A CASE OF METACHRONOUS CANCER OF THE REMNANT STOMACH ARISING IN THE REMNANT GASTRIC MUCOSA AT ANASTOMOSIS BETWEEN THE COLON AND JEJUNUM AFTER OPERATION FOR ESOPHAGEAL CANCER

• Published in: Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) Vol. 66; no. 5; pp. 1049 - 1053
• Main Authors: HIRAYAMA, Nobuo, MIYAZAKI, Shin-ichi, MATSUBARA, Hisahiro, AOKI, Taito, GUNJI, Yoshio, OCHIAI, Takenori
• Format: Journal Article
• Language: English
• Published: Japan Surgical Association 2005
• ISSN: 1345-2843; 1882-5133
• DOI: 10.3919/jjsa.66.1049

The patient was a 73-year-old man. There were previous histories of undergoing a distal gastrectomy with Billroth II reconstruction (B-II) for gastric cancer in 1982, a cholecystectomy for gallstones in 1988, and by a right thoracotomy and laparotomy, an esophagectomy and resection of the remnant stomach were carried out followed by an esophageal reconstruction using right colon through a subcutaneous route for esophageal cancer in 1994. Upper gastrointestinal series conducted for observation of his clinical course in 2001 revealed an irregularity of the mucosa at the anastomosis between the reconstructed colon and jejunum. A biopsy provided a diagnosis of adenocarcinoma. His surgical records clarified that the surgical margin of the remnant stomach was used for the anastomosis between the reconstructed colon and jejunum. Accordingly the distal part of the colon used for esophageal substitution, the small remnant stomach, a part of the jejunum connecting to the remnant stomach, and the lymph nodes along the colonic margin were excised. The reconstruction was performed according to the B-II style. The patient developed afferent loop syndrome after the operation, but he was discharged from the hospital very much improved after conservative treatment of the syndrome. The resected material revealed type 3, tub2, pT2(ss), ly2, v1, infβ, surgical margin negative, and one positive mural lymph node. The patient is on medication with oral antineoplastic agent (5FU) on an ambulant basis, and he has been free from any signs of recurrence at present. This is a case which has renewed our understanding that examinations are always required by keeping a possibility of another carcinogenesis after surgery for a malignant tumor in mind.