A Case of Perforation of Esophageal Cancer trated with Esophagectomy, Simultaneous Reconstruction and Adjuvant Therapy

Itaru Omoto, Hiroshi Okumura, Masataka Matsumoto, Ken Sasaki, Yoshiaki Kita, Tsutomu Kozono, Kosei Maemura, Tetsuhiro Owaki, Sumiya Ishigami and Shoji Natsugoe

Department of Surgical Oncology and Digestive Surgery, Kagoshima University Graduate School of Medical and Dental Sciences

A 46-year-old man esophageal cancer admitted as an emergency due to sever chest pain and high fever, was diagnosed with perforated esophageal cancer based on chest computed tomography (CT) findings. Right thoracotomy showed perforation of the lower thoracic esophagus with empyema. Esophagectomy with lymph node dissection was done with subsequent reconstruction using a gastric tube via a presternal route. After the intrathoracic cavity was washed with normal saline, drains were inserted. Macroscopic findings showed type 2 esophageal cancer with perforation in the center of the ulceration. Histological findings showed moderately differentiated squamous cell carcinoma with twelve metastases in perigastric nodes and marked lymphatic and venous invasion. The postoperative course was uneventful and the man was treated with adjuvant chemoradiation 2 months after surgery. He underwent chemotherapy for recurrence 10 months after surgery, dying 22 months after surgery. If a patient's general condition can tolerate surgery, esophagectomy with lymphadenectomy plus simultaneous reconstruction may be an option in the surgical management of esophageal cancer perforation, and adjuvant therapy may provide long-term survival.

Key words
perforation of esophageal cancer, simultaneous reconstraction, adjuvant therapy

Reprint requests
Itaru Omoto Department of Surgical Oncology and Digestive Surgery, Kagoshima University Graduate School of Medical and Dental Sciences
8-35-1 Sakuragaoka, Kagoshima, 890-8520 JAPAN

Accepted
January 28, 2009

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