Department of Surgery, Tokyo Women's Medical University Medical Center East, 2-1-10 Nishiogu Arakawa-ku, Tokyo 116-8567, Japan.
Anticancer Res. 2010 Sep;30(9):3763-7.
Nephrotic syndrome associated with a malignant tumor may remit following resection of the tumor. This report documents a case of esophageal cancer with concurrent nephrotic syndrome in which a surgical resection of the tumor resulted in a complete remission of nephrotic syndrome. A 78-year-old male patient noticed edema of his lower legs in February 2009 and was diagnosed with nephrotic syndrome. An endoscopic examination revealed an indented lesion with a nearly semiannular low elevation on the posterior wall of the esophagus at 31 to 34 cm from the upper incisors, and a diagnosis of esophageal cancer was made. A two-stage operation was planned. In March 2009, a subtotal resection of the thoracic esophagus through a right thoracic approach and cervical external esophagostomy were performed, and in April 2009, antethoracic route esophagogastrostomy was performed. The urinary protein levels were negative by the 86th day of hospitalization, and the patient progressively improved and was discharged on the 91st hospital day. There has been no recurrence of esophageal cancer or relapse of nephrotic syndrome at 12 months following the operation. In esophageal cancer patients with nephrotic syndrome, surgical treatment should be undertaken because the remission of nephrotic syndrome may be expected following tumor resection. For this purpose, selecting the appropriate operative procedures and careful perioperative management, including nutritional management, are of profound importance.
肾病综合征与恶性肿瘤相关，肿瘤切除后可能缓解。本报告记录了一例合并肾病综合征的食管癌患者，其肿瘤切除术后肾病综合征完全缓解。一位 78 岁男性患者于 2009 年 2 月发现双下肢水肿，并被诊断为肾病综合征。内镜检查发现食管后壁距上门齿 31-34cm 处有一凹陷性病变，呈近半环形轻度隆起，诊断为食管癌。计划行两阶段手术。2009 年 3 月，行右胸入路胸段食管次全切除术和颈外食管造口术，2009 年 4 月，行前路胸内食管胃吻合术。患者住院第 86 天尿蛋白转阴，病情逐渐好转，第 91 天出院。术后 12 个月，未见食管癌复发和肾病综合征复发。对于合并肾病综合征的食管癌患者，应行手术治疗，因为肿瘤切除后可能缓解肾病综合征。为此，选择合适的手术方法和围手术期的精心管理，包括营养管理，非常重要。
