J Gastrointest Canc DOI 10.1007/s12029-014-9629-4
CASE REPORT
Adenocarcinoma on Colon Interposition for Corrosive Esophageal Injury: Case Report and Review of Literature Hadrien Tranchart & Mircea Chirica & Nicolas Munoz-Bongrand & Emile Sarfati & Pierre Cattan
# Springer Science+Business Media New York 2014
Case Report A 66-year-old man, without familial or personal previous history of colorectal polyp or cancer, was hospitalized for dysphagia and extreme weakness. Nineteen years ago, he underwent a right colon interposition for esophageal reconstruction after esophagectomy for caustic ingestion. Restoration of intestinal continuity was performed by terminoterminal coloduodenal anastomosis on the second part of the duodenum. In the postoperative course, a supra-anastomotic stenosis associated with an important biliary reflux was recorded. Repeated endoscopic dilatations were required for treatment of the stricture. The last dilatation was performed 2 years ago. The patient suffered from recurrent pneumonia due to the biliary reflux. In order to control this reflux, 10 months after the reconstruction, we performed a colostomy in the intra abdominal part of the colon interposition and the intestinal continuity was restored 5 months later. Symptoms associated with the reflux did not appear since restoration of intestinal continuity. An endoscopy was performed in front of this recent dysphagia and showed a 3-cm nonobstructive tumor in the colon interposition, few centimeters below the level of the ileocecal valve (Fig. 1), distant from the coloduodenal anastomosis. Biopsies and histological examination revealed an infiltrating poorly differentiated colon adenocarcinoma. Thoracic and abdominal CT scans showed numerous synchronous liver
metastases (Fig. 2a) and mediastinal carcinomatosis surrounding the colon tumor (Fig. 2b, arrow). A palliative chemotherapy by FOLFOX was started but the patient died 3 months after the diagnosis from liver failure.
Discussion Esophageal reconstruction with colon interposition after esophagectomy for caustic ingestion is a standardized procedure. The feasibility of this operation reaches 100 % with a low mortality but an important late morbidity (anastomotic stricture, reflux) [1]. In the literature, most of the cancer reported after colon interposition concern the malignant evolution of the native esophagus, which is sometimes left in place.
H. Tranchart (*) : M. Chirica : N. Munoz-Bongrand : E. Sarfati : P. Cattan Department of Digestive Surgery, Saint Louis Hospital, 1 avenue Claude-Vellefaux, 75010 Paris, France e-mail: [email protected] H. Tranchart : M. Chirica : N. Munoz-Bongrand : E. Sarfati : P. Cattan University Diderot, Paris VII, Paris, France
Fig. 1 Endoscopy showing tumor on the colon interposition
J Gastrointest Canc
A
B
Fig. 2 Abdominal CT scan showing numerous synchronous liver metastases (a) and mediastinal carcinomatosis (b, arrow) surrounding the graft
Cases of cancer arising in the colon interposition are scarce [2–14] (Table 1). In our unit, after 271 esophageal reconstructions with colon interposition for caustic injuries, this is the first and only case recorded (0.4 %). In order to prevent this complication, a preoperative colonoscopy can be performed [15–18] or only in elderly patients (>50 years) or in case of familial or personal previous history of colorectal polyp or cancer [19]. In this case, the prolonged delay between the reconstruction and the occurrence of the cancer is in favor of a de novo tumor rather than a preexisting colon tumor. This patient and seven others had a major reflux that required a surgical procedure, the only patient who was not treated by duodenal switch, which is the only treatment able to
control the reflux. The remaining biliary reflux could have promoted the development of the colon cancer as the relationship between colon carcinogenesis and fecal bile acids was proved [20, 21]. The characteristics of the tumor at diagnosis (small tumor poorly differentiated, numerous liver metastases, mediastinal carcinomatosis) and the rapid evolution of the disease despite chemotherapy suggest an aggressive biology. Dysphagia and symptoms related to graft dysfunction are frequent and sometimes can last long after esophageal reconstruction, which makes the early diagnosis of a cancer arising in a colon interposition difficult. However, in front of atypical symptoms, this diagnosis has to be suggested.
