Nishida Takahiro, Takeno Shinsuke, Nakashima Koji, Kariya Masato, Inatsu Haruhiko, Kitamura Kazuo, Nanashima Atsushi
Division of Gastrointestinal, Endocrine and Pediatric Surgery, Department of Surgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan.
Division of Gastrointestinal, Endocrine and Pediatric Surgery, Department of Surgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan.
Int J Surg Case Rep. 2017;36:155-160. doi: 10.1016/j.ijscr.2017.05.025. Epub 2017 May 26.
Salvage surgery for locoregional failures after definitive chemoradiotherapy (dCRT) for esophageal cancer is widely practiced, but treatment options complementing it are also needed due to the high morbidity and mortality and low rate of curative resection.
A 58-year-old man with a surgical history of right upper lobectomy for lung cancer was diagnosed as having esophageal squamous cell carcinoma. Computed tomography revealed swelling of the lesser curvature lymph node, and it had invaded the stomach, the body and tail of the pancreas and the left gastric artery, splenic artery and celiac artery. The patient underwent definitive-dose radiation with chemotherapy. Complete response was attained for the primary tumor, but the metastatic lymph node infiltrating the stomach, pancreas and major vessels remained. Therefore, the Appleby operation was proposed to the patient and subsequently performed aiming at curability. However, the primary tumor recurred 38 months after surgery, so the novel modality of photodynamic therapy using talaporfin sodium and a diode laser was performed, and a complete response was attained for this lesion. The patient is alive at 50 months after the salvage Appleby operation.
Salvage lymphadenectomy for esophageal cancer may be insufficient as a curative treatment because of regrowth of the primary lesion. However, photodynamic therapy may be applicable as a curative treatment option for recurrence of the primary lesion after salvage lymphadenectomy.
对于食管癌根治性放化疗（dCRT）后局部区域复发进行挽救性手术是广泛应用的治疗方式，但由于其高发病率、高死亡率以及根治性切除率低，还需要其他辅助治疗方案。
一名58岁男性，有因肺癌行右上叶切除术的手术史，被诊断为食管鳞状细胞癌。计算机断层扫描显示小弯侧淋巴结肿大，且已侵犯胃、胰腺体尾部以及胃左动脉、脾动脉和腹腔动脉。患者接受了根治剂量的放疗联合化疗。原发肿瘤达到完全缓解，但侵犯胃、胰腺和主要血管的转移性淋巴结仍然存在。因此，向患者提议并随后实施了旨在实现治愈的Appleby手术。然而，术后38个月原发肿瘤复发，于是采用了使用替莫泊芬钠和二极管激光的光动力疗法这一新型治疗方式，该病变获得了完全缓解。在挽救性Appleby手术后50个月，患者仍然存活。
食管癌的挽救性淋巴结清扫术作为一种根治性治疗可能并不充分，因为原发病变会复发。然而，光动力疗法可能适用于挽救性淋巴结清扫术后原发病变复发的根治性治疗选择。
