Wada H et al. (2005) Clinical outcome of esophageal cancer patients with history of gastrectomy. J Surg Oncol 89: 67–74

A new study from Japan has shown that surgical treatment for esophageal cancer is safe in gastrectomized patients, despite the complicated nature of such an approach.

This retrospective study by Wada et al. included 948 patients who had undergone surgery for primary thoracic esophageal cancer. Of these, 72 (7.6%) patients had a history of partial or total gastrectomy because of gastric cancer or peptic ulcer. The operative time was longer in these patients than in the non-gastrectomized group, partly because it was necessary to use the colon or jejunum, rather than the gastric tube, for esophageal replacement. Operative mortality and blood loss, however, were similar in the two groups.

Overall and cause-specific survival rates were significantly higher in gastrectomized patients. The authors suggest that this might have been due to differences in the 'biological behaviors' of esophageal cancer in patients who have undergone gastrectomy. Among the gastrectomized patients, tumors tended to be at a lower position in the esophagus. In the gastrectomized group, the most common gross tumor morphology was expansive growth, whereas the non-gastrectomized patients were more likely to show an infiltrative pattern.

Wada et al. conclude that gastrectomized patients have a favorable prognosis following surgery for esophageal cancer, and that this treatment is warranted. Ongoing studies will explore the potential of chemotherapy or radiotherapy to further improve outcomes.