LAUSR

Stomach is the best conduit available after esophageal resection for both benign and malignant esophageal disorders. Malignancy in the gastric conduit after esophageal resection is a rare occurrence with worst outcome. 13 cases of gastric conduit malignancy admitted in our institution from 2006 to 2016 were analysed. Malignancy in the conduit may be a second primary or a recurrence of the tumor bed or at anastamotic site. Indication for surgery, Demographic profile, Interval between occurrence and primary disease, site, type, stage and grade of malignancy, route of the conduit (retro sternal/posterior mediastinum), presence of pyloroplasty, post operative therapy and complications were analysed. The mean interval between primary esophageal malignancy and conduit cancer was 4.3 years. 6 cases represented the second primary, 4 represented anastamotic recurrence and 3 cases of bed recurrence. All cases were adenocarcinoma. Out of 13 patients 8 were advanced malignancy. Out this 8, one patient had conduit pulmonary fistula. Only feeding/stenting procedure and chemo/RT were done. In the remaining 5 patients wedge resection in 1patient and total conduit gastrectomy in 4 patients with colonic replacement were done. Comparing 2 cases of substernal with 2 cases of posterior mediastinal colonic conduit placement the post operative pulmonary complications are less and no need for delay in RT in substernal route. Median overall survival in non surgical patients was 6.2 months (range 4–11 months) and 1.9 months (range 6months -5.6 years) in surgical patients.(P = 0.003) Colonic reconstruction and even partial resection is possible in the management of conduit malignancy after esophagectomy and even yields survival closer to primary gastric maligmancy. Placement of the conduit in the substernal route offers some advantage in treating the tumour bed with radiotherapy. Continuous postoperative monitoring after esophagectomy with the monotored surveillance program is needed to select appropriate cases for better results. All authors have declared no conflicts of interest.