Comprehensive Treatment of Synchronous Double Cancers of The Esophagus and Stomach：An Analysis of 8 Cases_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

CAO Qinhong , CHEN Che , YAO Xuequan ,  LIU Fukun

Department of Digestive Tumor Surgery， The Hospital of Traditional Chinese Medicine of Jiangsu Province， Nanjing 210029， Jiangsu Province， China;

Corresponding author：

LIU Fukun, Email: liufukun2@163.com

Keywords：

Synchronous double cancers of the esophagus and stomach; Comprehensive treatment; Surgery; Endoscopic mucosal resection

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Objective 　To explore the comprehensive treatment of synchronous double cancers of the esophagus and stomach.
Methods 　The treatment procedures of 8 patients with synchronous double cancers of the esophagus and
stomach admitted in the Department of Digestive Tumor Surgery of The Hospital of Traditional Chinese Medicine of Jiangsu Province between Oct. 2006 to Feb. 2013 were analyzed. Some experience of comprehensive treatment of synch-
ronous double cancers of the esophagus and stomach was explored.
Results 　Eight cases of synchronous double cancers of the esophagus and stomach were all diagnosed by endoscopic biopsy. According to the results of CT and endoscopic ultrasonography assessment， lesions which were staged earlier than T1a were cured by endoscopic mucosal resection（6 cases， including 4 cases of esophagus cancer and 2 cases of gastric cancer）， and resection operation （1 cases of esop-hagus cancer）. The lesions staged later than T2 were treated by preoperative neoadjuvant chemoradiation， surgery， and adjuvant chemoradiation after operation （8 cases， including 2 cases of esophagus cancer and 6 cases of gastric cancer）， and simple operation （1 case）. Eight patients had been followed-up for 10-76 months （averaged 41.3 months）. Six patients survived without recurrence and metastasis during the followed-up， 1 patient died in 7 months after operation， and 1 patient relapsed in 20 months after operation.
Conclusions 　Individually designed comprehensive treatment using neo-chemotherapy， intervention chemotherapy， radio-chemotherapy， radical resction surgery， adjuvant chemotherapy， and endoscopic mucosal resection can treat synchronous double cancers of the esophagus and stomach effectively. Impr-actical pursuit for radical surgery will not result in good prognosis

Citation： CAO Qinhong,CHEN Che,YAO Xuequan,LIU Fukun. Comprehensive Treatment of Synchronous Double Cancers of The Esophagus and Stomach：An Analysis of 8 Cases. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2013, 20(10): 1141-1145. doi: Copy

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8.	Yokoyama A， Ohmori T， Makuuchi H， et al. Successful screeningfor early esophageal cancer in alcoholics using endoscopy and mucosa iodine staining[J]. Cancer， 1995， 76(6)：928-934.
9.	Kim HS， Lee DK， Baik SK， et al. Endoscopic mucosal resection with a ligation device for early gastric cancer and precancerouslesions：comparison of its therapeutic efficacy with surgical resection[J]. Yonsei Med J， 2000， 41(5)：577-583.
10.	Nishimura Y， Okuno Y， Ono K， et al. External beam radiation therapy with or without high-dose-rate intraluminal brachytherapy for patients with superficial esophageal carcinoma[J]. Cancer， 1999， 86(2)：220-228.
11.	Vallböhmer D， Hölscher AH， DeMeester S， et al. A multicenter study of survival after neoadjuvant radiotherapy/chemotherapy and esophagectomy for ypT0N0M0R0 esophageal cancer[J]. Ann Surg， 2010， 252(5)：744-749.
12.	Kim TJ， Kim HY， Lee KW， et al. Multimodality assessment ofesophageal cancer：preoperative staging and monitoring of responseto therapy[J]. Radiographics， 2009， 29(2)：403-421.
13.	Bergman JJ. The endoscopic diagnosis and staging of oesophagealadenocarcinoma[J]. Best Pract Res Clin Gastroenterol， 2006， 20(5)：843-866.
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15.	Vazquez-Sequeiros E， Wiersema MJ， Clain JE， et al. Impact of lymph node staging on therapy of esophageal carcinoma[J]. Gastroenterology， 2003， 125(6)：1626-1635.
16.	Abdalla EK， Pisters PW. Staging and preoperative evaluation of upper gastrointestinal malignancies[J]. Semin Oncol， 2004， 31(4)：513-529.
17.	Kwee RM， Kwee TC. Imaging in local staging of gastric cancer：a systemic review[J]. J Clin Oncol， 2007， 25(15)：2107-2116.
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23.	Okada K， Fujisaki J， Kasuga A， et al. Endoscopic ultrasonography is valuable for identifying early gastric cancers meeting expanded-indication criteria for endoscopic submucosal dissection[J]. Surg Endosc， 2011， 25(3)：841-848.
24.	Matsumoto Y， Yanai H， Tokiyama H， et al. Endoscopic ultrason-ography for diagnosis of submucosal invasion in early gastric cancer[J]. J Gastroenterol， 2000， 35(5)：326-331.
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27.	Sarela AI， Lefkowitz R， Brennan MF， et al. Selection of patients with gastric adenocarcinoma for laparoscopic staging[J]. Am J Surg， 2006， 191(1)：134-138.
28.	Oda I， Saito D， Tada M， et al. A multicenter retrospective study of endoscopic resection for early gastric cancer[J]. GastricCancer， 2006， 9(4)：262-270.
29.	Cao Y， Liao C， Tan A， et al. Meta-analysis of endoscopic submucosal dissection versus endoscopic mucosal resection for tumors of the gastrointestinal tract[J]. Endoscopy， 2009， 41(9)：751-757.
30.	Hoteya S， Iizuka T， Kikuchi D， et al. Benefits of endoscopic submucosal dissection according to size and location of gastric neoplasm， compared with conventional mucosal resection[J]. J Gastroenterol Hepatol， 2009， 24(6)：1102-1106.
31.	Nakamoto S， Sakai Y， Kasanuki J， et al. Indications for the use of endoscopic mucosal resection for early gastric cancer in Japan：a comparative study with endoscopic submucosal dissection[J]. Endoscopy， 2009， 41(9)：746-750.
32.	Watanabe T， Kume K， Taip M， et al. Gastric mucosal cancer smaller than 7 mm can be treated with conventional endoscopic mucosal resection as effectively as with endoscopic submucosal dissection[J]. Hepatogastroenterology， 2010， 57(99-100)：668-673.