Table 1 Adenocarcinoma on colon interposition: review Authors
Year of Indication publication
Restoration of Delay before Metastatic disease Treatment intestinal continuity occurrence (year) (M0/M1)
Survival (month)
Bando et al. [6]
2010
Cologastrostomy
14
M0
Endoscopic
–
Sikorszki et al. [3] Kuwabara et al. [4] Roos et al. [7] Hsieh et al. [2] Martín et al. [8] Liau et al. [9] Altorjay et al. [12] Lee et al. [11]
2010 2009 2007 2005 2005 2004 1995 1994
– Coloduodenal – – – – – –
44 9 40 39 14 30 5 20
M0 M0 M0 M0 M0 – M0 –
Surgery Surgery Surgery Surgery Surgery – Surgery Surgery
– – – – – – – –
Theile et al. [13] Houghton et al. [5] Haerr et al. [10]
1992 1989 1987
– Cologastrostomy Cologastrostomy
12 20 9
M0 M0 M0
– – 6
Cologastrostomy
2
M0
Surgery Surgery Palliative chemoradiotherapy Surgery
Goldsmith et al. [14] 1968
Squamous cell carcinoma Caustic Esophageal cancer Caustic Caustic Caustic Esophageal cancer Caustic Squamous cell carcinoma Adenocarcinoma Caustic Squamous cell carcinoma Squamous cell carcinoma
17
J Gastrointest Canc Conflict of Interest The authors declare that they have no conflict of interest.
References 1. Chirica M, Veyrie N, Munoz-Bongrand N, et al. Late morbidity after colon interposition for corrosive esophageal injury: risk factors, management, and outcome. A 20-years experience. Ann Surg. 2010;252:271–80. 2. Hsieh YS, Huang KM, Chen TJ, et al. Metachronous adenocarcinoma occurring at an esophageal colon graft. J Formos Med Assoc. 2005;104:436–40. 3. Sikorszki L, Horvath OP, Papp A, et al. Colon cancer after colon interposition for oesophageal replacement. Magy Seb. 2010;63:157–60. 4. Kuwabara Y, Kimura M, Mitsui A, et al. Adenocarcinoma arising in a colonic interposition following a total gastrectomy: report of a case. Surg Today. 2009;39:800–2. 5. Houghton AD, Jourdan M, McColl I. Dukes A carcinoma after colonic interposition for oesophageal stricture. Gut. 1989;30:880–1. 6. Bando H, Ikematsu H, Fu KI, et al. A laterally-spreading tumor in a colonic interposition treated by endoscopic submucosal dissection. World J Gastroenterol. 2010;16:392–4. 7. Roos D, Busch OR, van Lanschot JJ. Primary colon carcinoma in a colon interposition graft after oesophageal resection. Ned Tijdschr Geneeskd. 2007;151:2111–4. 8. Martin MA, Ferras A. Colon cancer: a rare complication in a colonic esophageal segment after coloesophagoplasty. Cir Esp. 2005;77:46–7.
9. Liau CT, Hsueh S, Yeow KM. Primary adenocarcinoma arising in esophageal colon interposition: report of a case. Hepatogastroenterology. 2004;51:748–9. 10. Haerr RW, Higgins EM, Seymore CH, El-Mahdi AM. Adenocarcinoma arising in a colonic interposition following resection of squamous cell esophageal cancer. Cancer. 1987;60:2304–7. 11. Lee SJ, Koay CB, Thompson H, et al. Adenocarcinoma arising in an oesophageal colonic interposition graft. J Laryngol Otol. 1994;108:80–3. 12. Altorjay A, Kiss J, Voros A, et al. Malignant tumor developed in colon-esophagus. Hepatogastroenterology. 1995;42:797–9. 13. Theile DE, Smithers BM, Strong RW, Windsor CJ. Primary adenocarcinoma in a colonic ‘oesophageal’ segment. Aust N Z J Surg. 1992;62:158–60. 14. Goldsmith HS, Beattie Jr EJ. Malignant villous tumor in a colon bypass. Ann Surg. 1968;167:98–100. 15. Furst H, Hartl WH, Lohe F, Schildberg FW. Colon interposition for esophageal replacement: an alternative technique based on the use of the right colon. Ann Surg. 2000;231:173–8. 16. Gregorie Jr HB. Esophagocoloplasty. Ann Surg. 1972;175:740–51. 17. Cerfolio RJ, Allen MS, Deschamps C, et al. Esophageal replacement by colon interposition. Ann Thorac Surg. 1995;59:1382–4. 18. Mansour KA, Bryan FC, Carlson GW. Bowel interposition for esophageal replacement: twenty-five-year experience. Ann Thorac Surg. 1997;64:752–6. 1 9 . C h i r i c a M , d e C h a i s e m a rt i n C , G o a s g u e n N , e t a l . Colopharyngoplasty for the treatment of severe pharyngoesophageal caustic injuries: an audit of 58 patients. Ann Surg. 2007;246:721–7. 20. Hill MJ. Bile, bacteria and bowel cancer. Gut. 1983;24:871–5. 21. Savage AP, Sian MS, Matthews JL, et al. Experimental colonic carcinogenesis: changes in faecal bile acids after promotion of intestinal tumours by small bowel resection in the rat. Gut. 1988;29:495–502.
