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This study investigated the clinical characteristics of patients with gastric tube cancer following esophagectomy at our hospital, and to examine the outcomes of gastrectomy versus endoscopic submucosal dissection. Of 49 patients who underwent treatment for gastric tube cancer that developed 1 year or more after esophagectomy, 30 patients underwent subsequent gastrectomy (Group A), and 19 patients underwent endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) (Group B). The characteristics and outcomes of these two groups were compared. The interval between esophagectomy and diagnosis of gastric tube cancer ranged from 1 to 30 years. The most common location was the lesser curvature of the lower gastric tube. When the cancer was detected early, EMR or ESD was performed, and the cancer did not recur. In advanced tumors, gastrectomy was performed but the gastric tube was difficult to approach and lymph node dissection was difficult; two patients died as a result of the gastrectomy. In Group A, recurrence occurred most often as axillary lymph node, bone, or liver metastases; in Group B, no recurrence or metastases were observed. In addition to recurrence and metastasis, gastric tube cancer is often observed after esophagectomy. The present findings highlight the importance of early detection of gastric tube cancer after esophagectomy and that the EMR and ESD procedures are safe and have significantly fewer complications compared with gastrectomy. Follow-up examinations should be scheduled with consideration given to the most frequent sites of gastric tube cancer occurrence and the time elapsed since esophagectomy.

Esophageal neuroendocrine carcinoma (ENEC) are rare and aggressive behavior with early dissemination and poor prognosis. According to previous reports, including case reports and reviews, the incidence of ENEC ranges from about 0.8–2.8%. Unfortunately, the rarity of this tumor has not yet permitted the prospective recruitment of patients in clinical trials, in order to establish the optimal therapy. The purpose of this study was to determine the optimal surgical treatment of ENEC. The histological diagnosis of ENEC was determined by examination of surgically resected specimens in patients who underwent surgery. The patients were selected from a prospective study of Department of Surgery, Institute of Gastroenterology Tokyo Women’s Medical University from 1968 to 2021. We study 27 cases of ENEC who performed operation with lymph node dissection. We investigated (1) the patient characteristics, (2) pathological findings including immunohistochemical profiles, (3) recurrence pattern, and survival curves, (4) ki-67 index. This study was approved by the ethics committee of Tokyo Women’s Medical University in Tokyo Japan. (1) gender (mail: female=23: 4), depth (T1: T2; T3: T4)=8: 3: 12: 4 Lymph node (N0: N1)=2: 25 (2) Immunohistochemistry of synaptophysin: chromogranin A: NCAM = 70.4%: 45%: 60% (3) recurrence pattern (liver: lung: Lymph node: bone: dissemination = 8: 6: 4: 2: 4) 50% survival rate (T1: T2-4= 19 months: 6.5 months) p=0.0202, numbers of lymph node (0-2: 3< = 19 months: 4mnths)p Cases in which long-term survival was obtained by surgical treatment was T1 or 0-2 numbers of lymph node. Ki-67 index was more than 80%.

BackgroundIncidence of adenocarcinoma of the esophagogastric junction (AEG) is increasing in Japan as well as Western Country. However, there is no consensus on treatment strategy. The purpose of this study was to determine the optimal range of resection and lymph node dissection for Siewert type II AEG and to develop a strategy for treatment that includes adjuvant therapy to improve the survival rate. MethodsWe retrospectively investigate 88 cases of advanced AEG in patients who underwent surgery with lymph node dissection with 52 cases of superficial AEG, 23 of whom underwent endoscopic treatment (endoscopic mucosal resection [EMR] or endoscopic submucosal dissection [ESD]), and 29 of whom underwent surgery with lymph node dissection. ResultsThe optimal lymph nodes to resect for advanced AEG were in the inferior mediastinum (No. 110), in the lesser curvature (Nos. 1, 3, 7), No. 2, and No 11. According to area of actual lymph node metastasis, lymphadenectomy of lymph nodes 1, 2, 3, 7, and 11 was sufficient to improve survival of patients with superficial AEG. If esophageal involvement was >40 mm, we performed esophagectomy through right thoracotomy. The 5-year overall survival rates were 88% for patients treated with ESD, 78% for those with superficial AEG who under-went surgery, and 24% for those with advanced AEG (p = 0.011). Despite of lymph node dissection, twenty-five patients experienced lymph node metastasis after operation in advanced AEG and there were many disseminations in advanced AEG. There were no differences in survival between patients who received postoperative adjuvant therapy with S-1 for advanced AEG and those who received surgery alone (p = 0.5192).Conclusion Although surgical procedures of superficial and locally advanced AEG are standardized, the role of adjuvant therapy for AEG is still controversial. We recommend nab-paclitaxel plus radiotherapy for advanced AEG as neoadjuvant therapy.

