A STUDY OF SEVEN PATIENTS WITH ESOPHAGEAL CANCER WHO HAD UNDERGONE GASTRECTOMY

This paper presents outlines of 7 cases of esophageal cancer with a previous history of gastrectomy as well as some problems at the operation. Outlines: 1) All 7 cases were males and an average age was 62.7 years. Their gastric diseases were benign in 6 cases and malignant in one case. Average time interval since gastrectomy was 14 years. Six out of 7 cases had an advanced esophageal cancer in Stage III or IV. 2) In 6 cases the remnant stomach was conserved and the remaining case underwent total gastrectomy. Four cases were operated on an one-step approach, while 3 on a multi-step approach. Reconstruction was performed by using the jejunum in 5 cases or colon in 2 cases through the antethoracic route in 4 cases, retrosternal route in 2 cases, and intrathoracic route in one case. 3) Postoperative complications occurred in a high rate, 72% (5 cases), and one patient died of MOF one month after the operation. 4) There was no significant difference in intraoperative blood loss and operating time between standard operations for patients without previous history and those on an one-step approach, however, an increased blood loss and prolonged operating time were observed in operations on a multi-step approach. Conclusions: Total gastrectomy is recommended in terms of radicality, but sometimes it can be proper to conserve the remnant stomach in terms of operative intervention. It is ideal to reconstruct on an one-step approach, but in a high risk case the reconstruction can be undertaken on a multi-step approach. The jejunum should be first selected as the reconstruction organ. In a high risk case, it is better to use the anterthoracic route, in anticipation of the safety.