Nous rapportons l’observation de deux patients ayant développé un
adénocarcinome sur plastie gastrique. Le traitement a consisté, dans
un cas, en une résection chirurgicale de la plastie gastrique et réalisation
d’une anastomose oeso-jéjunale. Le diagnostic, dans le
deuxième cas était orienté par des douleurs thoraciques. Le traitement
était à base de chimiothérapie, Carboplatine-5Fluoro-Uracil,
en raison des métastases pulmonaires. Les meilleurs résultats sont
observés dans le premier cas. Ceci souligne l’intérêt de la surveillance
des patients opérés d’un cancer de l’oesophage par une endoscopie
régulière.
Metachronous cancer of gastroplasty after esophagectomy
The incidence of gastric tube cancer after esophagectomy has increased
recently with prolongation of survival of patient with esophageal
cancer. It may be found in 0,2 to 3,5% of patients treated
for esophageal carcinomas. In our experience, we observed 2 cases
of gastric tube carcinomas among 750 cases who had surgical resection
for esophageal cancer by Ivor Lewis procedure from 1980 to
2005 (0,2%). In the first case, the cancer was detected during the
follow-up by endoscopic examination. Total resection of gastric
tube and reconstruction by Roux-en-Y were performed. The patient
is alive and disease free one year after surgery. In the second case,
the gastric tumor was revealed by thoracic pain. Chemotherapy,
using Carboplatin-5Fluoro-Uracil, was performed because of lung
metastasis. Patient died of disease one year later.
The clinical symptoms related to tumors are associated with shortterm
survival, whereas the cancers detected by periodic endoscopy
screening have occasional long-term survival. Total gastrectomy is
proposed for surgical treatment but the operating procedure is complicated
and invasive. Early single location and mucosal cancer can
be treated by endoscopic mucosal resection. A majority of reports
experienced good results with this technique.
Early diagnosis, by annual endoscopic examination, permits best
results in the treatment of metachronous gastric carcinoma arising
from gastric tubes used for reconstruction after oesophagectomy
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