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Yamashita T, Otsuka K, Goto S, Ariyoshi T, Motegi K, Kohmoto M, Saito A, Fujimasa K, Sato Y, Kato R, Sawatani T, Murakami M. Thoracoscopic esophageal drainage for tracheal compression due to mucocele after esophagogastric bypass: a case report. Surg Case Rep 2023; 9:107. [PMID: 37316766 DOI: 10.1186/s40792-023-01693-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 06/09/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Esophagogastric bypass is performed for esophageal strictures. Mucus retention, known as mucocele, sometimes occurs at the stricture oral side of the remnant esophagus. It is often asymptomatic and is expected to be naturally decompressed, but it may cause respiratory failure depending on the case. Herein, we report a case in which we successfully performed thoracoscopic esophageal drainage as emergency airway management due to tracheal compression by a mucocele after esophagogastric bypass for unresectable esophageal cancer with esophagobronchial fistula. CASE PRESENTATION A 56-year-old man underwent esophageal bypass surgery for an unresectable esophageal carcinoma with an esophagobronchial fistula following chemotherapy and radiation therapy. Nine months after bypass surgery, he experienced severe dyspnea due to tracheal compression caused by mucus retention on the oral side of the esophageal tumor. We planned thoracoscopic surgery for mucus retention drainage through the right thoracic cavity to secure the airway as an emergency procedure under general anesthesia. Intubation can be performed safely by guiding bronchoscopy in the semi-supine position. Upper esophageal dilation was observed on the cranial side of the azygos arch. We dissected the mediastinal pleura of the upper thoracic esophagus and exposed its wall. A 12-Fr silicone drain was placed in the esophagus through the right chest wall and 120 ml of white fluid was aspirated. He was discharged 9 days after surgery without complications and resumed treatment with an immune checkpoint inhibitor 23 days after surgery. Thereafter, he continued chemotherapy for esophageal cancer, but died of tumor progression and lung metastasis 35 months after bypass surgery and 25 months after thoracoscopic surgery. CONCLUSIONS Thoracoscopic esophageal drainage could be performed safely as emergency airway management, shorten the period of discontinuance, and allow cancer treatment to be resumed promptly. We believe that this thoracoscopic procedure is an effective and less invasive method if the percutaneous approach is difficult.
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Affiliation(s)
| | - Koji Otsuka
- Esophageal Cancer Center, Showa University Hospital, Tokyo, Japan
| | - Satoru Goto
- Esophageal Cancer Center, Showa University Hospital, Tokyo, Japan
| | | | - Kentaro Motegi
- Esophageal Cancer Center, Showa University Hospital, Tokyo, Japan
| | - Masahiro Kohmoto
- Esophageal Cancer Center, Showa University Hospital, Tokyo, Japan
| | - Akira Saito
- Esophageal Cancer Center, Showa University Hospital, Tokyo, Japan
| | | | - Yoshihito Sato
- Esophageal Cancer Center, Showa University Hospital, Tokyo, Japan
| | - Rei Kato
- Esophageal Cancer Center, Showa University Hospital, Tokyo, Japan
| | - Tetsuo Sawatani
- Esophageal Cancer Center, Showa University Hospital, Tokyo, Japan
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Wang H, Li W, Wang Z, Chen L, Lai G, Jin F, Ke M, Sun J, Zhang J, Xie B, Zhang N, Li W, Zhou H, Wang X, Lin D, Zhou Y, Zhang H, Li D, Wang C, Song X, Wang J, Wu S, Yang J, Zhang L, Tao M, Zeng Y, Zou H, Li H, Song F, Sha Z, Tan Q, Cong M, Shi H, Wang Z, Han X, Luo L, Ma H, Wu G, Wang Z, Liu X, Wu W, Zhang L, Ye Y, Zhu G. Chinese expert consensus on interventional diagnosis and management of acquired digestive-respiratory tract fistulas (second edition). THE CLINICAL RESPIRATORY JOURNAL 2023; 17:343-356. [PMID: 37094822 DOI: 10.1111/crj.13607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 10/15/2022] [Accepted: 03/23/2023] [Indexed: 04/26/2023]
Abstract
Acquired digestive-respiratory tract fistulas occur with abnormal communication between the respiratory tract and digestive tract caused by a variety of benign or malignant diseases, leading to the alimentary canal contents in the respiratory tract. Although various departments have been actively exploring advanced fistula closure techniques, including surgical methods and multimodal therapy, some of which have gotten good clinical effects, there are few large-scale evidence-based medical data to guide clinical diagnosis and treatment. The guidelines update the etiology, classification, pathogenesis, diagnosis, and management of acquired digestive-respiratory tract fistulas. It has been proved that the implantation of the respiratory and digestive stent is the most important and best treatment for acquired digestive-respiratory tract fistulas. The guidelines conduct an in-depth review of the current evidence and introduce in detail the selection of stents, implantation methods, postoperative management and efficacy evaluation.
