PD02.05. Long-Term Incidence and Treatment Outcomes of Gastric Conduit Cancer After Esophagectomy

Abstract

Esophageal Cancer: Other Gastric conduit cancer (GCC), a primary carcinoma arising in the reconstructed gastric conduit after esophagectomy, is rare, and its true incidence and long-term outcomes remain unclear. We aimed to determine its cumulative incidence and treatment-related outcomes. We retrospectively reviewed 4,490 patients who underwent esophagectomy with gastric conduit reconstruction between 1994 and August 2025. Among them, 93 developed GCC during follow-up. Clinical characteristics and treatment outcomes of these patients were analyzed. The cumulative incidence of GCC was 2.22% at 10 years and 3.16% at 20 years, with a median interval of 48.2 months (IQR, 26.0–94.1) from esophagectomy to diagnosis. All tumors were adenocarcinomas. Surgical resection was performed in 14 patients (take-down of gastric conduit and colon interposition, n=11; partial gastrectomy or wedge resection, n=3) without postoperative mortality, with a median event-free survival (EFS) of 107.9 months and a 5-year EFS of 77.9%. Endoscopic therapy was the most common treatment (n=64; endoscopic submucosal dissection (ESD), n=62; argon plasma coagulation, n=2), with a median EFS of 56.4 months and a 5-year EFS of 48.2%; two patients required salvage surgery, and seven experienced recurrence at a median of 30.9 months. Eight patients received radiation therapy / concurrent chemoradiation therapy (median EFS 83.0 months; 5-year EFS 60.0%), and eight underwent chemotherapy or palliative care (median EFS 11.1 months; 5-year EFS 0%). GCC remains a clinically significant long-term complication after esophagectomy. Endoscopic therapy offers favorable outcomes for early-stage disease, whereas advanced-stage GCC carries a poor prognosis. Therefore, structured and lifelong endoscopic surveillance is crucial for early detection and for improving long-term survival after esophagectomy.