Procedures of simultaneous radical resection indicated for primary synchronous esophageal and liver cancers--from the personal experience of three cases.

Primary double cancers of the liver and esophagus are extremely rare. Only 7 cases, both cancers resected, were reported. A 2 stage surgical procedure has been recommended for such a case. We experienced 3 consecutive patients who underwent successful simultaneous radical resection with a good outcome. Case 1 with an advanced esophageal cancer (EC) and hepatocellular carcinoma (HCC) without liver dysfunction received subtotal esophagectomy and posterior segmentectomy of the liver under a thoraco-laparotomy. Case 2, with an early stage EC and HCC with Child A cirrhosis, received the same surgical procedures as case 1 to complete stanching under good visibility for esophagectomy, because of his bleeding tendency due to liver dysfunction. But post operative bleeding from the thoracic cavity continued for 5 consecutive postoperative days. Case 3, with an early stage EC and cholangiocellular carcinoma (CCC), underwent transhiatal esophagectomy and right hepatic lobectomy under laparotomy. All cases received active enteral nutritional (EN) support from the early postoperative day with good outcomes. In conclusion, simultaneous radical resection for synchronous cancers of the esophagus and liver might be a possible indication for patients who have little or slight liver dysfunction. In the case with liver dysfunction, esophagectomy should be performed under thoracotomy, but transhiatal resection, for complete stanching, even in the early stage EC. Post-operative EN support is essential for these patients to obtain a good outcome.