Esophageal cancer in patients with a history of distal gastrectomy

Arch Surg. 2002 Nov;137(11):1238-42. doi: 10.1001/archsurg.137.11.1238.

Abstract

Hypothesis: There is an association between a history of distal gastrectomy and the development of esophageal cancer. Surgical treatment of esophageal cancer in patients with a history of gastrectomy is more complicated but will not result in increased mortality in an experienced center.

Design: Case-control study.

Setting: Tertiary care center for the treatment of esophageal cancer.

Patients: Forty patients with a history of gastrectomy and 1266 patients with intact stomachs who underwent esophagectomy for cancer.

Main outcome measures: Patients' demographic characteristics, tumor characteristics, operative morbidity, mortality, and long-term survival.

Results: There were more squamous tumors located in the lower third of the esophagus in those who had a history of gastrectomy compared with those with intact stomachs (16 [41%] of 40 patients vs 318 [25%] of 1266 patients; P=.04). This difference was more pronounced after Billroth I vs Billroth II gastrectomy (8 [73%] of 11 patients vs 8 [29%] of 28 patients; P=.03). Twenty-four patients (60%) in the gastrectomy group and 738 (58%) in the nongastrectomy group underwent surgical resection (P=.87). The operative time (300 [160-465] vs 220 [90-520] minutes; P<.001) was longer and more blood loss (1000 [300-2500] vs 700 [150-7000] mL;P<.001) was encountered for esophagectomy after previous gastrectomy (data are given as median [range]). A colon interposition was the substitute conduit of choice in the gastrectomy group (20 [83%] of 24 patients), and the stomach was the preferred loop in those with intact stomachs (729 [99%] of 738 patients). Postoperative complication rates were similar. In-hospital mortality rates also did not differ for those with a history of gastrectomy vs those without such a history (12% for both,P>.99). Median survival after resection was 13.8 and 12.5 months for patients who did and did not undergo prior gastrectomy, respectively (P=.62).

Conclusions: A history of gastrectomy (especially the Billroth I type) is associated with more lower-third squamous cell esophageal carcinomas. Surgical resections in patients with such a history were more complicated but resulted in similar outcomes.

MeSH terms

  • Adenocarcinoma / etiology
  • Adenocarcinoma / surgery
  • Aged
  • Anastomosis, Surgical / adverse effects
  • Carcinoma / etiology
  • Carcinoma / surgery
  • Carcinoma, Squamous Cell / etiology*
  • Carcinoma, Squamous Cell / surgery
  • Case-Control Studies
  • Esophageal Neoplasms / etiology*
  • Esophageal Neoplasms / surgery
  • Esophagectomy
  • Female
  • Gastrectomy / adverse effects*
  • Humans
  • Intestine, Small / surgery
  • Male
  • Middle Aged
  • Stomach / surgery*