Abstract
The patient was a 75-year-old man who underwent subtotal esophagectomy and antethoracic gastric tube reconstruction via right thoracolaparotomy for esophageal cancer 14 years previously. He then developed reflux symptoms and was followed up for 6 months without improvement. He consulted a local doctor and progressive gastric tube cancer was diagnosed. He was referred to our hospital for the purpose of surgery. We diagnosed gastric tube cancer Type 2, 35 mm, por, T4a(SE)N1M0 cStage IIIA. Since detachment surgery was difficult because of adhesions around the gastroesophageal junction, Roux-en-Y anastomosis using a pedunculated jejunum with vascular anastomosis of the second artery/vein of jejunum and the internal thoracic artery/vein was used for reconstruction, ensuring an oral margin of 5 cm (preserving about 5 cm of the oral gastric tube) and resecting the aboral gastric tube. Pathological examination indicated a poorly differentiated adenocarcinoma with neuroendocrine differentiation. No postoperative complications were observed. The patient has had recurrence-free survival for 4 years and 2 months after the surgery for gastric tube cancer. In cases of long-term survival after reconstruction of the gastric tube, blood may be supplied to the distal part of the gastric tube from peri-connective tissue. Therefore, if curability is assured, the operative technique should attempt to preserve the distal part of the gastric tube.