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Affiliation(s)
- Hongwu Wang
- Center for Respiratory Disease, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Wen Li
- Department of Respiratory Medicine, PLA General Hospital, Beijing, China
| | - Zikai Wang
- Department of Respiratory Medicine, PLA General Hospital, Beijing, China
| | - Liangan Chen
- Department of Respiratory Medicine, PLA General Hospital, Beijing, China
| | - Guoxiang Lai
- Department of Respiratory Medicine, 900 Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army, Fuzhou, China
| | - Faguang Jin
- Department of Respiratory Medicine, Tangdu Hospital, Air Force Medical University, China
| | - Mingyao Ke
- Department of Respiratory Medicine, Xiamen Second Hospital, Xiamen, China
| | - Jiayuan Sun
- Department of Respiratory Medicine, Shanghai Chest Hospital, Shanghai, China
| | - Jie Zhang
- Department of Respiratory Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Baosong Xie
- Department of Respiratory Medicine, Fujian Provincial Hospital, Fuzhou, China
| | - Nan Zhang
- Department of Respiratory Medicine, Emergency General Hospital, Beijing, China
| | - Wangping Li
- Department of Respiratory Medicine, Tangdu Hospital, Air Force Medical University, China
| | - Hongmei Zhou
- Department of Respiratory Medicine, Tianyou Hospital Affiliated to Tongji University, Shanghai, China
| | - Xiaoping Wang
- Department of Respiratory Medicine, Shandong Provincial Chest Hospital, Jinan, China
| | - Dianjie Lin
- Department of Respiratory Medicine, Shandong Provincial Hospital, Jinan, China
| | - Yunzhi Zhou
- Department of Respiratory Medicine, Emergency General Hospital, Beijing, China
| | - Huaping Zhang
- Department of Respiratory Medicine, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Dongmei Li
- Department of Respiratory Medicine, Emergency General Hospital, Beijing, China
| | - Changhui Wang
- Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Shanghai, China
| | - Xiaolian Song
- Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Shanghai, China
| | - Juan Wang
- Department of Respiratory Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shiman Wu
- Department of Respiratory Medicine, The First Affiliated Hospital of Shanxi Medical University, Taiyuan, China
| | - Junyong Yang
- Department of Respiratory Medicine, Xinjiang Chest Hospital, Wulumuqi, China
| | - Lei Zhang
- Department of Respiratory Medicine, 900 Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army, Fuzhou, China
| | - Meimei Tao
- Department of Respiratory Medicine, Emergency General Hospital, Beijing, China
| | - Yiming Zeng
- Department of Respiratory Medicine, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Heng Zou
- Center for Respiratory Disease, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Hui Li
- Department of Thoracic Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing, China
| | - Fujie Song
- Department of Thoracic Surgery, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Zhengbu Sha
- Department of Thoracic Surgery, The Third Affiliated Hospital of Xuzhou Medical University, China
| | - Qiang Tan
- Department of Thoracic Surgery, Shanghai Lung Hospital, Shanghai, China
| | - Minghua Cong
- Department of Oncology, Cancer Hospital of Chinese Academy of Medical Sciences, Beijing, China
| | - Hanping Shi
- Department of Oncology, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing, China
| | - Zhina Wang
- Department of Oncology, Emergency General Hospital, Beijing, China
| | - Xinwei Han
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou Medical University, Zhengzhou, China
| | - Lingfei Luo
- Department of Interventional Radiology, Emergency General Hospital, Beijing, China
| | - Hongming Ma
- Department of Interventional Radiology, Emergency General Hospital, Beijing, China
| | - Gang Wu
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou Medical University, Zhengzhou, China
| | - Zhiqiang Wang
- Department of Gastroenterology, PLA General Hospital, Beijing, China
| | - Xiaochuan Liu
- Department of Gastroenterology, Emergency General Hospital, Beijing, China
| | - Weiping Wu
- Center for Respiratory Disease, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Lishan Zhang
- Center for Respiratory Disease, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yongan Ye
- Department of Gastroenterology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Guangying Zhu
- Department of Radiology, Beijing Cancer Hospital Affiliated to Peking University, Beijing, China
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3
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Ohno S, Tanaka Y, Sato Y, Endo M, Asai R, Fukada M, Yasufuku I, Okumura N, Takahashi T, Matsuhashi N. A case of advanced hypopharyngeal cervical esophageal cancer treated by curative resection with management of tracheoesophageal fistula. Clin J Gastroenterol 2023:10.1007/s12328-023-01792-z. [PMID: 37029250 DOI: 10.1007/s12328-023-01792-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/27/2023] [Indexed: 04/09/2023]
Abstract
Advanced esophageal cancer with tracheal invasion is fatal due to airway narrowing and the possibility of tracheoesophageal fistula (TEF) formation during the treatment process. If a TEF develops, palliative care is often chosen. It is very rare that curative treatment is performed including with chemoradiotherapy (CRT) or surgery in such cases. A 71-year-old man presented with dysphagia. He was diagnosed as having hypopharyngeal and cervical esophageal cancer with severe airway stenosis (cT4b [main bronchus, thyroid] N3 M0 cStage IIIC), and we initially created a tracheostomy. Second, we chose induction chemotherapy to avoid fistula formation by CRT, but after one course of chemotherapy, he developed a TEF due to remarkable tumor shrinkage. We strictly managed both his airway and nutrition by continuous suctioning over the cuff of the tracheal cannula and prohibiting swallowing of saliva and enteral nutrition via nasogastric tube. After three courses of chemotherapy were administered, we performed pharyngo-laryngo-esophagectomy followed by adjuvant chemotherapy. The patient remains alive and recurrence free at 9 years postoperatively. In cases of upper TEF caused by advanced hypopharyngeal and cervical esophageal cancer, radical treatment may be possible by effective induction chemotherapy combined with strict airway and nutritional management after prior tracheostomy.
