Abstract
Mucosal damage to the whole stomach as an esophageal substitute, via the postmediastinal route, was pathologically investigated to elucidate the influence of postoperative radiation therapy. Subjects were 26 and 16 operated cases of esophageal cancer with and without postoperative radiation therapy, respectively. Endoscopic biopsy of the replaced stomach was performed preoperatively, before and after the radiation, and then at various different times for 2 years. The biopsy specimens obtained by endoscopic examination from the upper, middle and lower sites of the stomach were evaluated for the following pathological factors; atrophy, intestinal metaplasia, neutrophil infiltration, edema, erosion, necrosis and atypia. These findings were rated in score and changes in scores were studied. In both radiation and non-radiation groups, the degree of inflammatory change was strongest in the upper site, following middle and lower site in this order, in that some hematogenic involvement was considered. When the both groups compared for the inflammatory change, the changes in the radiation group were stronger than the other group in all sites. Necrosis and especially atypia were seen only in the upper and middle sites of radiated patients. Cronological inflammatory changes in each patient revealed that, as the site went up, the inflammation became stronger and was intensified by radiation therapy. But these inflammatory changes and atypia disappeared within a year after radiation therapy. These results suggest that postoperative radiation therapy would not be contraindicated for patients undergoing an esophageal substitution.
