Yurttas C, Wichmann D, Gani C, Bongers MN, Singer S, Thiel C, Koenigsrainer A, Thiel K. Beware of gastric tube in esophagectomy after gastric radiotherapy: A case report. World J Clin Cases 2022; 10(17): 5854-5860 [PMID: 35979123 DOI: 10.12998/wjcc.v10.i17.5854]
Corresponding Author of This Article
Karolin Thiel, MD, Department of General, Visceral and Transplant Surgery, University Hospital of Tuebingen, Hoppe Seyler Str 3, Tuebingen 72076, Germany. karolin.thiel@med.uni-tuebingen.de
Research Domain of This Article
Surgery
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Jun 16, 2022; 10(17): 5854-5860 Published online Jun 16, 2022. doi: 10.12998/wjcc.v10.i17.5854
Beware of gastric tube in esophagectomy after gastric radiotherapy: A case report
Can Yurttas, Doerte Wichmann, Cihan Gani, Malte N Bongers, Stephan Singer, Christian Thiel, Alfred Koenigsrainer, Karolin Thiel
Can Yurttas, Doerte Wichmann, Christian Thiel, Alfred Koenigsrainer, Karolin Thiel, Department of General, Visceral and Transplant Surgery, University Hospital of Tuebingen, Tuebingen 72076, Germany
Cihan Gani, Department of Radiooncology, University Hospital of Tuebingen, Tuebingen 72076, Germany
Malte N Bongers, Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Tuebingen 72076, Germany
Stephan Singer, Department of Pathology, University Hospital of Tuebingen, Tuebingen 72076, Germany
Author contributions: Yurttas C, Thiel K and Koenigsrainer A conceived and wrote the manuscript; Thiel K and Koenigsrainer A were responsible for overall treatment; Endoscopic treatment was performed by Wichmann D; Yurttas C and Bongers MN prepared the figures; Yurttas C, Thiel K, Gani C, Thiel C, Singer S and Koenigsrainer A revised the manuscript; all authors read and approved the final version of the manuscript.
Informed consent statement: For all clinical data and personal images written consent for publication was obtained from the patient.
Conflict-of-interest statement: The authors have no competing interests to declare in the context of the current case.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Karolin Thiel, MD, Department of General, Visceral and Transplant Surgery, University Hospital of Tuebingen, Hoppe Seyler Str 3, Tuebingen 72076, Germany. karolin.thiel@med.uni-tuebingen.de
Received: December 27, 2021 Peer-review started: December 27, 2021 First decision: March 10, 2022 Revised: March 11, 2022 Accepted: April 9, 2022 Article in press: April 9, 2022 Published online: June 16, 2022 Processing time: 163 Days and 21.9 Hours
Abstract
BACKGROUND
Gastric tube formation and pull-up is the most common technique of reconstruction following esophagectomy for esophageal cancer. If previous treatment with radiotherapy for gastric mucosa-associated lymphoid tissue (MALT)-lymphoma restricts suitability of the stomach for anastomosis to the esophagus is unknown.
CASE SUMMARY
A 57-year-old man underwent sequential chemotherapy and radiotherapy for gastric MALT-lymphoma seven years prior to diagnosis of esophageal adenocarcinoma. Esophagectomy without neoadjuvant treatment was recommended by the multidisciplinary tumor board due to early tumor stage [uT1 (sm2) uN+ cM0 according to TNM-classification of malignant tumors, 8th edition] without lymph node involvement. Minimal invasive esophageal resection with esophagogastrostomy was performed. Due to gastric tube necrosis with anastomotic leakage on the twelfth postoperative day, diverting resection with construction of a cervical salivary fistula was necessary. Rapid recovery facilitated colonic interposition without any complications six months afterwards.
CONCLUSION
This case report may represent the start for further investigation to know if it is reasonable to refrain from esophagogastrostomy in patients with a long interval between gastric radiotherapy and surgery.
Core Tip: A patient with previous radiotherapy for gastric mucosa-associated lymphoid tissue lymphoma underwent esophagectomy and esophagogastrostomy for esophageal cancer more than seven years later. Gastric tube necrosis, made diversion surgery with salivary fistula necessary. Six months later, interposition of the transverse colon was performed without occurrence of any complications. The patient fully recovered with unlimited oral intake capability and remains free of tumor recurrence at date of publication. In patients with a long interval between gastric radiotherapy and surgery esophagogastrostomy should be avoided.