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Affiliation(s)
- Shinya Ohno
- Department of Gastroenterological Surgery, Pediatric Surgery, Gifu Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Yoshihiro Tanaka
- Department of Gastroenterological Surgery, Pediatric Surgery, Gifu Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan.
| | - Yuta Sato
- Department of Gastroenterological Surgery, Pediatric Surgery, Gifu Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Masahide Endo
- Department of Gastroenterological Surgery, Pediatric Surgery, Gifu Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Ryuichi Asai
- Department of Gastroenterological Surgery, Pediatric Surgery, Gifu Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Masahiro Fukada
- Department of Gastroenterological Surgery, Pediatric Surgery, Gifu Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Itaru Yasufuku
- Department of Gastroenterological Surgery, Pediatric Surgery, Gifu Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Naoki Okumura
- Department of Gastroenterological Surgery, Pediatric Surgery, Gifu Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Takao Takahashi
- Department of Gastroenterological Surgery, Pediatric Surgery, Gifu Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Nobuhisa Matsuhashi
- Department of Gastroenterological Surgery, Pediatric Surgery, Gifu Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
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Grass JK, Küsters N, von Döhren FL, Melling N, Ghadban T, Rösch T, Simon M, Izbicki JR, König A, Reeh M. Management of Esophageal Cancer-Associated Respiratory–Digestive Tract Fistulas. Cancers (Basel) 2022; 14:cancers14051220. [PMID: 35267527 PMCID: PMC8909259 DOI: 10.3390/cancers14051220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/16/2022] [Accepted: 02/21/2022] [Indexed: 12/04/2022] Open
Abstract
Respiratory–digestive tract fistulas are fatal complications that occur in esophageal cancer treatment. Interdisciplinary treatment strategies are still evolving, especially in anatomical treatment stratification. Thus, this study aims to evaluate general therapeutic strategies for this rare condition. Medical records were reviewed for esophageal cancer-associated respiratory–digestive tract fistula patients treated between January 2008 and September 2021. Fistulas were classified according to being surgery- and tumor-associated. Treatment strategies, clinical success, and survival were analyzed. A total of 51 patients were identified: 28 had tumor-associated fistulas and 23 surgery-associated fistulas. Risk factors for fistula development such as radiation (OR = 0.290, p = 0.64) or stent implantation (OR = 1.917, p = 0.84) did not correlate with lack of symptom control for RDF patients. In contrast, advanced lymph node metastasis as another risk factor was associated with persistent symptoms after treatment for RDF patients (OR = 0.611, p = 0.01). Clinical success significantly correlated with bilateral fistula repair in surgery-associated fistulas (p = 0.01), while tumor-associated fistulas benefited the most from non-surgical (p = 0.04) or combined surgical and non-surgical intervention (p = 0.04) and a bilateral fistula repair (p = 0.02) in terms of overall survival. The therapeutic strategy should aim for bilateral fistula closure. A multidisciplinary, stepwise approach might have the best chance for restoration or symptom control with optimized overall survival in selected patients.
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Affiliation(s)
- Julia K. Grass
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany; (N.K.); (F.L.v.D.); (N.M.); (T.G.); (J.R.I.); (A.K.); (M.R.)
