Evaluation of a new surgical procedure for simultaneous resection of synchronous thoracic middle-lower segment esophageal and distal gastric cancers

Xusheng Ding; Bin Li; Hui Shen; Zezhou Wang; Longlong Shao; Jiaqing Xiang

doi:10.21037/jtd-23-1777

Evaluation of a new surgical procedure for simultaneous resection of synchronous thoracic middle-lower segment esophageal and distal gastric cancers

J Thorac Dis. 2024 Apr 30;16(4):2236-2243. doi: 10.21037/jtd-23-1777. Epub 2024 Apr 18.

Authors

Xusheng Ding^#^{1

2

3}, Bin Li^#^{1

2

3}, Hui Shen^{1

2

3}, Zezhou Wang^{3

4

5}, Longlong Shao^{1

2

3}, Jiaqing Xiang^{1

2

3}

Affiliations

¹ Departments of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China.
² Institute of Thoracic Oncology, Fudan University, Shanghai, China.
³ Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
⁴ Department of Cancer Prevention, Fudan University Shanghai Cancer Center, Shanghai, China.
⁵ Shanghai Municipal Hospital Oncological Specialist Alliance, Shanghai, China.

^# Contributed equally.

Abstract

Background: An increasing number of patients with synchronous esophageal cancer (EC) and gastric cancer (GC) have been diagnosed in recent years. Colon or jejunal interposition for esophageal reconstruction has been frequently performed. This study aimed to evaluate the technical feasibility of a new surgical procedure for patients with synchronous thoracic middle-lower segment EC and distal GC.

Methods: Between July 2012 and December 2021, 18 patients underwent simultaneous esophagectomy and distal gastrectomy, in which the tubular stomach was formed by greater curvature of proximal stomach, with the right gastroepiploic vessels used as the blood supply. Patient demographics and perioperative data were analyzed.

Results: All 18 patients were male, with a mean age of 64.9 years (range, 51-72 years). The mean ± standard deviation (SD) operative duration was 249.6±17.4 min (range, 195-275 min) and mean estimated blood loss was 200.0±86.6 mL (range, 100-400 mL). Ten (55.6%) patients recovered well without any complications, with a mean postoperative length of hospitalization of 9.2±2.6 days (range, 6-13 days). Overall, postoperative complications, defined as Clavien-Dindo grades I-V, occurred in eight (44.4%) patients, with anastomotic leakage in four (22.2%), and hydrothorax (11.1%), gastric retention (5.6%), pneumonia (5.6%), and jaundice (5.6%) occurring in two, one, one, and one patient(s), respectively. All patients who experienced complications recovered after treatment, except for one who died of anastomotic leakage.

Conclusions: The surgical procedure might be a new treatment option for selected patients with synchronous thoracic middle-lower segment EC and distal GC.

Keywords: Esophagectomy; anastomotic leakage; distal gastrectomy; multiple malignant neoplasms.