Late Management of Patients after Esophagectomy and Reconstruction for Esophageal Cancer

Abstract

We examined the late condition of patients after esophagectomy and reconstraction to study their problems. From 1991 to 1994, the incidence of disorders caused by endoscopy was 64% of 498 cases in 181 patients after esophagectomy and reconstruction. Of these, anastmotic stricture accounted for 34%, reflux esophagitis/esophageal ulcer 17%, gastric tube ulcer 13%, metachronous cancer 7% (5 patients in gastric tube, 6 in the pharynx or larynx), and recurrence 3%. Postoperatative endoscopic follow-up revealed reflux esophagitis in patients with reconstruction by the posterior mediastinal route, (especialy, serious disease in young patients), and gastric tube ulcers and erosion in patients with reconstruction by the mediastinal route, especialy in patients who underwent post-operative radiotherapy. It was possible to perform minimal invasive surgery for patients with metachronous cancer diagnosed by follow-up endoscopy. From 1985 to 1994, 24 patients underwent re-operation a long time after esophagectomy and reconstruction. Of these, 8 patients had cervical esophageal cancer, 4 had gastric tube cancer, 4 had stagnation of food in the gastric tube, 4 had anastomotic stricture, 2 had perforation of the gastric tube by an ulcer, and 2 had marginal recurrence. The anastomotic route had an advantage in treating gastric tube diseases, such as gastric cancer.