CASE REPORT
Adenocarcinoma on Colon Interposition for Corrosive Esophageal Injury: Case Report and Review of Literature Hadrien Tranchart & Mircea Chirica & Nicolas Munoz-Bongrand & Emile Sarfati & Pierre Cattan
# Springer Science+Business Media New York 2014
Case Report A 66-year-old man, without familial or personal previous history of colorectal polyp or cancer, was hospitalized for dysphagia and extreme weakness. Nineteen years ago, he underwent a right colon interposition for esophageal reconstruction after esophagectomy for caustic ingestion. Restoration of intestinal continuity was performed by terminoterminal coloduodenal anastomosis on the second part of the duodenum. In the postoperative course, a supra-anastomotic stenosis associated with an important biliary reflux was recorded. Repeated endoscopic dilatations were required for treatment of the stricture. The last dilatation was performed 2 years ago. The patient suffered from recurrent pneumonia due to the biliary reflux. In order to control this reflux, 10 months after the reconstruction, we performed a colostomy in the intra abdominal part of the colon interposition and the intestinal continuity was restored 5 months later. Symptoms associated with the reflux did not appear since restoration of intestinal continuity. An endoscopy was performed in front of this recent dysphagia and showed a 3-cm nonobstructive tumor in the colon interposition, few centimeters below the level of the ileocecal valve (Fig. 1), distant from the coloduodenal anastomosis. Biopsies and histological examination revealed an infiltrating poorly differentiated colon adenocarcinoma. Thoracic and abdominal CT scans showed numerous synchronous liver
metastases (Fig. 2a) and mediastinal carcinomatosis surrounding the colon tumor (Fig. 2b, arrow). A palliative chemotherapy by FOLFOX was started but the patient died 3 months after the diagnosis from liver failure.
Discussion Esophageal reconstruction with colon interposition after esophagectomy for caustic ingestion is a standardized procedure. The feasibility of this operation reaches 100 % with a low mortality but an important late morbidity (anastomotic stricture, reflux) [1]. In the literature, most of the cancer reported after colon interposition concern the malignant evolution of the native esophagus, which is sometimes left in place.
H. Tranchart (*) : M. Chirica : N. Munoz-Bongrand : E. Sarfati : P. Cattan Department of Digestive Surgery, Saint Louis Hospital, 1 avenue Claude-Vellefaux, 75010 Paris, France e-mail: [email protected] H. Tranchart : M. Chirica : N. Munoz-Bongrand : E. Sarfati : P. Cattan University Diderot, Paris VII, Paris, France
Fig. 1 Endoscopy showing tumor on the colon interposition
J Gastrointest Canc
A
B
Fig. 2 Abdominal CT scan showing numerous synchronous liver metastases (a) and mediastinal carcinomatosis (b, arrow) surrounding the graft
Cases of cancer arising in the colon interposition are scarce [2–14] (Table 1). In our unit, after 271 esophageal reconstructions with colon interposition for caustic injuries, this is the first and only case recorded (0.4 %). In order to prevent this complication, a preoperative colonoscopy can be performed [15–18] or only in elderly patients (>50 years) or in case of familial or personal previous history of colorectal polyp or cancer [19]. In this case, the prolonged delay between the reconstruction and the occurrence of the cancer is in favor of a de novo tumor rather than a preexisting colon tumor. This patient and seven others had a major reflux that required a surgical procedure, the only patient who was not treated by duodenal switch, which is the only treatment able to
control the reflux. The remaining biliary reflux could have promoted the development of the colon cancer as the relationship between colon carcinogenesis and fecal bile acids was proved [20, 21]. The characteristics of the tumor at diagnosis (small tumor poorly differentiated, numerous liver metastases, mediastinal carcinomatosis) and the rapid evolution of the disease despite chemotherapy suggest an aggressive biology. Dysphagia and symptoms related to graft dysfunction are frequent and sometimes can last long after esophageal reconstruction, which makes the early diagnosis of a cancer arising in a colon interposition difficult. However, in front of atypical symptoms, this diagnosis has to be suggested.
