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Andreas Alexandrou, MD; Peter A. Davis, MA,MB,MChir,FRCS; Simon Law, MA,MB,BChir,FRCSEd; Brian P. Whooley, MD; Sudish C. Murthy, MD,PhD; John Wong, PhD,FRACS

Arch Surg. 2002;137:1238-1242.

Hypothesis  There is an association between a history of distal gastrectomy and the development of esophageal cancer. Surgical treatment of esophageal cancer in patients with a history of gastrectomy is more complicated but will not result in increased mortality in an experienced center.

Design  Case-control study.

Setting  Tertiary care center for the treatment of esophageal cancer.

Patients  Forty patients with a history of gastrectomy and 1266 patients with intact stomachs who underwent esophagectomy for cancer.

Main Outcome Measures  Patients' demographic characteristics, tumor characteristics, operative morbidity, mortality, and long-term survival.

Results  There were more squamous tumors located in the lower third of the esophagus in those who had a history of gastrectomy compared with those with intact stomachs (16 [41%] of 40 patients vs 318 [25%] of 1266 patients; P = .04). This difference was more pronounced after Billroth I vs Billroth II gastrectomy (8 [73%] of 11 patients vs 8 [29%] of 28 patients; P = .03). Twenty-four patients (60%) in the gastrectomy group and 738 (58%) in the nongastrectomy group underwent surgical resection (P = .87). The operative time (300 [160-465] vs 220 [90-520] minutes; P<.001) was longer and more blood loss (1000 [300-2500] vs 700 [150-7000] mL;P<.001) was encountered for esophagectomy after previous gastrectomy (data are given as median [range]). A colon interposition was the substitute conduit of choice in the gastrectomy group (20 [83%] of 24 patients), and the stomach was the preferred loop in those with intact stomachs (729 [99%] of 738 patients). Postoperative complication rates were similar. In-hospital mortality rates also did not differ for those with a history of gastrectomy vs those without such a history (12% for both, P>.99). Median survival after resection was 13.8 and 12.5 months for patients who did and did not undergo prior gastrectomy, respectively (P = .62).

Conclusions  A history of gastrectomy (especially the Billroth I type) is associated with more lower-third squamous cell esophageal carcinomas. Surgical resections in patients with such a history were more complicated but resulted in similar outcomes.

From the Division of Esophageal Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China.

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