of those undergoing radical resection were 79.3%, 52.2%, and 37.8%, respectively. The 5-year survival rates for stages I, II, III, and IV were 85.7%, 47.4%, 16.0%, and 13.3%, respectively (P = 0.005).
CONCLUSION: The appearance of GSC occurs sooner in patients with primary malignant cancer than in patients with a primary benign disease. Therefore, close follow-up is necessary. The overall survival of patients with GSC is poor, and curative resection can improve their prognosis.
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Yoo JH, Seo SH, An MS, Ha TK, Kim KH, Bae KB, Choi CS, Oh SH, Choi YK. Recurrence of gastric cancer in the jejunal stump after radical total gastrectomy. World J Gastrointest Surg 2014; 6:74-76. [PMID: 24829626 PMCID: PMC4013714 DOI: 10.4240/wjgs.v6.i4.74] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 12/09/2013] [Accepted: 02/19/2014] [Indexed: 02/06/2023] Open
Abstract
This is a very rare case of the recurrence of gastric cancer in the jejunal stump after radical total gastrectomy with Roux-en-Y reconstruction. In January 2008, a 65-year-old man underwent radical total gastrectomy with Roux-en-Y reconstruction for stage IB gastric cancer of the upper body. At a follow-up in December 2011, the patient had a recurrence of gastric cancer on gastroduodenal fibroscopy. The gastroduodenal fibroscopic biopsy specimens show a well-differentiated tubular adenocarcinoma. Computed tomography showed no lymphadenopathy or hepatic metastases. At laparotomy, there was a tumor in the jejunal stump involving the pancreatic tail and spleen. Therefore, the patient underwent jejunal pouch resection, distal pancreatectomy and splenectomy. The patient was diagnosed with gastric cancer on histopathological examination.
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Recurrence of gastric cancer in the jejunal pouch after completion gastrectomy. Gastric Cancer 2008; 10:256-9. [PMID: 18095082 DOI: 10.1007/s10120-007-0441-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2006] [Accepted: 10/28/2007] [Indexed: 02/06/2023]
Abstract
We herein present a case of recurrence of gastric cancer in the jejunal pouch after total gastrectomy in a 74-year-old man. He had a history of two operations for gastric cancer. The second operation was a completion gastrectomy with jejunal pouch reconstruction and regional lymphadenectomy, for gastric cancer in the cardia of the remnant stomach, performed 2 years and 9 months before the present admission. A follow-up endoscopy showed three elevated tumors along the suture lines in the jejunal pouch in the upper digestive tract. Resection of the jejunal pouch was performed. Gross pathological examination revealed elevated lesions along the staple suture lines in the jejunal pouch. Histopathologically, moderately differentiated tubular adenocarcinoma involving the muscular layer, without lymphatic metastases, was recognized. Recurrence of gastric cancer in the jejunal pouch after resection is rare. We suggest that implantation of exfoliated cancer cells gave rise to the recurrence of tumors on the suture line in this patient. We also review two cases of gastric cancer in the jejunal pouch after resection previously described in the literature.
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7
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Barbour AP, Rizk NP, Gonen M, Tang L, Bains MS, Rusch VW, Coit DG, Brennan MF. Adenocarcinoma of the gastroesophageal junction: influence of esophageal resection margin and operative approach on outcome. Ann Surg 2007; 246:1-8. [PMID: 17592282 PMCID: PMC1899203 DOI: 10.1097/01.sla.0000255563.65157.d2] [Citation(s) in RCA: 173] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To determine whether the length of esophageal resection or the operative approach influences outcome for patients with adenocarcinoma of the gastroesophageal junction (GEJ). SUMMARY BACKGROUND DATA While R0 resection remains the mainstay of curative treatment of patients with GEJ cancer, the optimal length of esophageal resection remains controversial. METHODS Patients with Siewert I, II, or III adenocarcinoma who underwent complete gross resection without neoadjuvant therapy were identified from a prospectively maintained database. Proximal margin lengths were recorded ex vivo as the distance from the gross tumor edge to the esophageal transection line. Operative approaches were grouped into gastrectomy (limited esophagectomy) or esophagectomy (extended esophagectomy). RESULTS From 1985 through 2003, 505 patients underwent R0/R1 gastrectomy (n = 153) or esophagectomy (n = 352) without neoadjuvant treatment. There were no differences in R1 resection rate, number of nodes examined or operative mortality between gastrectomy and esophagectomy. Univariate analysis found >3.8 cm to be the ex vivo proximal margin length (approximately 5 cm in situ) most predictive of improved survival. Multivariable analysis in patients who underwent R0 resection with >or=15 lymph nodes examined (n = 275) found the number of positive lymph nodes, T stage, tumor grade, and ex vivo proximal margin length >3.8 cm to be independent prognostic factors. Subset analysis found that the benefit associated with >3.8 cm margin was limited to patients with T2 or greater tumors and <or=6 positive lymph nodes. CONCLUSIONS In patients not receiving neoadjuvant therapy, the goal for patients with adenocarcinoma of the GEJ should be R0 resection including at least 15 lymph nodes, preferably with 5 cm of grossly normal in situ proximal esophagus for those with <or=6 positive lymph nodes. The operative approach may be individualized to achieve these goals.