Table 1 Adenocarcinoma on colon interposition: review Authors
Year of Indication publication
Restoration of Delay before Metastatic disease Treatment intestinal continuity occurrence (year) (M0/M1)
Survival (month)
Bando et al. [6]
2010
Cologastrostomy
14
M0
Endoscopic
–
Sikorszki et al. [3] Kuwabara et al. [4] Roos et al. [7] Hsieh et al. [2] Martín et al. [8] Liau et al. [9] Altorjay et al. [12] Lee et al. [11]
2010 2009 2007 2005 2005 2004 1995 1994
– Coloduodenal – – – – – –
44 9 40 39 14 30 5 20
M0 M0 M0 M0 M0 – M0 –
Surgery Surgery Surgery Surgery Surgery – Surgery Surgery
– – – – – – – –
Theile et al. [13] Houghton et al. [5] Haerr et al. [10]
1992 1989 1987
– Cologastrostomy Cologastrostomy
12 20 9
M0 M0 M0
– – 6
Cologastrostomy
2
M0
Surgery Surgery Palliative chemoradiotherapy Surgery
Goldsmith et al. [14] 1968
Squamous cell carcinoma Caustic Esophageal cancer Caustic Caustic Caustic Esophageal cancer Caustic Squamous cell carcinoma Adenocarcinoma Caustic Squamous cell carcinoma Squamous cell carcinoma
17
J Gastrointest Canc Conflict of Interest The authors declare that they have no conflict of interest.
References 1. Chirica M, Veyrie N, Munoz-Bongrand N, et al. Late morbidity after colon interposition for corrosive esophageal injury: risk factors, management, and outcome. A 20-years experience. Ann Surg. 2010;252:271–80. 2. Hsieh YS, Huang KM, Chen TJ, et al. Metachronous adenocarcinoma occurring at an esophageal colon graft. J Formos Med Assoc. 2005;104:436–40. 3. Sikorszki L, Horvath OP, Papp A, et al. Colon cancer after colon interposition for oesophageal replacement. Magy Seb. 2010;63:157–60. 4. Kuwabara Y, Kimura M, Mitsui A, et al. Adenocarcinoma arising in a colonic interposition following a total gastrectomy: report of a case. Surg Today. 2009;39:800–2. 5. Houghton AD, Jourdan M, McColl I. Dukes A carcinoma after colonic interposition for oesophageal stricture. Gut. 1989;30:880–1. 6. Bando H, Ikematsu H, Fu KI, et al. A laterally-spreading tumor in a colonic interposition treated by endoscopic submucosal dissection. World J Gastroenterol. 2010;16:392–4. 7. Roos D, Busch OR, van Lanschot JJ. Primary colon carcinoma in a colon interposition graft after oesophageal resection. Ned Tijdschr Geneeskd. 2007;151:2111–4. 8. Martin MA, Ferras A. Colon cancer: a rare complication in a colonic esophageal segment after coloesophagoplasty. Cir Esp. 2005;77:46–7.
9. Liau CT, Hsueh S, Yeow KM. Primary adenocarcinoma arising in esophageal colon interposition: report of a case. Hepatogastroenterology. 2004;51:748–9. 10. Haerr RW, Higgins EM, Seymore CH, El-Mahdi AM. Adenocarcinoma arising in a colonic interposition following resection of squamous cell esophageal cancer. Cancer. 1987;60:2304–7. 11. Lee SJ, Koay CB, Thompson H, et al. Adenocarcinoma arising in an oesophageal colonic interposition graft. J Laryngol Otol. 1994;108:80–3. 12. Altorjay A, Kiss J, Voros A, et al. Malignant tumor developed in colon-esophagus. Hepatogastroenterology. 1995;42:797–9. 13. Theile DE, Smithers BM, Strong RW, Windsor CJ. Primary adenocarcinoma in a colonic ‘oesophageal’ segment. Aust N Z J Surg. 1992;62:158–60. 14. Goldsmith HS, Beattie Jr EJ. Malignant villous tumor in a colon bypass. Ann Surg. 1968;167:98–100. 15. Furst H, Hartl WH, Lohe F, Schildberg FW. Colon interposition for esophageal replacement: an alternative technique based on the use of the right colon. Ann Surg. 2000;231:173–8. 16. Gregorie Jr HB. Esophagocoloplasty. Ann Surg. 1972;175:740–51. 17. Cerfolio RJ, Allen MS, Deschamps C, et al. Esophageal replacement by colon interposition. Ann Thorac Surg. 1995;59:1382–4. 18. Mansour KA, Bryan FC, Carlson GW. Bowel interposition for esophageal replacement: twenty-five-year experience. Ann Thorac Surg. 1997;64:752–6. 1 9 . C h i r i c a M , d e C h a i s e m a rt i n C , G o a s g u e n N , e t a l . Colopharyngoplasty for the treatment of severe pharyngoesophageal caustic injuries: an audit of 58 patients. Ann Surg. 2007;246:721–7. 20. Hill MJ. Bile, bacteria and bowel cancer. Gut. 1983;24:871–5. 21. Savage AP, Sian MS, Matthews JL, et al. Experimental colonic carcinogenesis: changes in faecal bile acids after promotion of intestinal tumours by small bowel resection in the rat. Gut. 1988;29:495–502.
