McKeown esophagectomy for a thoracic esophageal carcinoma patient who has a history of definitive chemoradiotherapy for esophageal carcinoma and total pharyngolaryngectomy for hypopharyngeal cancer

World Journal of Surgical Oncology · 7 authors, 3 centres

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TL;DR

A case report describes the first documented thoracoscopic McKeown esophagectomy performed as salvage treatment in a patient with prior definitive chemoradiotherapy for esophageal carcinoma and total pharyngolaryngectomy for hypopharyngeal cancer.

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This is a single case report of a 64-year-old man with thoracic superficial esophageal squamous cell carcinoma (type 0–IIc, cT1b) who had a complex oncological history including endoscopic mucosal resection and chemoradiotherapy (50 Gy with 2 cycles of cisplatin plus 5-fluorouracil) for superficial ESCC in 2008, total pharyngolaryngectomy with free jejunal graft reconstruction for hypopharyngeal cancer in 2009, and multiple subsequent endoscopic submucosal dissections. Selective lymphadenectomy omitting prophylactic upper mediastinal dissection was performed to preserve tracheal blood supply. The case suggests technical feasibility of this approach, though outcomes are limited by the single-patient design.

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case_report

SPECIALTY

surgery

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ORIGINAL PAPER

PMC10041727

McKeown esophagectomy for a thoracic esophageal carcinoma patient who has a history of definitive chemoradiotherapy for esophageal carcinoma and total pharyngolaryngectomy for hypopharyngeal cancer

World Journal of Surgical Oncology

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ABSTRACT

A 64-year-old man, who had previously undergone definitive chemoradiotherapy (dCRT) and endoscopic resections for metachronous multiple esophageal squamous cell carcinoma (ESCC) and had also received total pharyngolaryngectomy (TPL) for hypopharyngeal cancer, was diagnosed with ESCC in the middle thoracic esophagus (cT3N0M0). Thoracoscopic McKeown esophagectomy was performed for the patient. Although the tumor was tightly adherent to the thoracic duct and both main bronchi, they were successfully mobilized. In order to maintain the blood supply to the trachea, we preserved the bilateral bronchial arteries and avoided prophylactic upper mediastinal lymph node dissection. Cervical end-to-side anastomosis between the jejunum and a gastric conduit was performed. Minor pneumothorax was managed conservatively, and the patient was discharged 44 days after the surgery. Overall, thoracoscopic McKeown esophagectomy was safely performed in a patient with a history of TPL and dCRT. Surgeons should be very careful to prevent tracheobronchial ischemia by optimizing the extent of lymph node dissection. Supplementary Information The online version contains supplementary material available at 10.1186/s12957-023-02999-7.

CITATION EXPORT

Kotaro Sugawara, Takashi Fukuda, Yutaka Kishimoto et al.. McKeown esophagectomy for a thoracic esophageal carcinoma patient who has a history of definitive chemoradiotherapy for esophageal carcinoma and total pharyngolaryngectomy for hypopharyngeal cancer. World Journal of Surgical Oncology. (2023). https://doi.org/10.1186/s12957-023-02999-7

AUTHORS

7 · 3 CENTRES

Kotaro Sugawara, Takashi Fukuda, Yutaka Kishimoto, Daiji Oka, Satoru Shirakura, Hiroaki Kanda, Yoshiyuki Kawashima

1grid.416695.90000 0000 8855 274XDepartment of Gastroenterological Surgery, Saitama Cancer Center Hospital, Saitama, 362-0806 Japan
2grid.416695.90000 0000 8855 274XDivision of Head and Neck Surgery, Saitama Cancer Center, Saitama, Japan
3grid.416695.90000 0000 8855 274XDepartment of Pathology, Saitama Cancer Center, Saitama, Japan