- Correspondence: ; Tel.: +49-040-7410-52401
| | - Natalie Küsters
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany; (N.K.); (F.L.v.D.); (N.M.); (T.G.); (J.R.I.); (A.K.); (M.R.)
| | - Fabien L. von Döhren
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany; (N.K.); (F.L.v.D.); (N.M.); (T.G.); (J.R.I.); (A.K.); (M.R.)
| | - Nathaniel Melling
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany; (N.K.); (F.L.v.D.); (N.M.); (T.G.); (J.R.I.); (A.K.); (M.R.)
| | - Tarik Ghadban
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany; (N.K.); (F.L.v.D.); (N.M.); (T.G.); (J.R.I.); (A.K.); (M.R.)
| | - Thomas Rösch
- Department of Interdisciplinary Endoscopy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany;
| | - Marcel Simon
- Department of Respiratory Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany;
| | - Jakob R. Izbicki
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany; (N.K.); (F.L.v.D.); (N.M.); (T.G.); (J.R.I.); (A.K.); (M.R.)
| | - Alexandra König
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany; (N.K.); (F.L.v.D.); (N.M.); (T.G.); (J.R.I.); (A.K.); (M.R.)
| | - Matthias Reeh
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany; (N.K.); (F.L.v.D.); (N.M.); (T.G.); (J.R.I.); (A.K.); (M.R.)
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5
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Ohsawa M, Hamai Y, Ibuki Y, Emi M, Okada M. Successful Management of Esophageal Cancer With Perforation Using Bypass Surgery Followed by Definitive Chemoradiotherapy. In Vivo 2020; 34:2169-2172. [PMID: 32606200 DOI: 10.21873/invivo.12025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 03/31/2020] [Accepted: 04/01/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Esophageal perforation in advanced esophageal cancer requires immediate treatment. However, no clear treatment protocol has been established for this condition. We report a case of advanced esophageal cancer with esophageal perforation treated with esophageal bypass surgery and definitive chemoradiotherapy (CRT). CASE REPORT A 45-year-old woman was diagnosed with locally advanced esophageal cancer with esophageal perforation. Although the patient's general condition was relatively stable, no improvement was expected through conservative treatment. Esophageal gastric bypass surgery was performed; her symptoms improved postoperatively and oral ingestion became possible. Definitive CRT with 66 Gy radiotherapy and chemotherapy with cisplatin and 5-fluorouracil was administered. A complete clinical response was achieved. The patient is alive and well without recurrence 20 months after treatment. CONCLUSION Definitive CRT after esophageal bypass surgery is a potential treatment option for locally advanced esophageal cancer with esophageal perforation to improve treatment response and quality of life.
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Affiliation(s)
- Manato Ohsawa
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Yoichi Hamai
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Yuta Ibuki
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Manabu Emi
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Morihito Okada
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
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Wang H, Ke M, Li W, Wang Z, Li H, Cong M, Zeng Y, Chen L, Lai G, Xie B, Zhang N, Li W, Zhou H, Wang X, Lin D, Zhou Y, Zhang H, Li D, Song X, Wang J, Wu S, Tao M, Sha Z, Tan Q, Han X, Luo L, Ma H, Wang Z. Chinese expert consensus on diagnosis and management of acquired respiratory-digestive tract fistulas. Thorac Cancer 2018; 9:1544-1555. [PMID: 30221470 PMCID: PMC6209773 DOI: 10.1111/1759-7714.12856] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 08/01/2018] [Indexed: 01/21/2023] Open
Abstract
Acquired respiratory‐digestive tract fistulas occur with abnormal communication between the airways and digestive tract, causing the interflow of gas and liquid. Despite advances in surgical methods and the development of multimodal therapy in recent years, patients with acquired respiratory‐digestive tract fistulas continue to exhibit unfavorable clinical outcomes. Therefore, in order to guide clinical practice in China, the Respiratory and Cancer Intervention Alliance of the Beijing Health Promotion Association organized a group of experienced experts in the field to develop this consensus document. Based on a study of clinical application and expert experience in the diagnosis and management of acquired respiratory‐digestive tract fistulas at home and abroad, an Expert Consensus was developed. The panelists recruited comprised experts in pulmonology, oncology, thoracic surgery, interventional radiology, and gastroenterology. PubMed, Chinese Biology Abstract, Chinese Academic Journal, and Wanfang databases were used to identify relevant articles. The guidelines address etiology, classification, pathogenesis, diagnosis and management of acquired respiratory‐digestive tract fistulas. The statements on treatment focus on the indications for different procedures, technical aspects, and preprocedural, post‐procedural and complication management. The proposed guidelines for the diagnosis and management of acquired respiratory‐digestive tract fistulas are the first to be published by Chinese experts. These guidelines provide an in‐depth review of the current evidence and standard of diagnosis and management.
