Barrett's adenocarcinoma arising 30 years after a Nissen fundoplication

Anti-reflux surgery (ARS) for reflux esophagitis is believed to inhibit the progression of Barrett's epithelium (BE), although there is still a chance that Barrett's adenocarcinoma will develop following ARS. Here, we relate our experience of a patient who developed a Barrett's adenocarcinoma despite undergoing ARS. The patient was a 60-year-old male who underwent a Nissen fundoplication 30 years ago due to reflux esophagitis. Endoscopic examination revealed that there was a protruding tumor in the lower thoracic esophagus. The pathological diagnosis of the biopsied specimen was adenocarcinoma. We performed a subtotal esophagectomy with a lymph node dissection and reconstructed the esophagus with an ileocolic interposition. Postoperative pathological diagnosis showed moderately differentiated adenocarcinoma with a BE section. Six lymph nodes were positive for metastasis. The postoperative course was uneventful. Our case suggests that careful surveillance of patients who underwent ARS a long time ago is needed.