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Affiliation(s)
- Andrew P Barbour
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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8
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Affiliation(s)
- J L Sawyers
- Vanderbilt University Medical Center, Nashville, Tennessee
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9
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Abstract
Surgical cure requires that a given cancer be removed without inadvertent spillage of cancer cells by technical error. Potential mishaps include pressing a ligature, while tying, against a protruding tumor and cutting into it; inserting a hemostat into the tumor area to gain control of an escaped short pancreaticoduodenal artery stump which has retracted; grasping a lymph node with forceps which invariably fragments it spilling any cancer cells it may contain; and injecting local anesthesia into or adjacent to a lesion for biopsy. If the lesion is a cutaneous melanoma or other cancer the resulting pressure may force cancer cells into the lymphatic or bloodstream. Other misadventures include touching that portion of a biopsy needle which has been in the tumor and doing an intraoperative biopsy which allows blood or tissue fluid to flow out the opening from the tumor. Sensitivity to such dangers appears essential to avoiding spillage of cancer cells and obtaining maximal benefit from surgery.
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Affiliation(s)
- J G Fortner
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021
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10
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Meyer HJ, Jähne J, Wilke H, Pichlmayr R. Surgical treatment of gastric cancer: retrospective survey of 1,704 operated cases with special reference to total gastrectomy as the operation of choice. SEMINARS IN SURGICAL ONCOLOGY 1991; 7:356-64. [PMID: 1759084 DOI: 10.1002/ssu.2980070607] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Total gastrectomy is discussed as the operation of choice among different surgical approaches for gastric carcinoma. We prefer the performance of an elective total gastrectomy with systematic lymphadenectomy (compartments I and II) and obligatory splenectomy. A retrospective study of 1,704 consecutive cases of gastric carcinomas showed a better outcome following total gastrectomy in relationship to distal subtotal gastrectomy, but these results cannot be used as evidence because of the lack of a prospective study. Nevertheless, a precise analysis of our cases in regard to tumor site and tumor type could show a frequency of only 6% to maximally 30%, in which elective total gastrectomy may represent a procedure too extensive to justify for an oncological course.
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Affiliation(s)
- H J Meyer
- Klinik für Abdominal- und Transplantationschirurgie, Medizinische Hochschule Hannover, Germany
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12
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González EM, Gomez M, Jover JM, Calleja J, Landa I, Arias J, Escudero F, Garcia I. Cancer of the Cardia: The Role of Extended Esophagogastrectomy. Surg Oncol 1989. [DOI: 10.1007/978-3-642-72646-0_50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Günther B. [Stomach cancer--late prognosis following radical interventions]. LANGENBECKS ARCHIV FUR CHIRURGIE 1987; 372:593-7. [PMID: 3431273 DOI: 10.1007/bf01297888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Procedure of choice in the treatment of gastric cancer is total gastrectomy and radical lymphadenectomy. Despite an improvement of long-term results concerning localization, depth of infiltration, lymph node metastasis and histological type of tumor according to Laurén the main determinant of late results is the stage of disease. Suggestions for treatment of cancers on the oesophagogastric junction cannot yet be given. Despite possible advantages of preservation of the spleen for the early result, the impact on late results remains unclear.
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Affiliation(s)
- B Günther
- Chirurgische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, Klinikum Grosshadern
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14
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O'Dwyer P, Ravikumar TS, Steele G. Serum dependent variability in the adherence of tumour cells to surgical sutures. Br J Surg 1985; 72:466-9. [PMID: 4016515 DOI: 10.1002/bjs.1800720621] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Five commonly used surgical sutures were tested for their abilities to adhere tumour cells by an in vitro adherence assay. Adherence was quantified in vitro using radiolabelled tumour cells after standard incubation with a set length of the differing sutures. Tumour cells consistently adhered least to Prolene. All suture materials tested adhered significantly more tumour cells than Prolene (P less than 0.002 for chromic and less than 0.0001 for nylon, silk and Vicryl when compared with Prolene, with increasing cell numbers adhering to the sutures tested in that order). These differences in adherence were dependent upon an as yet unidentified macromolecule(s) in serum. All of the suture materials supported tumour growth in vivo after pre-incubation with tumour cells. Rapidity of in vivo tumour growth, however, correlated well with the in vitro tumour adherence characteristics of the different suture materials. The clinical significance of these findings is discussed.