1. Beech DJ， Madan AK， Aliabadi-Wahle S， et al. Synchronous occurrence of glioblastoma multiforme and esophageal adenocarcinoma[J]. Am Surg， 2003， 69(2)：136-139.
2. Edge SB， Compton CC. The American joint committee on cancer：the 7th edition of the AJCC cancer staging manual and the future of TNM[J]. Ann Surg Oncol， 2010， 17(6)：1471-1474.
3. Kumagai Y， Kawano T， Nakajima Y， et al. Multiple primary cancers associated with esophageal carcinoma[J]. Surg Today， 2001， 31(10)：872-876.
4. Bae JS， Lee JH， Ryu KW， et al. Characteristics of synchronous cancers in gastric cancer patients[J]. Cancer Res Treat， 2006， 38(1)：25-29.
5. Yasumura T， Maruyama T， Kaji S， et al. Complete response in a case of advanced esophageal and gastric double cancer treated by chemotherapy of TS-1 and low-dose cisplatin[J]. Gan To Kagaku Ryoho， 2006， 33(13)：2069-2071.
6. Yano K， Yamashita T， Chishiki M， et al. Two cases of synchro-nous superficial double cancers in the esophagus and stomach[J].J UOEH， 2002， 24(2)：225-232.
7. Noguchi H， Naomoto Y， Kondo H， et al. Evaluation of endoscopicmucosal resection for superficial esophageal carcinoma[J]. Surg Laparosc Endosc Percutan Tech， 2000， 10(6)：343-350.
8. Yokoyama A， Ohmori T， Makuuchi H， et al. Successful screeningfor early esophageal cancer in alcoholics using endoscopy and mucosa iodine staining[J]. Cancer， 1995， 76(6)：928-934.
9. Kim HS， Lee DK， Baik SK， et al. Endoscopic mucosal resection with a ligation device for early gastric cancer and precancerouslesions：comparison of its therapeutic efficacy with surgical resection[J]. Yonsei Med J， 2000， 41(5)：577-583.
10. Nishimura Y， Okuno Y， Ono K， et al. External beam radiation therapy with or without high-dose-rate intraluminal brachytherapy for patients with superficial esophageal carcinoma[J]. Cancer， 1999， 86(2)：220-228.
11. Vallböhmer D， Hölscher AH， DeMeester S， et al. A multicenter study of survival after neoadjuvant radiotherapy/chemotherapy and esophagectomy for ypT0N0M0R0 esophageal cancer[J]. Ann Surg， 2010， 252(5)：744-749.
12. Kim TJ， Kim HY， Lee KW， et al. Multimodality assessment ofesophageal cancer：preoperative staging and monitoring of responseto therapy[J]. Radiographics， 2009， 29(2)：403-421.
13. Bergman JJ. The endoscopic diagnosis and staging of oesophagealadenocarcinoma[J]. Best Pract Res Clin Gastroenterol， 2006， 20(5)：843-866.
14. Vazquez-Sequeiros E， Norton ID， Clain JE， et al. Impact of EUS-guided fine-needle aspiration on lymph node staging in patients with esophageal carcinoma[J]. Gastrointest Endosc， 2001， 53(7)：751-757.
15. Vazquez-Sequeiros E， Wiersema MJ， Clain JE， et al. Impact of lymph node staging on therapy of esophageal carcinoma[J]. Gastroenterology， 2003， 125(6)：1626-1635.
16. Abdalla EK， Pisters PW. Staging and preoperative evaluation of upper gastrointestinal malignancies[J]. Semin Oncol， 2004， 31(4)：513-529.
17. Kwee RM， Kwee TC. Imaging in local staging of gastric cancer：a systemic review[J]. J Clin Oncol， 2007， 25(15)：2107-2116.
