Resection of esophageal cancer infiltrating the left main bronchus following complete response to preoperative radiochemotherapy--a case report

We report a case of esophageal cancer infiltrating the left main bronchus in which radical esophagectomy with clear surgical margins could be performed after preoperative radiochemotherapy. The patient was a 57-year-old man, who was found to have esophageal squamous cell carcinoma of the middle thoracic esophagus during a work-up of dysphagia. Bronchoscopy revealed an elevated region protruding into the lumen of the left main bronchus. After radiochemotherapy (liniac irradiation + low-dose FP therapy), the esophageal and bronchial lesion became smaller. The case was evaluated as a clinically complete response. Bronchoscopic ultrasonography showed a clear boundary between the membranous portion of the trachea and the esophageal wall. Based on these findings, the lesion was considered resectable and radical surgery, including 3-field lymph node dissection, was performed. The resected esophageal specimen had residual cancer cells in the muscularis propria covered with normal mucosa. However, the patient is currently healthy with no evidence of disease. The indication for surgical resection in cases of esophageal cancer with contiguous spread, and a good response to preoperative radiochemotherapy, is controversial. It is necessary to verify the effectiveness of surgical resection, as a secondary treatment, by accumulating data on cases such as the present one.     

A case of resection of esophageal cancer infiltrating the left main bronchus following preoperative chemo-radiotherapy and resection of metachronous lung metastasis

We herein report a case of T4 esophageal carcinoma, which was resected after chemo-radiation therapy. In addition, the metachronous lung metastasis was also resected. A 59-year-old female with esophageal carcinoma, which invaded the left main bronchus, underwent chemo-radiation therapy (the combination of systemic chemotherapy of 5-FU/CDDP and external radiation therapy) from January 2004. After the therapy, although the imaging showed a downstaging of esophageal carcinoma, a severe esophageal stricture appeared with ingestion defective. So hyper-alimentation was performed. After the state of nutrition was improved, esophagectomy was performed on March 2004 without a complication. Histopathological study revealed that no viable cells remained. Nine months after esophagectomy, chest CT scan revealed that a solitary pulmonary tumor appeared in S6 of the right. The solitary tumor enlarged gradually. On August 2005, a surgical resection for the solitary pulmonary tumor was performed. Histopathologically, the lesion was compatible for metastasis from esophageal carcinoma. The patient is alive without recurrence more than 23 months after the last surgery.     

Diaphragmatic hernia complicated with intestinal obstruction with colon perforation after surgery for esophageal cancer: a case report

We reported a case of diaphragmatic hernia complicated with intestinal obstruction with colon perforation after surgery for esophageal cancer. In this case, the conservative treatment took too long, which delayed the diagnosis and treatment and resulted in colon perforation. After computed tomography confirmed the diagnosis, an emergency operation was performed. During the operation, we found colon perforation. Because pollution of thoracic cavity was serious, we performed proximal end colon neostomy. The patient recovered and discharged with active treatment 35 days after operation. We consider surgical repair of the diaphragmatic hernia is recommended to avoid the potentially disastrous complications, such as strangulation or perforation of the herniated contents, which can threaten the life of the patient if diagnosis is delayed.     

Two-port hand-assisted laparoscopic surgery for the 2-stage treatment of a complete bowel obstruction by left colon cancer: a case report

A 69-year-old woman presented to her local clinic with vomiting and abdominal distension. Since a bowel obstruction by left colon cancer was suspected due to a marked dilation of the transverse colon, she was referred to our hospital. On admission, an enema disclosed a complete obstruction at the splenic flexure of the colon. An emergency operation was performed, and a temporary loop colostomy was fashioned on the left side of the transverse colon within the range of resection for 2-stage radical surgery. On hospital day 16, a left hemicolectomy D2 was performed by 2-port hand-assisted laparoscopic surgery (2P-HALS) using the stoma as the hand access site, and the tumor was resected along with the removal of the stoma. After surgery, a slight wound infection occurred at the hand access site, but this healed with conservative management. On day 36, she was discharged from hospital. The histological diagnosis was Type 2 circumferential well-differentiated adenocarcinoma with local peritoneal dissemination. Our experience suggests that 2-stage surgery combined with 2P-HALS is applicable even to a large obstructing left colon cancer. This method is less invasive, safe and achieves excellent results, including a good cosmetic outcome.     