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Abstract
A patient is presented who developed a second squamous cell carcinoma of the esophagus twelve years after a curative esophagogastrectomy for a similar lesion in the proximal stomach. Factors predisposing to local recurrence at an esophageal anastomosis are reviewed. The long disease-free interval in this patient, however, strongly suggests a metachronous primary tumor rather than local recurrence.
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Molina JE, Lawton BR, Myers WO, Humphrey EW. Esophagogastrectomy for adenocarcinoma of the cardia. Ten years' experience and current approach. Ann Surg 1982; 195:146-51. [PMID: 7055390 PMCID: PMC1352433 DOI: 10.1097/00000658-198202000-00004] [Citation(s) in RCA: 37] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
During a 10-year period, 94 surgical resections for adenocarcinoma of the cardia (75 "curative" and 19 palliative) were performed using three primary approaches: Group I (46 curative, 14 palliative), esophagogastrectomy performed through a left thoracotomy or left thoraco-abdominal incision; Group II (17 curative, 4 palliative), resection done through two separate incisions (abdominal and thoracic) with delayed reconstruction between two and three months later; and Group III (12 curative, 1 palliative), resection, also through abdominal and thoracic incisions, with simultaneous reconstruction. Operative mortality in the 75 procedures done for cure was 19.5%, 18%, and 8.3% in Groups I, II, and III, respectively. Microscopic residual tumor at the line of resection was 56%, 12%, and 8%. Free margins less than 3 cm had the same local recurrence rate (21%, 6%, and 8%) within 18 months as did margins with residual microscopic tumor. The length of time from operation to first regular meal was 12, 110, and 7 days, respectively. Wide resection with subtotal esophagectomy and simultaneous reconstruction is advocated.
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Gonzalez EM, Garcia JI, Selas PR, Azcoita MM, Garcia JI, Gonzalez JS. Extented esophago-gastretomy as surgical treatment for carcinoma of the cardia. THE JAPANESE JOURNAL OF SURGERY 1981; 11:311-6. [PMID: 7311192 DOI: 10.1007/bf02468953] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
With the object of designing a feasible and more radical surgical intervention for the treatment of carcinoma of the gastric cardia and improving the long term survival of these patients, a procedure was described which entails total esophagogastrectomy and resection of the distal pancreas, spleen and regional lymphnodes. The esophagus was mobilized via the diaphragmatic hiatus without thoracotomy. Intestinal continuity, installed isoperistaltically was restituted in the same operation using a segment of transverse and descending colon transferred to the left lateral cervical aspect by way of the posterior mediastinum. The procedure was used in four patients and mortality and serious complications were nil.
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18
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Kirk RM. A trial of total gastrectomy, combined with total thoracic oesophagectomy without formal thoracotomy, for carcinoma at or near the cardia of the stomach. Br J Surg 1981; 68:577-9. [PMID: 7272678 DOI: 10.1002/bjs.1800680817] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
There is a high incidence of residual tumour in the cut ends following orthodox resections for gastric adenocarcinoma and oesophageal squamous carcinoma at or near the cardia. In the hope of preventing the tragic recurrence of malignant dysphagia in patients who have survived a high-risk operation for its relief, the whole stomach and thoracic oesophagus were resected in 6 patients, establishing continuity using jejunum or colon, with anastomosis in the neck. Of 6 patients, 5 survived the operation. Of 2 followed up for more than 1 year, 1 has survived 5.5 years without recurrence, 1 died after 1 year with no post-mortem evidence of recurrence. This radical operation merits and extended trial in suitable patients.
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Abstract
A study of 257 gastric cancer patients treated with gastrectomy and followed to their death showed that (a) the incidence of local recurrence in the field of gastrectomy was 25%; (b) from the three types of gastrectomy used, extended total gastrectomy resulted in the lowest incidence of recurrence, followed by subtotal and total; (c) recurrences were more common in patients with TNM stages I, II, and III tumors where extended total gastrectomy was proven superior (p less than 0.05); (d) early stage tumors tended to recur in the gastric remnant and the esophagus; (e) narrow surgical margins and margins involved by disease predisposed to recurrence; (f) not every patient with histologically invaded margins developed recurrence; (g) the risk of recurrence did not decrease with time; (h) the longer the disease-free interval the better the prognosis; (i) the more advanced the original lesion the longer the disease-free interval; (j) of all patients with recurrence only 19% had resectable lesions on reexploration; (k) the longer the disease-free interval the higher the resectability rate; (l) the median interval from recurrence to death was 2 months; (m) the same interval of those undergoing resection was 18 months. Patients with early-stage tumors treated with gastrectomy should be followed closely for local recurrence and should recurrence develop they should be reexplored if there is no evidence of metastasis.
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