CLINICAL PATHOLOGICAL EXAMINATION OF ESOPHAGEAL CANCER OCCURRING AFTER GASTRECTOMY

In recent years, the number of cases of esophageal cancer occurring after gastrectomy has been increasing. To identify problems with its surgical treatment, we examined, from a clinical pathological point of view, 18 cases of esophageal cancer which developed after gastrectomy and were treated at our department (4.0% of all cases of esophageal cancer treated at our department). The underlying disease treated by gastrectomy was gastric or duodenal ulcer in 14 cases and gastric cancer in 4. The duration from gastrectomy to diagnosis of the esophageal cancer vaired according to the underlying disease, but was 12 years and 11 months on average. Among the 14 resected cases, the mass was macroscopically diagnosed as the ulcerative type in 10 cases. The extent of tissue differentiation was almost the same as in the control group. Many of the cases had deep invasion and advanced lymph node metastasis. Since cases positive for intraperitoneal lymph node metastasis were mainly those with tumors in the middle or lower part of the chest, resection of the residual stomach aiming at lymph node dissection was recommended. To avoid adhesion during reconstructive surgery, careful attention was needed in generating an enteric canal with good distensibility. The surgical invasion was large in terms of time and the amount of bleeding, and the incidence of complications was high (64.3%). These results suggest that it is necessary to choose the optimal technique for each patient in order to improve the treatment results.