Incidence of adenocarcinoma of the esophagogastric junction is increasing in Japan. However, in early cases (T1), there is no consensus on treatment strategy. The purpose of this study was to determine the optimal range of resection and lymph node dissection according to lymph node metastasis status and vascular invasion in early adenocarcinoma (T1) of the esophagogastric junction. Methods We investigated patient characteristics, surgical procedures, recurrence pattern, and optimum extent of lymph node dissection in 22 patients who underwent surgery in our hospital from 2000 to 2016 and were diagnosed with early adenocarcinoma of the esophagogastric junction (by Nishi’s classification). Results Four patients with lymph node metastasis, the depth of invasion was sm2 and lymphatic invasion was positive (ly1–ly3, focal lymphatic invasion to prominent lymphatic invasion). In all cases, the site of lymph node metastasis was the lesser gastric curvature. None of the patients developed postoperative lymph node recurrence. An examination of the outcomes revealed that the metastases were hematogenous in all patients with a depth of invasion of sm2 and a positive venous invasion (v1, focal vascular invasion). Conclusion We conclude that transhiatal esophagectomy should be selected as a minimal requirement, and that dissection of the abdominal lymph node (particularly on the lesser curvature side of the superior part of the stomach) is sufficient, for patients with early adenocarcinoma of the esophagogastric junction. In cases where the depth of invasion is sm2 or greater and vascular invasion is present, patients may require adjuvant therapy regardless of lymph node metastasis status.

Generally we use the stomach after esophagectomy as an organ of reconstruction. But we could not use it after we performed gastrectomy. We investigated the usefulness of the reconstruction with pedicled jejunum or pedicled right colon. Methods We performed esophagectomy from 2000 to 2015.15 patients use the reconstruction with pedicled jejunum as a A.10 patients use the reconstruction with pedicled right colon as a B.We study (1) background (2) complication. Results Average Age A:67.1 B:65.5 location(upper:middle:Lower)A:0:14:1 B:1:4:5 depth of tumor invasion (T1:T2:T3:T4)A:9:3:3:0 B:3:5:2 Stage(0:I:II:III:IVa)A:2:6:4:3:0 B:0:1:3:4:2 Reconstruction route(posterior mediastinal:retrosternal:antethoracic)A:4:2:9 B:0:5:5 The reason of the gastrectomy (ulcer: cancer)A 10:5 B 0:10 (distal gastrectomy:total gastrectomy)A:15:0 B:4:6 Reconstruction(BillrothI法:BillrothII法:Roux-Y) A:12:3:0 B:2:2:6 Complication (leakage)A:B = 3:0. (ileus)A:B = 2:0(weight loss)A:B = 10:0 (diarrhea)A:B = 3:5. Conclusion The best practice of reconstruction method is a reconstruction with pedicled jejunum without stomach. We can use the jejunum without damage of the vessel in the mesenteri of the jejunum. I want to show you our video.

Cardiac metastasis is uncommon and rarely diagnosed antemortem. Here, we describe a case of symptomatic cardiac metastasis from esophageal adenocarcinoma. A 64-year-old man developed chest symptoms 26 months after curative esophagogastrectomy for esophageal adenocarcinoma. Initially, ischemic cardiac disease was suspected based on electrocardiography findings, but an infiltrative tumor was seen morphologically in the wall of the interventricular septum and apex. No other lesions were detected. Histological examination of a transcatheter biopsy specimen indicated that the cardiac tumor was metastasis from esophageal adenocarcinoma. Chemoradiotherapy with cisplatin relieved his symptoms, and he had resumed normal activities. However, he opted not to undergo further aggressive treatment due to severe adverse effects from cisplatin. Seventeen months after completion of chemoradiotherapy, metastases to the right ventricle and the left thighbone were detected and he died 27 and 24 months after the diagnosis of cardiac metastasis and completion of chemoradiotherapy, respectively.

