[Resection of the posterior mediastinal gastric tube used in reconstruction after radical surgery for esophageal cancer--case reports].

Two patients are presented who underwent resection of a gastric tube placed in the posterior mediastinum during reconstruction following radical esophageal resection for esophageal cancer. The indications for gastric tube resection were bleeding from a peptic ulcer in one and gastric cancer in the other. Case 1: A 72-year-old man, who had undergone a thoracic esophagectomy 3.5 years prior to admission, presented with a chief complaint of hematemesis. The gastric tube was resected and replaced with an antethoracic, pedicled segment of left colon. Pathologic examination of the resected gastric tube revealed a penetrating peptic ulcer. Case 2: A 65-year-old man with esophageal cancer and early gastric cancer underwent thoracic esophagectomy with combined resection of the fundus and lesser curvature of the stomach. One year later, he was found to have a new early gastric cancer in the antrum. The distal portion of the gastric tube was resected and replaced with a pedicled jejunal graft. Of the 526 patients with esophageal cancer treated in our department from 1972 to 1993, peptic ulcers were evident in the gastric tube used to reconstruct the esophagus in only seven cases. The stomach was resected in only one of these patients. Similar patients requiring gastric tube resection have been reported. All six of these cases are reviewed. Cancer of the gastric tube developed in 3 of the 526 patients. Although 74 cases of gastric tube cancer have been reported in the Japanese literature, the patient presented here (case 2) is the first to undergo successful resection of the stomach from the posterior mediastinal position.