非小细胞肺癌患者术后单纯区域淋巴结复发的治疗及预后影响因素分析

背景与目的:术后局部淋巴结复发是非小细胞肺癌(non-small cell lung cancer,NSCLC)治疗失败的主要原因之一。本研究旨在探讨NSCLC患者术后单纯区域淋巴结复发的治疗选择和预后影响因素。方法:收集2000年—2009年143例NSCLC术后单纯区域淋巴结复发的患者,回顾性分析临床、病理因素以及不同治疗方式对复发后生存的影响。结果:126例患者发生同侧胸腔区域淋巴结复发,17例发生对侧胸腔区域淋巴结复发;复发后51例患者接受了放化疗联合治疗,27例单纯放疗,59例单纯化疗;单因素、多因素分析显示复发时患者PS评分、复发部位、复发病灶数目以及手术至复发的间隔时间均为独立预后因素;在64例术后1年以上复发患者中,放化疗联合治疗中位生存期为62个月,而单纯放疗或单纯化疗的中位生存期仅为24个月,放化疗联合治疗与单纯放疗和单纯化疗患者生存曲线差异有统计学意义(P<0.05)。结论:复发时患者PS评分高、同侧胸腔外淋巴结复发、多个复发病灶以及术后1年以内复发患者预后不佳,对于手术后1年以上复发患者采用放化疗联合治疗能获得更长的生存期。     

A case report of esophageal carcinoma developing esophago-brochial fistula successfully treated by esophageal bypass surgery

We have experienced a case of esophageal carcinoma developing esophago-bronchial fistula that was successfully treated by esophageal bypass surgery followed by chemo-radiation. A man aged 64 years old with developed esophago- bronchial fistula after initial chemo-radiation was undergone a gastric bypass surgery to separate esophagus and bronchus. Though closure of fistula was just 4 months after definitive chemo-radiation, an oral feeding was possible until the death of the patient. Stent placement for esophageal carcinoma was less invasive treatment though chemo-radiation after a stent placement was accompanied by high incidence of stent associated morbidity. Since esophageal bypass surgery can definitely separate airway from esophagus, chemo-radiation with oral feeding can be easily carried out. Esophageal bypass surgery was a treatment recommendation for the patient with esophageal carcinoma invading trachea or bronchus.     

A case of recurrent esophageal cancer with lung metastases successfully treated with docetaxel-combination chemotherapy

We report a case of a 67-year-old woman diagnosed with advanced esophageal cancer. She was treated with chemo-radiotherapy (5-FU/CDDP therapy and irradiation) initially, and primary lesion was well controlled.Two and a half years after first treatment, a chest CT showed multiple lung metastasis, which were confirmed by thoraco-laparoscopy. We chose docetaxel/CDDP combination chemotherapy, because of severe side effects due to the first treatment. After 3 courses, lung metastatic lesions were reduced. The following courses combining docetaxel-nedaplatin were done as ambulatory treatment. These regimens could be one choice for recurrent esophageal cancer, especially FP therapy-resistant or intolerant cases.     

A case of recurrent esophageal cancer maintaining complete long-term response after 5'-DFUR and ftorafur administrations]

The authors report a case with esophageal cancer who had undergone a non-curative resection and showed a recurrence. Treatment with only oral 5'-DFUR resulted in complete response. This was followed by oral ftorafur, and the case has remained complete response for 40 months. It is rare to obtain such an effect in esophageal cancers by oral and sole administration of a drug in the 5-FU class. Our experience with this case is described.     

Wedge tracheobronchoplasty technique for primary pulmonary carcinoma of the right upper bronchus

We describe a novel tracheobronchoplasty procedure for advanced squamous cell carcinoma of the right upper lung. A 78-year-old male was referred for further investigation of an abnormal shadow on a chest x-ray. A conventional right upper sleeve lobectomy was not applicable because of the invasion of lateral wall of the lower trachea. So, we performed a modified tracheobronchoplasty. This report shows that our cutting design for the trachea and bronchus was reasonable and appropriate for a caliber mismatch, with adaptation and suturing of each edge of the wedge-shaped defect of the trachea.     

