Tokumitsu Yukio, Yamamoto Tatsuhito, Kitamura Yoshinori, Ando Seiichiro, Tsushimi Kureo, Tangoku Akira
Department of Surgery, Iseikai Tsushimi Hospital.
Gan To Kagaku Ryoho. 2009 Nov;36(12):2445-7.
We herein report a case of thoracic esophageal cancer operated on by mediastinoscope-assisted transhiatal esophagectomy after a right upper lobectomy for primary lung cancer. A 70-year-old male with non-small-cell lung cancer (T4N2M0, cStage III B) underwent chemo-radiation therapy followed by an upper lobectomy of the right lung with mediastinal lymph node dissection. The lung cancer histologically showed complete remission (CR), and no recurrence has been shown. Five years after the operation of lung cancer, esophageal cancer (T3N0M0, cStage II) was endoscopically detected in this patient. Partial remission was obtained after neoadjuvant FP chemotherapy for esophageal cancer. Therefore, mediastinoscope-assisted transhiatal esophagectomy was performed in consideration of a history of a right thoracotomy and of pulmonary dysfunction. Preventive tracheostomy was performed because of recurrent nerve paralysis, but no other severe postoperative complication has developed in this case. Histopathological findings showed a well differentiated squamous cell carcinoma (pT3 (Ad), pN0, M0, pStage II), with involvement at resection margin. He was alive for 11 months after the operation for esophageal cancer, although a local recurrence was observed. There are still many problems remained of the treatment for esophageal cancer patients who had previously undergone a radical operation for lung cancer. However, mediastinoscope-assisted transhiatal esophagectomy may become a procedure for surgical approach if it seems to be difficult to approach the esophageal cancer by thoracotomy again.
我们在此报告一例原发性肺癌右上叶切除术后经纵隔镜辅助经裂孔食管切除术治疗的胸段食管癌病例。一名70岁男性非小细胞肺癌患者（T4N2M0，cIII B期）接受了放化疗，随后行右肺上叶切除及纵隔淋巴结清扫术。肺癌组织学显示完全缓解（CR），且未出现复发。肺癌手术后5年，该患者经内镜检查发现食管癌（T3N0M0，cII期）。食管癌新辅助FP化疗后获得部分缓解。因此，考虑到患者有右胸手术史及肺功能障碍，遂行纵隔镜辅助经裂孔食管切除术。因喉返神经麻痹行预防性气管切开术，但该病例未出现其他严重术后并发症。组织病理学检查结果显示为高分化鳞状细胞癌（pT3（Ad），pN0，M0，pII期），切缘受累。食管癌手术后患者存活了11个月，尽管观察到局部复发。对于先前接受过肺癌根治术的食管癌患者的治疗仍存在许多问题。然而，如果再次开胸手术难以处理食管癌，纵隔镜辅助经裂孔食管切除术可能会成为一种手术入路方法。
