Abstract
The clinical aspects of esophageal cancer associated with other primary cancers were discussed.
Patients and Method: Among 263 patients who had curative resections for esophageal cancer at our department between 1986 and 1998, 53 patients (20.2%) had primary cancer in other organs. The clinicopathologic factors, therapeutic strategies, and outcomes were studied in these patients.
Results: Other primary cancers were found symchronously in 23 patients and metachronously in 30. Other primary cancers were found in the following organs: stomach in 21 patients, head and neck in 16, liver in 3, colon in 3, lung in 3, breast in 3, kidney in 2, prostate in 2, and uterus in 2. Leukemia developed in 1 patient. There wes no difference in the clinicopathologic factors between patients with and without other primary cancer. Among 18 patients in whom gastric cancer was found synchronously or antecedent to esophageal cancer, reconstruction was performed with preserved stomach after curative resection for gastric cancer in 4 patients. For the other 14 patients, reconstruction using jejunum or colon was performed in 8 and 6 patients, respectively. Cancer was found in the stomach used as esophageal substitute in 3 patients. The cancer was curatively treated with endoscopic mucosal resection in 1 of these patients and with gastrectomy with jejunal reconstruction in 1 patient. The other patient at high risk is on TS-1 and has survived cancer free for 2 years. The head and neck cancers were treated with surgery in 7 patients and chemoradiotherapy in 9. The survival rate was 44% and 40% in the patients with and also other primary cancer, respectively, at 5 years after esophagectomy. The most significant factor in the multivariate analysis for prognosis was lymph node metastasis of esophageal cancer.
Conclusions: Other primary cancers were found in 20% of our patients with esophageal cancer. Association of gastric cancer, which was most common, required an organ other than the stomach for reconstruction. Because the association of other primary cancers did not reduce the survival rate for esophageal cancer, radical treatment for each malignancy is essential for a good outcome.
