Feasibility of surgical resection for gastric cancer in the gastric conduit following esophagectomy for esophageal squamous cell carcinoma.

Background: Gastric cancer in the gastric conduit is a rare and serious complication following esophagectomy. Surgical intervention continues to be a necessary treatment option for selected patients with gastric conduit cancer (GCC), though it carries inherent risks due to prior anatomical alterations. This study aimed to evaluate the safety and feasibility of surgical treatment in patients with GCC after esophagectomy. Methods: We conducted a retrospective analysis of 17 patients who underwent surgical resection for GCC between 2019 and 2024. Safety was assessed by the absence of 30- and 90-day mortality, incidence of major complications [Clavien-Dindo (C-D) ≥ IIIa], and unplanned reoperations. Feasibility was determined by the completion of intended resections, the ability to perform reconstructions and intraoperative metrics such as operative time and blood loss. Secondary outcomes included R0 resection rates, hospital and intensive care unit (ICU) stay and short-term survival. Results: All 17 patients underwent successful resection without abandonment or need for unplanned staged procedures. Total gastric conduit resection with colonic interposition was performed in 11 patients, partial distal or total gastric conduit resection with Roux-en-Y jejunal reconstruction was performed in five patients, and one patient had a partial proximal gastric conduit resection with the remaining stomach re-anastomosed. The mean operative time was 384±129 minutes, and the median blood loss was 100 mL [interquartile range (IQR) 100-150 mL]. No patients experienced 30- or 90-day mortality, and no unplanned reoperations were required. Postoperative complications occurred in 59% of patients. Grade IIIa complications, including pulmonary issues and one anastomosis leak, were noted in 18% of cases. No complications beyond grade IIIa were recorded in this cohort. The 1- and 2-year survival rates were 76% and 59%, respectively. Conclusions: Surgical resection for GCC appears to be a safe and feasible option in carefully selected patients who are not candidates for endoscopic treatment, with acceptable short-term morbidity and preliminary survival outcomes.