Background Definitive chemoradiotherapy for esophageal cancer which was unresectable tumor has become common therapy. In recently, we have perform chemoradiotherapy for resectable tumor because esophagectomy for esophageal cancer is an invasive surgical procedure. But some cases were recurrent. We examined the treatment strategy and clinical outcomes of salvage esophagectomy after definitive chemoradiotherapy for esophageal cancer. Methods We reviewed 46 cases of subjects with esophageal cancer who underwent salvage esophagectomy after definitive chemoradiotherapy with more than 50Gy of radiation from 2000 to 2017. We exam (1) Back ground (2) Term after Chemoradiotherapy (3)Surgical approach (4) Route of reconstruction (5)Rang of lymphanodectomy (6)Complication (7)Prognosis. Results Age 63.0(43–79), Male: Female = 44:2, Location: Upper/Middle/Lower = 15/25/8, T1/T2/T3/T4 = 11:2:25:8 R0: R1: R2 = 35:9:2 (2) Within1 year/More than 1 year = 31/15 (3) Neck digection/Right thoracotomy: Left thoracotomy: laparotomy = 8:31:5:2 (4) Mediastinal rute/Ante/Retro = 34:9:3 (5) 1 Field:2 Field:3 Field = 11:27:8 (6) Anastleakage/Pneumonia/Abcess/Meningitis/Fluid in the thoracic cavity = 11: 9: 4: 1: 8 (7) 5-years survival rate was 36%. Hospital death was4.3% Conclusion There were high rate complications for salvage esophagectomy after definitive chemoradiotherapy for esophageal cancer. Patients should be carefully selected for salvage esophagectomy.Surgeons should consider the indications and techniques for esophageal surgery to increase cure rates and decrease morbidity. Disclosure All authors have declared no conflicts of interest.

Background Incidence of adenocarcinoma of the esophagogastric junction is increasing in Japan as Europe or America. However, there is no consensus on treatment strategy. The purpose of this study was to determine the optimal range of resection and lymph node dissection according to lymph node metastasis status in adenocarcinoma of the esophagogastric junction Methods We investigated 75 patients who were diagnosed with advanced adenocarcinoma(A) of the esophagogastric junction and 22 patients were diagnosed with early adenocarcinoma(B). Results (1) Location(EG: E = G: GE: G) A = 37:20:17:1 B = 5:4:13(2)The depth of tumor (m2: m3: sm1: sm2: sm3: T2: T3: T4) = 1:6:2:10:3:13:59:3)(3) Degree of lymph node metastasis(n + : n-) A = 49:26 B = 4:18 (4) Surgical approach (Right thoracotomy:Left thoracoabdominal incision:Laparotomy (Transhiatal approach) A = 13:47:15 B = 1:5:16 (5) Neoadjuvant therapy (Chemotherapy before operation:Chemo-radiotherapy before operation:Chemotherapy after operation:Chemo-radiotherapy after operation) A = 1:12:33:1 B were without neoadjuvant therapy (6) Lymph node metastasis (Number of metastasis of lymphnode/Area of the dissection of lymphnode) Cervical: Upper thoracic: Middle: Lower: abdominal A = (1/7, 2/13, 4/31, 15/62, 46/75) B = (0/1, 0/3, 0/8, 4/22) (7) Type of the recurrence (Cervical Lymph node: mediastainal lymphnode: abdominal lymphnode: dissemination: Liver: Lung: Born: Remunant esophagus: Skin: Brain: Other disease) A = (3:8:6:13:9:4:2:1:1:1) B = (0:0:0:0:1:0:1:0:0:0:3) (8) Index (metastatic rate x3-yearOS/100)A = No1: No2: No3: No.7: No11: No20: No110: No112 = 12.1:10.6:12.9:13.5:18.1:50:12.9:9.09 B were not showed because incidence of metastasis of the lymph node were low.(9) 5-years survival rate for advanced cancer was 38% and early cancer was 88% Conclusion Proximal gastrectomy may be a minimally invasive surgical technique in for early and advanced adenocarcinoma of the esophagogastric junction according to the lymph node metastasis status. Surgical resection has been mainstream treatment but It was necessary to perform definitive or neoadjuvant chemoradiotherapy. Disclosure All authors have declared no conflicts of interest.