A case of early laryngeal cancer observed after surgery for lung cancer

A 56-year-old man, a heavy cigarette smoker, had his left upper lobe resected for lung cancer. Seventeen months later, he was diagnosed as early laryngeal cancer by bronchofiberscopy. In this case, postoperative follow-up study with septum cytology was extremely effective. He underwent radiation therapy for the laryngeal cancer. Today, three and a half years later, no signs or symptoms of any cancer can be found. Cases of preceding lung cancer in multiple primary cancer patients having lung and laryngeal cancer are very rare in the literature. All of them have been heavy cigarette smokers and majority of them men.     

A case of complete response after neoadjuvant chemotherapy for advanced esophageal cancer with low-dose FP therapy

The patient was a 58-year-old man complaining of vomit and body-weight loss of 10 kg with advanced lower thoraco-abdominal esophageal cancer, which was 9 cm in length and with a maximum diameter of 5.5 cm on thoracic CT examination. Moderately differentiated squamous cell carcinoma diagnosed by pre-operative endoscopic biopsy. Low-dose FP therapy (continuous 5-FU div of 500 mg/day with intermittent CDDP div of 5 mg/day) was performed during 4 weeks as neoadjuvant chemotherapy. The side effect was little, and the tumor size was remarkably reduced. A histological complete response was diagnosed with no carcinoma cells evident in the resected specimen. The patient is alive and healthy with no relapse of the carcinoma 30 months after operation. We are first planning neoadjuvant chemotherapy, and then considering the additional radiotherapy after estimating the effect of chemotherapy. Low-dose FP therapy with low-dose cisplatin as a modulator does not show much side effect and is useful for esophageal cancer. We consider that the chemotherapy is more effective preoperatively than postoperatively because it preserves the feeding vessels for transporting the medicine to the focus of the disease.     

乳腺癌根治术后发生急性肺栓塞一例并文献复习

乳腺癌是全球女性发病率居第1位的疾病[1],其治疗措施是以手术为主的综合治疗。乳腺癌患者因为肥胖、慢性心脑血管疾病、肿瘤、化疗、手术、麻醉、术后肢体活动少等因素极易发生血栓。急性肺栓塞(acute pulmonary embolism,APE)指来自静脉系统或右心的血栓阻塞肺动脉及其分支所致疾病,以肺循环和呼吸功能障碍为主要病理生理特征,是乳腺癌患者术后最严重的并发症之一,也是乳腺癌本身常见的第2类致死原因[2]。     

A case of lung metastases after surgery for colon cancer demonstrating complete response for more than six years after treatment with UFT/LV

A 54-year-old female with cecal cancer underwent Rt. hemicolectomy in December 2000. The lesion was mod, ss, p1(+), n1, stage IV. The level of CEA increased around August 2002. Abdominal CT revealed a recurrent tumor in the RLQ in July 2003, peritoneal dissemination was suspected. In December 2003, we performed a partial resection of the ileum and transverse colon including initial anastomosis. Lung metastases were found by chest CT in right S4, S5, S9 and S3, S8 in February 2004. Because of experience of severe side effect of intravenous chemotherapy, UFT/LV was administered from February 2004. Chest CT revealed the disappearance of tumor in September 2004, and no signs of recurrence were observed for 65 months.     

A case of esophageal cancer showing complete remission of nephrotic syndrome after esophagectomy

Nephrotic syndrome associated with a malignant tumor may remit following resection of the tumor. This report documents a case of esophageal cancer with concurrent nephrotic syndrome in which a surgical resection of the tumor resulted in a complete remission of nephrotic syndrome. A 78-year-old male patient noticed edema of his lower legs in February 2009 and was diagnosed with nephrotic syndrome. An endoscopic examination revealed an indented lesion with a nearly semiannular low elevation on the posterior wall of the esophagus at 31 to 34 cm from the upper incisors, and a diagnosis of esophageal cancer was made. A two-stage operation was planned. In March 2009, a subtotal resection of the thoracic esophagus through a right thoracic approach and cervical external esophagostomy were performed, and in April 2009, antethoracic route esophagogastrostomy was performed. The urinary protein levels were negative by the 86th day of hospitalization, and the patient progressively improved and was discharged on the 91st hospital day. There has been no recurrence of esophageal cancer or relapse of nephrotic syndrome at 12 months following the operation. In esophageal cancer patients with nephrotic syndrome, surgical treatment should be undertaken because the remission of nephrotic syndrome may be expected following tumor resection. For this purpose, selecting the appropriate operative procedures and careful perioperative management, including nutritional management, are of profound importance.     

