A Case Report of Successful Radical Subtotal Esophagectomy on a Patient with Pectus Excavatum

Naoki Iwata, Masahiko Koike, Yuuichi Ito, Goro Nakayama, Michitaka Fujiwara, Yasuhiro Kodera, Yuzuru Kamei* and Akimasa Nakao

Department of Surgery II and Department of Plastic Surgery*, Nagoya University Graduate School of Medicine

Pectus excavatum is generally asymptomatic, but chest pain and cardiopulmonary dysfunction have been reported. Pectus excavatum may also be a risk for complications in extended thoracic surgery, such as esophagectomy with lymph node dissection. A 61-year-old man undergoing esophagogastroduodenoscopy was found to have a type 2 esophageal tumor 34-39 cm from the incisor teeth, confirmed in biopsy to be squamous cell carcinoma, stageIIA (T3, N0, M0) based on International Union Against Cancer (UICC) classification. We therefore administered 2 courses of 5-FU/cisplatine as a standard FP regimen in neoadjuvant chemotherapy. Chest computed tomography (CT) showed the distance between the breast bone and thoracic vertebrae to be 4 cm, making radical subtotal esophagectomy through a right thoracotomy unduly risky. Following the Ravitch procedure and abdominal manipulation a subtotal esophagectomy was done simultaneously with two-field lymph node dissection through a right thoracotomy. The perioperative field was well exposed. The postoperative course was uneventful, and the man was discharged on the postoperative day 22.

Key words
esophageal cancer, pectus excavatum, Ravitch procedure

Reprint requests
Naoki Iwata Department of Surgery II, Nagoya University Graduate School of Medicine
65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 JAPAN

Accepted
October 28, 2009

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