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Affiliation(s)
- Hongwu Wang
- Department of Respiratory Medicine, Meitan General Hospital, Beijing, China.,Department of Medical Oncology, Meitan General Hospital, Beijing, China
| | - Mingyao Ke
- Department of the Respiratory Centre, Xiamen Second Hospital, Teaching Hospital of Xiamen Medical University, Xiamen, China
| | - Wen Li
- Department of Gastroenterology, Chinese People's Liberation Army (PLA) General Hospital and Chinese PLA Medical School, Beijing, China
| | - Zikai Wang
- Department of Gastroenterology, Chinese People's Liberation Army (PLA) General Hospital and Chinese PLA Medical School, Beijing, China
| | - Hui Li
- Department of Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Minghua Cong
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yiming Zeng
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Fujian Medical University, Center of Respiratory Medicine of Fujian Province, Quanzhou, China
| | - Liangan Chen
- Department of Respiratory Medicine, Chinese People's Liberation Army (PLA) General Hospital and Chinese PLA Medical School, Beijing, China
| | - Guoxiang Lai
- Department of Pulmonary and Critical Care Medicine, Dongfang Hospital Affiliated to Xiamen University, Fuzhou, China
| | - Baosong Xie
- Department of Respiratory and Critical Care Medicine, Fujian Provincial Hospital, Fujian Provincial Medical College, Fujian Medical University, Fuzhou, China
| | - Nan Zhang
- Department of Medical Oncology, Meitan General Hospital, Beijing, China
| | - Wangping Li
- Department of Respiratory Medicine, Tangdu Hospital, Fourth Military Medical University, Xian, China
| | - Hongmei Zhou
- Department of Respiratory Medicine, Zhongshan Hospital, Guangdong Medical University, Zhongshan, China
| | - Xiaoping Wang
- Respiratory Endoscopy Center, Shandong Chest Hospital, Jinan, China
| | - Dianjie Lin
- Department of Respiratory Medicine, Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Yunzhi Zhou
- Department of Respiratory Medicine, Meitan General Hospital, Beijing, China
| | - Huaping Zhang
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Fujian Medical University, Center of Respiratory Medicine of Fujian Province, Quanzhou, China
| | - Dongmei Li
- Department of Respiratory Medicine, Meitan General Hospital, Beijing, China
| | - Xiaolian Song
- Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Juan Wang
- Department of Respiratory Medicine, Tangdu Hospital, Fourth Military Medical University, Xian, China
| | - Shiman Wu
- Department of Respiratory Medicine, The First Affiliated Hospital of Shangxi Medical University, Taiyuan, China
| | - Meimei Tao
- Department of Medical Oncology, Meitan General Hospital, Beijing, China
| | - Zhengbu Sha
- Department of Thoracic Surgery, The Third Affiliated Hospital, Xuzhou Medical University, Xuzhou, China
| | - Qiang Tan
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Xinwei Han
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Respiratory Department, Interventional Institute of Zhengzhou University, Zhengzhou, China
| | - Lingfei Luo
- Department of Medical Oncology, Meitan General Hospital, Beijing, China
| | - Hongming Ma
- Department of Medical Oncology, Meitan General Hospital, Beijing, China
| | - Zhiqiang Wang
- Department of Gastroenterology, Chinese People's Liberation Army (PLA) General Hospital and Chinese PLA Medical School, Beijing, China
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7
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Tanoue Y, Takeno S, Kawano F, Tashiro K, Hamada R, Miyazaki Y, Nanashima A. A case of separation surgery with drainage tube-less (DRESS) esophagostomy for advanced cancer with a respiratory fistula. Int J Surg Case Rep 2018; 44:24-28. [PMID: 29462754 PMCID: PMC5832673 DOI: 10.1016/j.ijscr.2018.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 02/12/2018] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION An esophagorespiratory fistula (ERF) can cause severe pneumonia or a lung abscess which progresses to life-threatening sepsis. A case of a patient with esophageal cancer and an esophagopulmonary fistula (EPF) who underwent separation surgery with drainage tube-less (DRESS) esophagostomy and was promptly started on definitive chemoradiotherapy (CRT) is reported. PRESENTATION OF CASE A 79-year-old man visited a clinic with a month-long history of dysphagia. Esophageal cancer at the middle thoracic esophagus was detected, and invasion of the left main bronchus and lower lobe of the right lung was seen on contrast-enhanced computed tomography (CT). Three weeks later, the patient was transferred to our hospital. CT showed a lung abscess in the lower lobe of the right lung that continued into the adjacent esophageal cancer. Due to the EPF, the patient underwent emergency surgery that consisted of esophageal separation surgery and double bilateral esophagostomy and enterostomy. Definitive CRT for the esophageal cancer was started from postoperative day 25. At six-month follow-up, the patient achieved relapse-free survival. DISCUSSION Separation surgery with a DRESS esophagostomy provides good control of inflammation because of division of the respiratory tract from the alimentary tract, which allows prompt initiation of CRT. Alternatively, a DRESS esophagostomy allows patients to be free from any tube trouble. CONCLUSION Separation surgery with a DRESS esophagostomy for an ERF is a promising method to improve patient quality of life that is less invasive, controls inflammation, and facilitates subsequent definitive CRT.