A case of recurrent esophageal cancer successfully treated by combined therapies

We report here a case of recurrent esophageal cancer successfully treated by cervical lymph node dissection and chemo-radiation therapy. A 66-year-old woman received esophagectomy for advanced esophageal cancer in February 2003. Cervical CT and ultrasonography revealed multiple lymph node metastases in February 2008. Surgical excision was performed to the lymph node recurrence. After the operation, she received radiation therapy combined with cisplatin and 5-FU. She is alive without recurrence for two years after the treatment. We conclude that surgery and chemo-radiation therapy may be effective for cervical lymph node recurrence of esophageal cancer.     

肺癌并发肺栓塞20例治疗体会

目的 总结临床肺癌患者并发肺栓塞的治疗经验体会.方法 收集20例肺癌并发肺栓塞患者的临床资料,包括患者的性别、年龄、侧别、肺癌病理性质及治疗预后等.结果 20例肺癌并发肺栓塞患者的年龄为(64.3±7.8)岁;男12例,女8例;病理活检显示,腺癌11例,鳞癌5例,小细胞肺癌4例;Ⅰ期2例,Ⅱ期3例,Ⅲ期7例,Ⅳ期8例.3例患者发生肺栓塞后24 h内死亡,8例患者发生肺栓塞后4周内死亡,其中最长生存时间为11.5个月.结论 肺癌并发肺栓塞的病死率较高,因此临床中应注意静脉血栓栓塞症风险评估,做好预防措施,确诊肺栓塞后应及时给予抗凝、溶栓、对症支持等治疗.     

同期放化疗对侵犯气管的局部晚期食管癌的疗效观察

目的　探讨同期放化疗对晚期食管癌侵及气管的临床疗效。方法　收集经病理检查确诊的１６８例食管癌侵及气管病例,其中７３例采取单纯放射治疗（单放组）,以６／１５ＭＶＸ线常规外照射,１.８Ｇｙ／次,５次／周,照射总剂量６１.２～６４.８Ｇｙ;９５例患者行化放疗治疗（化放组）,予顺铂（ＤＤＰ）联合氟尿嘧啶（５-ＦＵ）方案化疗（ＤＤＰ２０ｍｇｄ１～ｄ５,５-ＦＵ５００ｍｇ／ｍ２ｄ１～ｄ５）４个周期,２８天为１周期,于第２周期化疗开始时行同期放疗,放疗方案同单放组。观察两组的近期疗效、毒副反应和远期疗效。结果　化放组的有效率（ＲＲ）为６５.３％,高于单放组的４５.２％（Ｐ＝０.００９）;化放组较单放组ＫＰＳ评分提高更显著（Ｐ＝０.００４）。化放组的３年生存率为１７.９％,高于单放组的６.９％（Ｐ＝０.０３５）。两组主要毒副反应包括急性放射性食管炎、放射性气管炎和白细胞减少,化放组的白细胞减少发生率高于单放组（Ｐ＝０.０２２）。结论　同期放化疗对晚期食管癌侵及气管患者较单纯放射治疗的近期疗效好,明显改善患者的生活质量,生存时间延长,且相对安全。     

A case of complete response in a primary lesion treated by gefitinib for two years after surgery of brain metastasis from lung cancer

A 54-year-old woman was admitted to our hospital for vertigo, headache and vomiting at the end of July, 2001. Under a diagnosis of cerebellar tumor and right lung tumor, she underwent a resection of cerebellar tumor on August 7, 2001. The histopathological diagnosis was "metastatic adenocarcinoma". Lung cancer was doubted as for the origin, however, she did not want further examination. The patient was given 2 courses of postoperative chemotherapy (CBDCA+VNR) and radiotherapy (50 Gy), and discharged. Gefitinib treatment was begun in September, 2002 at her request. The tumor marker was not elevated, and the tumor size on CT showed the tendency toward some reduction. Close examination including PET revealed no metastasis. The patient then underwent right upper lobectomy (ND 2 a) on October 8, 2004 at her request. Histopathologically, psammoma body existed but no cancer cells nor lymph node metastasis. It seemed that there was a complete response by gefitinib after 3 years.