Colonic interposition for recurrent GE junction adenocarcinoma of stomach: a case report.
AbstractIntroduction: Gastric cancer is a major cause of cancer death worldwide. Potential curative treatment for gastric cancer is radical gastrectomy. The reasons for local recurrence could be many like inadequate margin at the time of resection, biology of the disease, bad patient compliance. Esophagogastrectomy with colonic interposition may be required in case of distal esophageal carcinoma, carcinoma of proximal stomach and also in esophagogastric anastomotic recurrence, especially when the stomach is not suitable or available.
Case description: A 30-year-old female, who had undergone proximal partial gastrectomy about 14 months back for poorly differentiated mucinous adenocarcinoma of stomach, was admitted with a 20 days history of dysphagia which was initially for solid food but later progressed causing difficulty in swallowing liquid as well. In past 14 months patient had undergone 6 cycles of chemotherapy. Transhiatal esophagectomy with interposition of right colon with terminal ileum with end to end anastomosis of oesophagus and ileal ends followed by colojejunostomy and ileocolostomy with FJ placement.
Conclusion: When enough stomach remains it can be used as an esophageal replacement. However, when the stomach cannot be used due to more extensive primary disease or like in this case, needs to be resected due to recurrence of the disease, the interposed colon or jejunum needs to be used for esophageal reconstruction.
Keyword: Recurrent adenocarcinoma oesophagus, colonic interposition, oesophageal resection.
2. Kim JP, Kwon OJ, Oh ST, Yang HK. Results of surgery on 6589 gastric cancer patients and immunochemosurgery as the best treatment of advanced gastric cancer. Ann Surg. 1992 Sep;216(3):269-78.
3. Inokuchi K. Prolonged survival of stomach cancer patients after extensive surgery and adjuvant treatment: an overview of the Japanese experience. Semin Surg Oncol. Nov-Dec 1991;7(6):333-8.
4. Shchepotin I, Evans SR, Shabahang M, Cherny V, Buras RR, Zadorozhny A, et al. Radical treatment of
locally recurrent gastric cancer. 1995 Apr;61(4):371- 6.
5. Paulino F, Roselli A. Carcinoma of the stomach with special reference to total gastrectomy. Curr Probl Surg. 1973 Nov;3-72.
6. Humphrey EW, Kersten TE. Adenocarcinoma at the esophagogastric junction. In: Varco RL, Delaney JP.
Controversy in Surgery. Philadelphia and London: WB Saunders, 1976: 603-8.
7. Papachristou DN, Agnanti N, D'Agostino H, Fortner JG. Histologically Positive Esophageal Margin in the Surgical Treatment of Gastric Cancer. Am J Surg. 1980 May;139(5):711-3.
8. Paul D DiMusto , Mark B Orringer. Transhiatal Esophagectomy for Distal and Cardia Cancers: Implications of a Positive Gastric Margin. Ann Thorac Surg. 2007 Jun;83(6):1993-8.
9. Taslimi R, Jowkar A, Ghavam MRH, Tavasol T, Allameh SF, Rakhshani N. Squamous cell carcinoma (SCC) arising in esophageal colon interposition. Oxf Med Case Reports. 2017 Dec 18;2017(12):omx068.
10. Davis PA, Law S, Wong J. Colonic Interposition After Esophagectomy for Cancer. Arch Surg. 2003 Mar;138(3):303-8.
11. Sefton GK, Cooper DJ, Giddings A E, Grech P. Assessment and resection of carcinoma at the gastroesophageal junction. Surg Gynecol Obstet. 1977 Apr;144(4):563-6.
12. Sanchuan L, Tingting S, Xingkang H, Zhenghua L, Shujie C: Prognostic value of resected lymph nodes numbers for Siewert II gastroesophageal junction cancer. Oncotarget. 2017 Dec 20;9(2):2797-2809.
13. Mazer LM, Poultsides GA: What is the best operation for proximal gastric cancer and distal esophageal
cancer? Surg Clin North Am. 2019 Jun;99(3):457-469.
14. Buunen M, Rooijens PP, Smaal HJ, Kleinrensink GJ, Van Der Harst E, Tilanus HW, et al: Vascular anatomy
of the stomach related to gastric tube construction. Dis Esophagus. Dis Esophagus. 2008;21(3):272-4.
15. Blackmon SH, Correa AM, Skoracki R, Chevray PM, Kim PM, Mehran RJ. et al. Supercharged pedicle jejunal interposition for esophageal replacement: a 10-year experience. Ann Thorac Surg. 2012 Oct;94(4):1104-11.
16. Wilkings EW Jr: Long-segment colon substitution for the esophagus. Ann Surg. 1980 Dec;192(6):722-5.
17. Matsumoto H, Hirai T, Kubota H, Murakami H,Higashida M, Hirabayashi Y: Safe esophageal reconstruction by ileocolic interposition. Dis Esophagus. 2012 Apr;25(3):195-200.
18. Neri A, Marrelli D, Voglino C, Mare GD, Ferrara F, Marini M, et al. Recurrence after surgery in esophago-gastric junction adenocarcinoma: current management and future perspectives. Surg Oncol. 2016 Dec;25(4):355-363.
19. Badgwell B, Cormier JN, Xing Y, Yao J, Bose D, Krishnan S, et al. Attempted salvage resection for
recurrent gastric or gastroesophageal cancer. Ann Surg Oncol. 2009 Jan;16(1):42-50.
20. Carboni F, Lepiane P, Santoro R, Lorusso R, Mancini P, Carlini M, et al. Treatment for isolated loco-regional recurrence of gastric adenocarcinoma: does surgery play a role?. World J Gastroenterol.
2005 Nov 28;11(44):7014-7.
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