食道癌根治手術後の再建胃管癌の2症例と重複癌に対する考察

Carcinoma of Stomach Tube after Radical Operation of Esophageal Carcinoma

　食道癌切除後の食道再建には胃を使用することが多い．したがって食道癌病巣のみならず，胃も精査して，胃癌はもとより潰瘍，ポリープ等の病変の有無を調べ，胃が食道再建に適しているかどうかを確かめる必要がある．しかし術前に胃を精査したにもかかわらず，胸壁前および胸骨後経路で食道を再建してから，それぞれ1年半，4年半後に形成胃管の胃癌の存在に気づいた2症例を経験した．食道と他臓器，特に胃との重複癌は以前にも報告したように³⁾それほど稀なものではないが，食道癌手術後の再建胃管の胃癌の報告は稀である．そこで2症例を報告するとともに文献的考察を加えた．

　The esophagus is reconstructed by the stomach in many patients whose original esophagus has been resected because of carcinoma. Although stomach cancer is common in Japan, few have reported carcinoma arising from the reconstructed gastric tube. We have come across two cases of cancer originating here.

　The patient in Case 1 died of liver metastasis and peritoneal dissemination due to esophageal carcinoma two years and one month after its resection. Another patient in Case 2 died of metastases to various organs proven initially originating from gastric cancer four years and nine months after esophageal resection. Their clinical courses are described here. It is emphasized that the stomach of the patients who are to undergo operation for esophageal carcinoma must be carefully exaimined both before and after surgical intervention not only because they may harbor gastric cancer from the outset but also the incidence multiple cancer is reportedly becoming higher.