Hirose Kosuke, Saeki Hiroshi, Nakashima Yuichiro, Kamori Tomohiro, Fujimoto Yoshiaki, Kawazoe Tetsuro, Matsuoka Hiroya, Haruta Yasuhiro, Sasaki Shun, Jogo Tomoko, Hu Qingjiang, Tsuda Yasuo, Ando Koji, Oki Eiji, Hiratsuka Ryuzo, Oda Yoshinao, Mori Masaki
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka-shi, Fukuoka-ken, 812-8582, Japan.
Hiratsuka Gastrointestinal Surgical Clinic, 2-7-5, Jiyugaoka, Munakata-shi, Fukuoka-ken, 811-4163, Japan.
Surg Case Rep. 2019 May 3;5(1):72. doi: 10.1186/s40792-019-0634-5.
Recurrences after radical esophagectomy are common. The prognosis for recurrent esophageal cancer is generally poor. Recurrences usually occur between 1 and 3 years of surgery, with the duration of median survival after recurrence ranging from 5 to 10 months. The number of sites and involved organs vary among patients. Consequently, a standard therapeutic strategy has not been established, and the role of surgery in the management of recurrence is unclear.
A 67-year-old man presented with dysphagia 6 months previously and was diagnosed with esophageal squamous cell carcinoma (ESCC) in the upper thoracic region (T2M0M0, stage IB), for which he underwent thoracoscopy-assisted esophagectomy and lymphadenectomy. Adjuvant chemotherapy was not prescribed. Three years after the operation, he developed a solitary metastasis in the left lung, requiring segmentectomy followed by chemotherapy with combined cisplatin (CDDP) and 5-fluorouracil (5-FU). The following year, a metastatic lesion was recognized in the right lung, invading the chest wall, for which he underwent partial lobectomy with local chest wall resection. Multiple mediastinal and abdominal lymph node (LN) metastases were detected in the right lung a year later, which necessitated chemoradiation to a dose of 50.4 Gy with concomitant CDDP and 5-FU. Post-treatment computed tomography (CT) showed a good response. Positron emission tomography (PET)-CT revealed a reduction in the metastatic LNs with no fluoro-deoxy-glucose (FDG) uptake. The following year, metastases were detected in the left cervical LNs. Owing to the limited extent of metastases, resection was followed by chemoradiation to a dose of 50 Gy with CDDP and 5-FU. The following year, metastases were detected in the mediastinal LNs; chemotherapy was administered with nedaplatin and docetaxel. The follow-up CT and PET-CT demonstrated complete disappearance of the tumor, and the patient is currently surviving without recurrence for 11 years from the first curative operation.
This case demonstrates that aggressive multidisciplinary treatment including surgery and radiation to achieve local control could be a meaningful treatment strategy in cases with limited and slowly occurring recurrences.
根治性食管切除术后复发很常见。复发性食管癌的预后通常较差。复发通常发生在手术后1至3年，复发后的中位生存期为5至10个月。不同患者的复发部位和受累器官数量各不相同。因此，尚未确立标准的治疗策略，手术在复发管理中的作用尚不清楚。
一名67岁男性6个月前出现吞咽困难，被诊断为胸上段食管鳞状细胞癌（ESCC，T2M0M0，IB期），为此他接受了胸腔镜辅助食管切除术和淋巴结清扫术。未进行辅助化疗。术后三年，他左肺出现孤立性转移，需要进行肺段切除术，随后接受顺铂（CDDP）和5-氟尿嘧啶（5-FU）联合化疗。次年，右肺发现转移灶并侵犯胸壁，为此他接受了局部胸壁切除的部分肺叶切除术。一年后，右肺发现多个纵隔和腹部淋巴结转移，需要进行剂量为50.4 Gy的同步放化疗，同时使用CDDP和5-FU。治疗后计算机断层扫描（CT）显示反应良好。正电子发射断层扫描（PET）-CT显示转移淋巴结减少，无氟脱氧葡萄糖（FDG）摄取。次年，左颈部淋巴结发现转移。由于转移范围有限，切除术后进行了剂量为50 Gy的同步放化疗，同时使用CDDP和5-FU。次年，纵隔淋巴结发现转移；使用奈达铂和多西他赛进行化疗。后续的CT和PET-CT显示肿瘤完全消失，患者自首次根治性手术后至今已存活11年，无复发。
该病例表明，对于复发局限且进展缓慢的病例，包括手术和放疗以实现局部控制的积极多学科治疗可能是一种有意义的治疗策略。
