A case of carcinoma developed in the reconstructed gastric tube after esophagectomy is reported. A 72-year-old female had undergone esophagectomy with reconstruction with a gastric tube through the retrosternal rote for a thoracic esophageal cancer in 1981. The patient was referred to the hospital in 1990 because of dysphasia and severe loss of body weight by a nearby hospital where she was followed up after the surgery for about 9 years. On admission endoscopic and barium contrast studies revealed Borrmann type 2 cancer in the lower part of the gastric tube.
Direct invasion of the carcinoma to the sternalbone was strongly suspected by CT examination. Total resection of the gastric tube and removal of lower part of the sternal bone were performed and reconstracted with the right half of the colon through the retrosternal route. The tumor was resected safely by this procedure. Pathological examination showed moderately-well differentiated tubular adenocarcinoma with negative lymph node metastasis. The patient is alive and well, as of 2 years after this second operation.
Regular follow up by endoscopy is necessary to find out the secondary cancer arising in the gastric tube, which has a poor prognosis and has been increasingly seen in recent years.