Multicentric occurrence of esophageal cancer after gastrectomy: A preliminary report

The effect of gastrectomy on the subsequent development of esophageal cance r was investigated, focusing on its multicentric occurrence. We retrospecti vely evaluated 28 patients who underwent subtotal esophagectomy for intrath oracic esophageal cancer between 1985 and 1999. They were divided into two groups according to whether or not they had previously undergone a gastrect omy: group 1, comprising 7 patients who had undergone gastrectomy and group 2, comprising 21 patients who had not. Clinical profiles of the patients w ere obtained from the medical records and the whole resected esophagus was histopathologically examined. The interval between gastrectomy and esophage ctomy in group I was significantly shorter in the patients who had undergon e gastrectomy for gastric cancer than in those who had undergone gastrectom y for a peptic ulcer, and also in the patients for whom anastomosis had bee n performed by Billroth I compared with Billroth II. The patients in group 1 were significantly younger than those in group 2. The multiple occurrence of esophageal cancer was found in 4 of 5 patients (80%) in group 1, and in 2 of 18 patients (11%) in group 2, with significantly higher frequency bei ng seen in group 1. More than two coexisting cancer lesions apart from the primary tumor were detected in all four patients. Histological examination of all the coexisting cancer lesions showed well-differentiated squamous ce ll carcinoma confined within the superficial mucosal laver. No significant differences were noted in the location of the coexisting lesions between th e oral and anal side of the primary tumors. Squamous dysplasia was randomly observed, especially around the cancer lesions. These findings suggest tha t gastrectomy precipitated subsequent chronic gastroesophageal reflux which in turn induced the development of squamous dysplasia and carcinoma at mul tiple locations in the esophagus.