Watanabe Isamu, Takamochi Kazuya, Oh Shiaki, Suzuki Kenji
Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
Interact Cardiovasc Thorac Surg. 2019 Oct 1;29(4):641-643. doi: 10.1093/icvts/ivz137.
A 48-year-old man presenting with cough, dysphagia and chest pain was diagnosed with advanced inoperable squamous cell carcinoma located in the right S2 with mediastinal lymph node metastases invading the oesophagus (c-T4N2M0 stage IIIB). Concurrent chemoradiotherapy (66 Gy) was planned, but he developed a tracheo-oesophageal fistula during the chemoradiotherapy course (26 Gy). A right sleeve pneumonectomy with oesophagectomy, cervical oesophagostomy and enterostomy were performed. Although bilateral recurrent nerve palsy occurred, he recovered via enhanced rehabilitation and was discharged 28 days after the salvage surgery. Three months after the initial surgery, staged reconstruction surgery of the stomach was performed. Intensive rehabilitation resulted in restored swallowing ability. He is alive with recurrent disease 12 months after surgery. This is the first report of salvage surgery for advanced lung cancer with tracheo-oesophageal fistula during concurrent chemoradiotherapy.
一名48岁男性，因咳嗽、吞咽困难和胸痛就诊，被诊断为位于右肺上叶S2段的晚期无法手术切除的鳞状细胞癌，伴有纵隔淋巴结转移并侵犯食管（c-T4N2M0，IIIB期）。计划进行同步放化疗（66 Gy），但在放化疗过程中（26 Gy）出现了气管食管瘘。遂行右肺袖状肺叶切除术联合食管切除术、颈部食管造口术和肠造口术。尽管出现了双侧喉返神经麻痹，但通过强化康复治疗后恢复，在挽救性手术后28天出院。初次手术后3个月，进行了分期胃重建手术。强化康复治疗使吞咽能力得以恢复。术后12个月，患者带复发病灶存活。这是关于同步放化疗期间发生气管食管瘘的晚期肺癌挽救性手术的首例报道。
