Takemura Masashi, Osugi Harushi, Lee Shigeru, Taguchi Shinichi, Kaneko Masahiro, Tanaka Yoshinori, Fukuhara Kenichirou, Fujiwara Yushi, Nishizawa Satoshi, Kinoshita Hiroaki
Dept. of Gastroenterological Surgery, Osaka City University Graduate School of Medicine.
Gan To Kagaku Ryoho. 2003 Nov;30(12):1949-53.
We report a case of esophageal cancer infiltrating the left main bronchus in which radical esophagectomy with clear surgical margins could be performed after preoperative radiochemotherapy. The patient was a 57-year-old man, who was found to have esophageal squamous cell carcinoma of the middle thoracic esophagus during a work-up of dysphagia. Bronchoscopy revealed an elevated region protruding into the lumen of the left main bronchus. After radiochemotherapy (liniac irradiation + low-dose FP therapy), the esophageal and bronchial lesion became smaller. The case was evaluated as a clinically complete response. Bronchoscopic ultrasonography showed a clear boundary between the membranous portion of the trachea and the esophageal wall. Based on these findings, the lesion was considered resectable and radical surgery, including 3-field lymph node dissection, was performed. The resected esophageal specimen had residual cancer cells in the muscularis propria covered with normal mucosa. However, the patient is currently healthy with no evidence of disease. The indication for surgical resection in cases of esophageal cancer with contiguous spread, and a good response to preoperative radiochemotherapy, is controversial. It is necessary to verify the effectiveness of surgical resection, as a secondary treatment, by accumulating data on cases such as the present one.
我们报告一例食管癌浸润左主支气管的病例，该患者在术前放化疗后接受了切缘清晰的根治性食管切除术。患者为一名57岁男性，在吞咽困难检查过程中发现胸段中段食管鳞状细胞癌。支气管镜检查发现左主支气管腔内有一隆起区域。放化疗（直线加速器放疗+低剂量氟尿嘧啶和顺铂治疗）后，食管和支气管病变缩小。该病例评估为临床完全缓解。支气管镜超声显示气管膜部与食管壁之间界限清晰。基于这些发现，认为该病变可切除，并进行了包括三野淋巴结清扫的根治性手术。切除的食管标本在覆盖正常黏膜的固有肌层中有残留癌细胞。然而，患者目前健康，无疾病证据。对于伴有连续性扩散且对术前放化疗反应良好的食管癌病例，手术切除的指征存在争议。有必要通过积累如本病例这样的数据来验证手术切除作为二线治疗的有效性。
