a 67-year - old male patient had undergone esophagectomy and intrathoracic esophagogastrostomy for carcinoma of the lower thoracic esophagus 27 months earlier .
the original pathologic condition was determined to be moderately differentiated squamous cell carcinoma invading the lamina propria without lymph node metastasis ( clinical t1bn0m0 ) .
he had undergone follow - up chest computed tomograph and esophagogastroduodenoscopy once or twice a year and a gastric carcinoma at the intra - abdominal part of the gastric conduit was found .
the tumor was a 2a+2c type lesion and located in the posterior wall of the antrum .
because of its morphology ( flat and depressed type with ulceration ) , size ( more than 10 mm ) and poor localization , endoscopic mucosal resection or partial gastric resection was not suitable ( fig .
1 ) , so we decided to perform a total resection of the gastric conduit .
the whole procedures were performed in 3 stages : first thoracic , second abdominal , and third thoracic and abdominal approaches . because of previous intrathoracic esophagogastrostomy , it was necessary to check the intrathoracic condition and operability .
the esophago - gastric anastomosis was located at the upper part of the paratracheal area ( figs . 2 , 3 ) .
after dissecting the adhesions between the pleura , lung , and gastric conduit with blunt and sharp procedures , we resected the gastric conduit at the level of the previous anastomosis .
the intrathoracic portion of the esophagus was about 4 cm segment long , so we saved it as long as possible and inserted the 28 mm anvil into it .
the antral portion of the stomach was adhered to the diaphragm , liver , and surrounding structures .
the length and vasculatures of the transverse and descending colon were considered to be suitable for an esophageal conduit .
the left side of the colon with a pedicle of the left colic artery was prepared for esophageal reconstruction .
the proximal sigmoid colon was connected ( end to side ) to the proximal part of the transverse colon with a 28 mm end - to - end anastomosis ( eea ) stapler . after the left - sided colon conduit into the thoracic cavity in the isoperistaltic manner , esophago - colonostomy was done with a 28 mm eea stapler .
the distal part of the colon conduit was anastomosed at the side of the proximal jejunum with a 25 mm stapler in the manner of roux - en - y anastomosis .
on the 10th postoperative day , an esophagogram showed no leakage or stenosis of the passage ( fig .
the patient has received follow - up care for 7 months after surgery without any problems .
after warren and gates reported on it in 1932 , the concept of multiple primary malignancies has been accepted widely and is supported by hypothesis of field cancerization .
synchronous or metachronous multiple primary malignancies in esophageal cancer have since been reported with a frequency of about 10% .
gastric conduit cancer is not only cancer arising in the remnant gastric conduit but also the second primary cancer following esophageal cancer .
the incidence of gastric conduit cancer has been reported to be 0.2%-3.5% [ 2 - 4 ] .
although the etiology of the secondary carcinoma in the gastric conduit is not well known , gastric conduit cancer has been reported increasingly because of survival prolongation of esophageal cancer patients after surgery . in our hospital , we have annually operated on about 30 esophageal cancer patients with gastric conduit and this surgical management of gastric conduit cancer was our first experience . because thoracotomy with adhesiolysis is necessary for performing a reoperation , total resection of the gastric conduit reconstructed via the posterior mediastinal route is very difficult .
in addition , it is more invasive because it requires reconstruction with another organ such as the colon , jejunum , or skin , for the conduit . therefore , it is important to detect the lesion at an early stage so as to treat it with minimally invasive surgery such as endoscopic mucosal resection or partial resection .
therefore , careful , periodic endoscopic evaluation after operation in the patient with esophageal cancer is needed .
we had performed annual esophagogastoduodenoscopy evaluation and other radiologic studies twice in a year . in conclusion , a careful , periodic , and endoscopic evaluation after surgery for esophageal cancer is needed for early detection of other primary malignancies .
in addition , surgical treatment of gastric conduit cancer after esophageal cancer surgery was found to be possible and safe in our experience .
 we report a very rare case of surgery on gastric conduit cancer . 
 a 67-year - old male patient underwent esophagectomy and intrathoracic esophagogastrostomy for squamous cell carcinoma of the lower thoracic esophagus 27 months ago . upon follow - up 
 , a gastric carcinoma at the intra - abdominal part of the gastric conduit was found on an esophagogastroduodenoscopy . 
 we performed total gastrectomy and esophagocolonojejunostomy in the manner of roux - en - y anastomosis . 
 the postoperative course was not eventful and an esophagogram on the 10th postoperative day showed no leakage or stenosis of the passage . 
 the patient was discharged on the 17th day with no complications . 
CASE REPORT
DISCUSSION