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Affiliation(s)
- Yukinori Tanoue
- Division of Gastrointestinal-Endocrine-Pediatric Surgery, Department of Surgery, University of Miyazaki Faculty of Medicine, Kihara 5200, Kiyotake, Miyazaki, 8891692, Japan.
| | - Shinsuke Takeno
- Division of Gastrointestinal-Endocrine-Pediatric Surgery, Department of Surgery, University of Miyazaki Faculty of Medicine, Kihara 5200, Kiyotake, Miyazaki, 8891692, Japan.
| | - Fumiaki Kawano
- Division of Gastrointestinal-Endocrine-Pediatric Surgery, Department of Surgery, University of Miyazaki Faculty of Medicine, Kihara 5200, Kiyotake, Miyazaki, 8891692, Japan
| | - Kousei Tashiro
- Division of Gastrointestinal-Endocrine-Pediatric Surgery, Department of Surgery, University of Miyazaki Faculty of Medicine, Kihara 5200, Kiyotake, Miyazaki, 8891692, Japan
| | - Rouko Hamada
- Division of Gastrointestinal-Endocrine-Pediatric Surgery, Department of Surgery, University of Miyazaki Faculty of Medicine, Kihara 5200, Kiyotake, Miyazaki, 8891692, Japan
| | - Yasuyuki Miyazaki
- Division of Gastrointestinal-Endocrine-Pediatric Surgery, Department of Surgery, University of Miyazaki Faculty of Medicine, Kihara 5200, Kiyotake, Miyazaki, 8891692, Japan
| | - Atsushi Nanashima
- Division of Gastrointestinal-Endocrine-Pediatric Surgery, Department of Surgery, University of Miyazaki Faculty of Medicine, Kihara 5200, Kiyotake, Miyazaki, 8891692, Japan
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8
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Kimura M. Bypass Operation for Unresectable Esophageal Cancer: Postoperative Complications After Thoracotomy Versus No Thoracotomy. Indian J Surg 2016; 78:351-355. [PMID: 27994329 DOI: 10.1007/s12262-016-1480-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 03/30/2016] [Indexed: 12/01/2022] Open
Abstract
Patients with unresectable esophageal cancer suffer from dysphagia, causing severe malnutrition and reduced quality of life (QOL). We elect to perform bypass because patients can have greater long-term survival with chemoradiation following this operation. We sought to compare complications in cases of bypass without thoracotomy versus those with thoracotomy. Thirty-four locally advanced esophageal cancer patients between 2007 and 2014 were studied. Eighteen patients underwent thoracotomy, and 16 patients did not have a thoracotomy. CT was obtained to check the anastomosis and the oral stump of the esophagus and to measure the diameter of the intrathoracic esophagus. In the thoracotomy group, the rate of postoperative pulmonary complications was high. On the other hand, in the non-thoracotomy group, the rates of anastomotic leak and recurrent nerve paralysis were high. The stump of the esophagus was 2 cm lower in the T group than in the nT group. As the esophagus shortens after division, the final difference in esophageal height between the groups was only around 1 cm. We concluded that a viable gastric tube with a good blood supply as well as a careful cervical operation are the most important aspects of the esophageal bypass operation.
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Affiliation(s)
- Masahiro Kimura
- Department of Surgery, Nagoya City East Medical Center, 2-23 Wakamizu 1, Chikusa-ku, Nagoya, 464-8547 Japan
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9
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Baba Y, Akiyama T, Kosumi K, Harada K, Shigaki H, Iwatsuki M, Sakamoto Y, Yoshida N, Watanabe M, Baba H. Esophageal Bypass Using a Y-Shaped Gastric Tube for Advanced Esophageal Cancer: Transabdominal Placement of the Decompression Tube. J Am Coll Surg 2015; 221:e87-90. [PMID: 26297480 DOI: 10.1016/j.jamcollsurg.2015.07.445] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 07/17/2015] [Accepted: 07/17/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Yoshifumi Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Takahiko Akiyama
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Keisuke Kosumi
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Kazuto Harada
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Hironobu Shigaki
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Masaaki Iwatsuki
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Yasuo Sakamoto
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Naoya Yoshida
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Masayuki Watanabe
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake, Koto, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan.
