Bilateral video-assisted thoracic surgery for esophageal cancer with left inferior pulmonary vein invasion following chemoradiation therapy
Tóm tắt
The surgical strategy for thoracic esophageal cancer that invades the lungs is controversial. In particular, invasion of the pulmonary vein is often regarded unresectable. We successfully applied bilateral video-assisted thoracic surgery (VATS) in esophagectomy for esophageal cancer with left inferior pulmonary vein invasion following induction chemoradiotherapy (CRT), with a favorable response. A 64-year-old woman was diagnosed with squamous cell carcinoma of the lower third of the esophagus. Computed tomography (CT) revealed that the tumor was suspected to be invading the main trunk of the left lower pulmonary vein and left lower lung. We initiated induction CRT comprising 5-fluorouracil, cisplatin, and concurrent radiotherapy at 50.4 Gy/28Fr. CT revealed shrinkage of the tumor, and the main trunk of the left inferior pulmonary vein was released from the tumor invasion. We considered the tumor to be completely resectable. VATS esophagectomy is usually performed using a right-sided approach. However, the right-sided approach is inappropriate for evaluating tumors around the left inferior pulmonary vein. We started with left-sided VATS to determine tumor resectability and dissected between the esophagus and the main trunk of the left inferior pulmonary vein. We only needed to perform partial resection of the left lower lobe. We then performed a right-sided VATS esophagectomy and lymphadenectomy with partial en bloc resection of the left lower lobe. Following this, we performed hand-assisted laparoscopic proximal gastrectomy and reconstruction using the gastric remnant. The postoperative course was uneventful. The patient was discharged on postoperative day 14. Histopathological examination of the surgical specimen revealed a complete pathological response without any remnant tumor or lymph node metastasis. There were no signs of recurrence or metastasis at the 1-year follow-up. Curative resection for thoracic esophageal cancer that invades the pulmonary vein could be possible via the bilateral VATS approach following induction CRT with a favorable response.
Tài liệu tham khảo
Makino T, Doki Y. Treatment of T4 esophageal cancer. Definitive chemoradiotherapy vs chemoradiotherapy followed by surgery. Ann Thorac Cardiovasc Surg. 2011;17:221–8.
Song X, Shen H, Li J, Wang F. Minimally invasive resection of synchronous triple primary tumors of the esophagus, lung, and thymus: a case report. Int J Surg Case Rep. 2016;29:59–62.
Shimada Y, Kawabe A, Nakajima S, Hata K, Takahashi Y, Kume M, et al. A bilateral thoracic approach for esophageal cancer in the prone position. Surg Today. 2015;45:91–5.
Shishido Y, Miyata H, Sugimura K, Motoori M, Miyoshi N, Yasui M, et al. Successful resection after neoadjuvant chemotherapy for esophageal cancer with posterior thoracic paraaortic lymph node metastasis: a case report and literature review. Gen Thorac Cardiovasc Surg. 2017;65:542–8.
Onodera Y, Nakano T, Heishi T, Sakurai T, Taniyama Y, Sato C, et al. Bilateral approach for thoracoscopic esophagectomy with lymph node dissection in the dorsal area of the thoracic aorta in patients with esophageal cancer: a report of two cases. Int J Surg Case Rep. 2017;31:154–8.
Itazaki Y, Tsujimoto H, Sugasawa H, Yaguchi Y, Nomura S, Ito N, et al. Bilateral approach for thoracoscopic esophagectomy in a patient with esophageal cancer and solitary posterior thoracic para-aortic lymph node metastasis. Acta Med Okayama. 2020;74:521–4.
James D, Brierley MKG, Wittekind C. TNM classification of malignant tumors. 8th ed. USA: Wiley; 2017. p. 57–63.
Eisenhauer EA, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009;45:228–47.
Watanabe M, Toh Y, Ishihara R, Kono K, Matsubara H, Murakami K, et al. Comprehensive registry of esophageal cancer in Japan, 2014. Esophagus. 2022;19:1–26.
Kitagawa Y, Uno T, Oyama T, Kato K, Kato H, Kawakubo H, et al. Esophageal cancer practice guidelines 2017 edited by the Japan Esophageal Society: part 1. Esophagus. 2019;16:1–24.
Makino T, Yamasaki M, Tanaka K, Miyazaki Y, Takahashi T, Kurokawa Y, et al. Treatment and clinical outcome of clinical T4 esophageal cancer: a systematic review. Ann Gastroenterol Surg. 2019;3:169–80.
Terada M, Hara H, Daiko H, Mizusawa J, Kadota T, Hori K, et al. Phase III study of tri-modality combination therapy with induction docetaxel plus cisplatin and 5-fluorouracil versus definitive chemoradiotherapy for locally advanced unresectable squamous-cell carcinoma of the thoracic esophagus (JCOG1510: TRIANgLE). Jpn J Clin Oncol. 2019;49:1055–60.
Matsubara T, Ueda M, Takahashi T, Nakajima T, Nishi M. Surgical treatment of cancer of the thoracic esophagus in association with a major pulmonary operation. J Am Coll Surg. 1997;185:520–4.
Wang XX, Liu TL, Wang P, Li J. Is surgical treatment of cancer of the gastric cardia or esophagus associated with a concurrent major pulmonary operation feasible? One center’s experience. Chin Med J (Engl). 2012;125:193–6.
Sasamori R, Motoyama S, Sato Y, Wakita A, Nagaki Y, Imai K, et al. Salvage robotic-assisted thoracoscopic esophagectomy after definitive chemoradiotherapy for clinical T4b esophageal cancer: a case report. Ann Thorac Cardiovasc Surg. 2023;29:97–102.
Zhang B, Ma J, Yan X, Li X, Xiao Q, Wang W, et al. Left minimally invasive esophagectomy in a patient with synchronous esophageal and lung cancers: case report. Medicine (Baltimore). 2018;97: e9173.
Mun M, Kohno T. Single-stage surgical treatment of synchronous bilateral multiple lung cancers. Ann Thorac Surg. 2007;83:1146–51.
Wang X, Guo H, Hu Q, Ying Y, Chen B. Efficacy of intraoperative recurrent laryngeal nerve monitoring during thoracoscopic esophagectomy for esophageal cancer: a systematic review and meta-analysis. Front Surg. 2021;8: 773579.