18. Weber WA， Ott K. Imaging of esophageal and gastric cancer[J]. Semin Oncol， 2004， 31(4)：530-541.
19. National Comprehensive Cancer Network. NCCN guidlines ver-sion 2[EB/OL]. 2013-04-25. http：//www. nccn. org/professional/physician_gls/pdf/gastric. pdf.
20. Stahl A， Ott K， Weber WA， et al. FDG PET imaging of locally advanced gastric carcinomas：correlation with endoscopic and histopathological findings[J]. Eur J Nucl Med Mol Imaging， 2003， 30(2)：288-295.
21. Chen J， Cheong JH， Yun MJ， et al. Improvement in preoperative staging of gastric adenocarcinoma with positron emission tomography[J]. Cancer， 2005， 103(11)：2383-2390.
22. Bentrem D， Gerdes H， Tang L， et al. Clinical correlation of endoscopic ultrasonography with pathologic stage and outcome in patients undergoing curative resection for gastric cancer[J]. Ann Surg Oncol， 2007， 14(6)：1853-1859.
23. Okada K， Fujisaki J， Kasuga A， et al. Endoscopic ultrasonography is valuable for identifying early gastric cancers meeting expanded-indication criteria for endoscopic submucosal dissection[J]. Surg Endosc， 2011， 25(3)：841-848.
24. Matsumoto Y， Yanai H， Tokiyama H， et al. Endoscopic ultrason-ography for diagnosis of submucosal invasion in early gastric cancer[J]. J Gastroenterol， 2000， 35(5)：326-331.
25. Tsendsuren T， Jun SM， Mian XH. Usefulness of endoscopic ultr-asonography in preoperative TNM staging of gastric cancer[J]. World J Gastroenterol， 2006， 12(1)：43-47.
26. Mekky MA， Yamao K， Sawaki A， et al. Diagnostic utility of EUS-guided FNA in patients with gastric submucosal tumors[J]. Gastrointest Endosc， 2010， 71(6)：913-919.
27. Sarela AI， Lefkowitz R， Brennan MF， et al. Selection of patients with gastric adenocarcinoma for laparoscopic staging[J]. Am J Surg， 2006， 191(1)：134-138.
28. Oda I， Saito D， Tada M， et al. A multicenter retrospective study of endoscopic resection for early gastric cancer[J]. GastricCancer， 2006， 9(4)：262-270.
29. Cao Y， Liao C， Tan A， et al. Meta-analysis of endoscopic submucosal dissection versus endoscopic mucosal resection for tumors of the gastrointestinal tract[J]. Endoscopy， 2009， 41(9)：751-757.
30. Hoteya S， Iizuka T， Kikuchi D， et al. Benefits of endoscopic submucosal dissection according to size and location of gastric neoplasm， compared with conventional mucosal resection[J]. J Gastroenterol Hepatol， 2009， 24(6)：1102-1106.
31. Nakamoto S， Sakai Y， Kasanuki J， et al. Indications for the use of endoscopic mucosal resection for early gastric cancer in Japan：a comparative study with endoscopic submucosal dissection[J]. Endoscopy， 2009， 41(9)：746-750.
32. Watanabe T， Kume K， Taip M， et al. Gastric mucosal cancer smaller than 7 mm can be treated with conventional endoscopic mucosal resection as effectively as with endoscopic submucosal dissection[J]. Hepatogastroenterology， 2010， 57(99-100)：668-673.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Comprehensive Treatment of Synchronous Double Cancers of The Esophagus and Stomach：An Analysis of 8 Cases

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