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10
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Hihara J, Hamai Y, Emi M, Aoki Y, Taomoto J, Miyata Y, Okada M. Esophageal bypass operation prior to definitive chemoradiotherapy in advanced esophageal cancer with tracheobronchial invasion. Ann Thorac Surg 2013; 97:290-5. [PMID: 24200399 DOI: 10.1016/j.athoracsur.2013.08.060] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 08/09/2013] [Accepted: 08/27/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND In T4 esophageal cancer with tracheobronchial invasion, an esophagorespiratory fistula (ERF) often occurs during or after chemoradiotherapy. We have performed esophageal bypass operations prior to definitive chemoradiotherapy for these patients to increase the chemoradiotherapy completion rate by minimizing the potential effect of an ERF. The aim of this study was to examine the clinical outcome of esophageal bypass surgery prior to chemoradiotherapy. METHODS Between 1997 and 2010, 17 patients underwent esophageal bypass surgery followed by definitive chemoradiotherapy for esophageal cancer with tracheobronchial invasion (bypass group). Ten patients in the same circumstances were treated with chemoradiotherapy alone (control group). Overall survival, the clinical effect of chemoradiotherapy, the ERF incidence rate, and the safety of esophageal bypass surgery were assessed. RESULTS The overall response rate to chemoradiotherapy was 64.7% in the bypass group and 90.0% in the control group. Except for 2 patients with ERF at initial diagnosis, 4 (26.7%) of the 15 patients developed ERF in the bypass group, and 3 (30.0%) of the 10 patients developed ERF in the control group during or after chemoradiotherapy. The 2-year and 3-year overall survival rates were 17.6% and 17.6% in the bypass group and 20.0% and 0% in the control group, respectively (p = 0.924); long-term survival of more than 3 years was seen only in the bypass group. CONCLUSIONS Esophageal bypass surgery prior to definitive chemoradiotherapy could be performed safely, and this strategy contributed to long-term survival in the patients who achieved a good response to chemoradiotherapy but developed an ERF.
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Affiliation(s)
- Jun Hihara
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan.
| | - Yoichi Hamai
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Manabu Emi
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Yoshiro Aoki
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Junya Taomoto
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Yoshihiro Miyata
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Morihito Okada
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
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11
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Successful esophageal bypass surgery in a patient with a large tracheoesophageal fistula following endotracheal stenting and chemoradiotherapy for advanced esophageal cancer: case report. Esophagus 2013; 10:27-29. [PMID: 23482402 PMCID: PMC3589656 DOI: 10.1007/s10388-012-0338-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 07/02/2012] [Indexed: 02/03/2023]
Abstract
A 63-year-old man with esophageal achalasia for more than 20 years complained of respiratory distress. He was admitted as an emergency to the referral hospital three months previously. Computed tomography revealed tracheobronchial stenosis due to advanced esophageal cancer with tracheal invasion. He underwent tracheobronchial stenting and chemoradiotherapy. A large tracheoesophageal fistula (TEF) developed after irradiation (18 Gy) and chemotherapy, and he was unable to eat. Thereafter, he was referred to our hospital, where we performed esophageal bypass surgery using a gastric conduit. A percutaneous cardiopulmonary support system was prepared due to the risk of airway obstruction during anesthesia. A small-diameter tracheal tube inserted into the stent achieved ordinary respiratory management. No anesthesia-related problems were encountered. Oral intake commenced on postoperative day 9. He was discharged on postoperative day 23 and was able to take in sustenance orally right up to the last moment of his life. Esophageal bypass under general anesthesia can be performed in patients with large TEF with sufficient preparation for anesthetic management.
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12
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Esophageal Bypass Using a Gastric Tube for a Malignant Tracheoesophageal/Bronchoesophageal Fistula: A Report of 4 Cases. Int Surg 2011; 96:189-93. [DOI: 10.9738/cc38.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
Tracheoesophageal/bronchoesophageal fistulas are often caused by locally advanced esophageal cancer and lung cancer, and result in life-threatening conditions such as severe cough and dyspnea due to pneumonia. We herein report the clinical characteristics of 4 patients with tracheoesophageal/bronchoesophageal fistulas. All patients were men, and ranged in age from 40–69 years. Three patients had esophageal cancer and 1 had lung cancer. All 4 underwent esophageal bypass using a gastric tube with tube drainage of the distal side of the esophagus. Three patients died at 3, 4, and 5 months after surgery. However, these patients were allowed to enjoy food orally up until the last few days of life. One patient who underwent esophageal bypass and chemoradiotherapy has remained well for 5 years without any evidence of recurrence. This bypass procedure is therefore considered to be a feasible treatment choice for patients with tracheoesophageal/bronchoesophageal fistulas.
