Matsumoto Tasuku, Noma Kazuhiro, Maeda Naoaki, Kato Takuya, Moriwake Kazuya, Kawasaki Kento, Hashimoto Masashi, Tanabe Shunsuke, Shirakawa Yasuhiro, Fujiwara Toshiyoshi
Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan.
Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan.
Surg Case Rep. 2023 Jun 26;9(1):119. doi: 10.1186/s40792-023-01692-x.
The prognosis of esophageal cancer (EC) with organ invasion is extremely poor. In these cases, definitive chemoradiotherapy (CRT) followed by salvage surgery can be planned; however, the issue of high morbidity and mortality rates persists. Herein, we report the long-term survival of a patient with EC and T4 invasion who underwent a modified two-stage operation after definitive CRT.
A 60-year-old male presented with type 2 upper thoracic EC with tracheal invasion. First, definitive CRT was performed, which resulted in tumor shrinkage and improvement in the tracheal invasion. However, an esophagotracheal fistula subsequently developed, and the patient was treated with fasting and antibiotics. Although the fistula recovered, severe esophageal stenoses made oral intake impossible. To improve quality of life and cure the EC, a modified two-stage operation was planned. In the first surgery, an esophageal bypass was performed using a gastric tube with cervical and abdominal lymph node dissections. After confirming improved nutritional status and absence of distant metastasis, the second surgery was performed with subtotal esophagectomy, mediastinal lymph node dissection, and tracheobronchial coverage of the fistula. The patient discharged without major complications after radical resection and has been recurrence-free for 5 years since the start of treatment.
A standard curative strategy could be difficult for EC with T4 invasion due to differences in the invaded organs, presence of complications, and patient condition. Therefore, patient-tailored treatment plans are needed, including a modified two-stage operation.
伴有器官侵犯的食管癌（EC）预后极差。对于这些病例，可以计划进行根治性放化疗（CRT）后再行挽救性手术；然而，高发病率和死亡率的问题依然存在。在此，我们报告一例伴有T4侵犯的EC患者在根治性CRT后接受改良两阶段手术的长期生存情况。
一名60岁男性，表现为2型胸上段EC伴气管侵犯。首先进行了根治性CRT，导致肿瘤缩小且气管侵犯情况有所改善。然而，随后出现了食管气管瘘，患者接受禁食和抗生素治疗。尽管瘘口愈合，但严重的食管狭窄导致无法经口进食。为了提高生活质量并治愈EC，计划进行改良两阶段手术。在第一次手术中，使用胃管进行食管旁路手术，并进行颈部和腹部淋巴结清扫。在确认营养状况改善且无远处转移后，进行了第二次手术，包括食管次全切除术、纵隔淋巴结清扫以及对瘘口的气管支气管覆盖。患者在根治性切除术后无重大并发症出院，自治疗开始以来已无复发存活5年。
由于受累器官不同、并发症的存在以及患者状况等因素，对于伴有T4侵犯的EC，制定标准的根治性策略可能具有难度。因此，需要制定个体化的治疗方案，包括改良两阶段手术。
