Primary gastric cancer in an oesophageal gastric graft after oesophagectomy

Objective: Recent advances in surgical treatment of oesophageal cancer have improved the prognosis of early, locally advanced oesophageal cancer. Primary cancer from oesophageal graft is rare, but has been detected in long-term survivor. We analyzed data from patients who developed primary gastric cancer in an oesophageal graft to evaluate strategies of treatment and their outcomes. Methods: We retrospectively reviewed data from patients who developed primary gastric cancer in oesophageal graft at Samsung Medical Center between September 1994 and December 2009. The clinico-pathologic features and prognoses were investigated. Long-term survival rate was determined by Kaplan-Meier analysis. Results: Ten primary gastric graft cancers (five early gastric cancer (EGC), five advanced gastric cancer (AGC)) were diagnosed. The mean age was 69.0 (range 59.6-74.6). Initial operation was Ivor-Lewis transthoracic oesophagectomy in eight cases and three-field lymphadenectomy in two. The median period to detection of the primary gastric graft cancer after oesophagectomy was 50 (9-102) months. Seven gastric graft cancers were diagnosed by regular endoscopic examination. EGCs were treated with ESD in two cases, partial resection of stomach in one, and oesophagocolojejunostomy in three, including one patient who underwent the operation after ESD. AGCs were treated with chemotherapy in one case, supportive care in one, and oesophagocolojejunostomy in three. There was no adjuvant chemotherapy used in any case. The median follow-up period after second operation was 14 months (range 1-97). Six patients survived during this period. Three of the five AGC patients died. The estimated 5-year survival rate of our cases was 70%. Conclusions: In areas of high prevalence of stomach cancer, regular endoscopic examinations of oesophageal gastric grafts may help in the early detection of primary gastric graft cancer. Reoperation with a colon graft is a potential treatment option for primary gastric graft cancer.