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13
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Shin JH, Kim JH, Song HY. Interventional management of esophagorespiratory fistula. Korean J Radiol 2010; 11:133-40. [PMID: 20191059 PMCID: PMC2827775 DOI: 10.3348/kjr.2010.11.2.133] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Accepted: 11/20/2009] [Indexed: 11/15/2022] Open
Abstract
An esophagorespiratory fistula (ERF) is an often fatal consequence of esophageal or bronchogenic carcinomas. The preferred treatment is placement of esophageal and/or airway stents. Stent placement must be performed as quickly as possible since patients with ERFs are at a high risk for aspiration pneumonia. In this review, choice of stents and stenting area, fistula reopening and its management, and the long-term outcome in the interventional management of malignant ERFs are considered. Lastly, a review of esophagopulmonary fistulas will also be provided.
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Affiliation(s)
- Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 138-736, Korea
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14
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Morota M, Gomi K, Kozuka T, Chin K, Matsuura M, Oguchi M, Ito H, Yamashita T. Late toxicity after definitive concurrent chemoradiotherapy for thoracic esophageal carcinoma. Int J Radiat Oncol Biol Phys 2009; 75:122-8. [PMID: 19327900 DOI: 10.1016/j.ijrobp.2008.10.075] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2008] [Revised: 09/30/2008] [Accepted: 10/26/2008] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate late cardiopulmonary toxicities after concurrent chemoradiotherapy (CCRT) for esophageal carcinomas. METHODS AND MATERIALS From February 2002 through April 2005, 74 patients with clinical Stage I-IVB carcinoma of the esophagus were treated with CCRT. Sixty-nine patients with thoracic squamous cell carcinoma were the core of this analysis. Patients received 60 Gy of radiation therapy in 30 fractions over 8 weeks, including a 2-week break, and received 2 cycles of fluorouracil/cisplatin chemotherapy concomitantly. Initial radiation fields included primary tumors, metastatic lymph nodes, and supraclavicular, mediastinal, and celiac nodes areas. Late toxicities were assessed with the late radiation morbidity scoring scheme of the Radiation Therapy Oncology Group/European Organiation for Research and Treatment of Cancer. RESULTS The median age was 67 years (range, 45-83 years). The median follow-up time was 26.1 months for all patients and 51.4 months for patients still alive at the time of analysis. Five cardiopulmonary toxic events of Grade 3 or greater were observed in 4 patients, Grade 5 heart failure and Grade 3 pericarditis in 1 patient, and Grade 3 myocardial infarction, Grade 3 radiation pneumonitis, and Grade 3 pleural effusion. The 2-year cumulative incidence of late cardiopulmonary toxicities of Grade 3 or greater for patients 75 years or older was 29% compared with 3% for younger patients (p = 0.005). CONCLUSION The CCRT used in this study with an extensive radiation field is acceptable for younger patients but is not tolerated by patients older than 75 years.
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Affiliation(s)
- Madoka Morota
- Department of Radiation Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
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15
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Seto Y, Chin K, Gomi K, Kozuka T, Fukuda T, Yamada K, Matsubara T, Tokunaga M, Kato Y, Yafune A, Yamaguchi T. Treatment of thoracic esophageal carcinoma invading adjacent structures. Cancer Sci 2007; 98:937-42. [PMID: 17441965 PMCID: PMC11159274 DOI: 10.1111/j.1349-7006.2007.00479.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
T4 esophageal cancer is defined as the tumor invading adjacent structures, using tumor-node-metastasis (TNM) staging. For clinically T4 thoracic esophageal carcinoma, multimodality therapy, that is, neoadjuvant chemoradiotherapy (CRT) followed by surgery or definitive CRT, has generally been performed. However, the prognosis of patients with these tumors remains poor. Another strategy is needed to achieve curative treatment. In the present article, the treatment strategies employed to date are reviewed. Furthermore, the strategies for these malignancies are reassessed, based on our experiences. R1/2 and R0 resections are regarded as those with residual and no tumor after surgery. The present data show that patients who underwent R1/2 resection after neoadjuvant CRT experienced little survival benefit, while complete response (CR) cases after definitive CRT had comparatively better results. Therefore, curative surgery should not be attempted without down-staging, and definitive CRT should be the initial treatment. Then surgery is indicated for the eradication of residual cancer cells. Close surveillance is essential for early detection of relapse even after CR, because the operation will gradually become increasingly difficult due to post-CRT fibrosis. In conclusion, multimodality therapy consists of definitive CRT followed by R0 resection, which can be the treatment of choice for T4 esophageal carcinoma. These challenging treatments have the potential to constitute the most effective therapeutic strategy.
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Affiliation(s)
- Yasuyuki Seto
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Tokyo 135-8550, Japan.
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