Salvage thoracoscopic esophagectomy after carbon-ion radiotherapy in a patient with esophageal squamous cell carcinoma: a case report
Abstract Background Carbon-ion radiotherapy (CIRT) for esophageal cancer has been receiving significant attention given its high local control rates and minimal damage to normal tissues. However, the efficacy and safety of salvage surgery after CIRT for esophageal cancer remain unclear. We report th...
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Japan Surgical Society
2022-02-01
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| Series: | Surgical Case Reports |
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| Online Access: | https://doi.org/10.1186/s40792-022-01372-2 |
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| author | Kengo Kuriyama Makoto Sohda Hideyuki Saito Yasunari Ubukata Nobuhiro Nakazawa Keigo Hara Makoto Sakai Akihiko Sano Hiroomi Ogawa Takaaki Sano Shigeo Yasuda Hitoshi Ishikawa Ken Shirabe Hiroshi Saeki |
| author_facet | Kengo Kuriyama Makoto Sohda Hideyuki Saito Yasunari Ubukata Nobuhiro Nakazawa Keigo Hara Makoto Sakai Akihiko Sano Hiroomi Ogawa Takaaki Sano Shigeo Yasuda Hitoshi Ishikawa Ken Shirabe Hiroshi Saeki |
| author_sort | Kengo Kuriyama |
| collection | DOAJ |
| description | Abstract Background Carbon-ion radiotherapy (CIRT) for esophageal cancer has been receiving significant attention given its high local control rates and minimal damage to normal tissues. However, the efficacy and safety of salvage surgery after CIRT for esophageal cancer remain unclear. We report the case of a patient who underwent salvage thoracoscopic surgery after CIRT. Case presentation A 51-year-old woman underwent upper gastrointestinal endoscopy and a type 0-IIa + 0-IIc esophageal squamous cell carcinoma located 27–29 cm from the patient’s incisors, classified as clinical stage I (T1bN0M0), was detected. She received CIRT (50.4 Gy [relative biological effectiveness, RBE]/12 fr) for localized esophageal cancer and achieved complete remission after 4 months. Six years after CIRT, follow-up endoscopic examination demonstrated a type 0-IIa + 0-IIc tumor in the previously treated area. In addition, a type 0-IIa lesion located 20–22 cm from the incisors was found. We diagnosed localized ESCC, classified as clinical stage I (T1bN0M0). Salvage thoracoscopic surgery was performed in the prone position with five access ports. Although the esophagus tightly adhered to the thoracic descending aorta and left main bronchus with severe fibrosis, the esophagus could be separated from the surrounding organs with careful forceps manipulation. The operation time and blood loss were 8 h 45 min and 253 mL, respectively. The patient was discharged from our hospital 17 days after the salvage surgery without any complications. Pathological findings revealed two squamous cell carcinomas. Both tumors were localized in the lamina propria mucosa, and lymph node metastasis was not detected. The tumors were diagnosed as pathological stage IA (pT1aN0M0) according to the TNM criteria. Moreover, pathological examinations showed severe fibrosis of the previously irradiated tissues compared to the normal esophagus located outside of the irradiation field. Following the surgery, the patient had no recurrence for 1 year and 6 months. Conclusions Thoracoscopic radical esophagectomy can be performed as salvage surgery. Careful and discreet surgery is integral to perform salvage surgery after CIRT since CIRT may cause severe adhesions and fibrosis in the irradiated field. |
| format | Article |
| id | doaj-art-3d0630ba6a684f7c8af0342eb0d996e3 |
| institution | Kabale University |
| issn | 2198-7793 |
| language | English |
| publishDate | 2022-02-01 |
| publisher | Japan Surgical Society |
| record_format | Article |
| series | Surgical Case Reports |
| spelling | doaj-art-3d0630ba6a684f7c8af0342eb0d996e32025-08-20T03:58:22ZengJapan Surgical SocietySurgical Case Reports2198-77932022-02-01811810.1186/s40792-022-01372-2Salvage thoracoscopic esophagectomy after carbon-ion radiotherapy in a patient with esophageal squamous cell carcinoma: a case reportKengo Kuriyama0Makoto Sohda1Hideyuki Saito2Yasunari Ubukata3Nobuhiro Nakazawa4Keigo Hara5Makoto Sakai6Akihiko Sano7Hiroomi Ogawa8Takaaki Sano9Shigeo Yasuda10Hitoshi Ishikawa11Ken Shirabe12Hiroshi Saeki13Division of Gastroenterological Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma UniversityDivision of Gastroenterological Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma UniversityDivision of Gastroenterological Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma UniversityDivision of Gastroenterological Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma UniversityDivision of Gastroenterological Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma UniversityDivision of Gastroenterological Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma UniversityDivision of Gastroenterological Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma UniversityDivision of Gastroenterological Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma UniversityDivision of Gastroenterological Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma UniversityDepartment of Diagnostic Pathology, Gunma University Graduate School of MedicineNational Institutes for Quantum Science and Technology, QST HospitalNational Institutes for Quantum Science and Technology, QST HospitalDepartment of General Surgical Science, Gunma University Graduate School of MedicineDivision of Gastroenterological Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma UniversityAbstract Background Carbon-ion radiotherapy (CIRT) for esophageal cancer has been receiving significant attention given its high local control rates and minimal damage to normal tissues. However, the efficacy and safety of salvage surgery after CIRT for esophageal cancer remain unclear. We report the case of a patient who underwent salvage thoracoscopic surgery after CIRT. Case presentation A 51-year-old woman underwent upper gastrointestinal endoscopy and a type 0-IIa + 0-IIc esophageal squamous cell carcinoma located 27–29 cm from the patient’s incisors, classified as clinical stage I (T1bN0M0), was detected. She received CIRT (50.4 Gy [relative biological effectiveness, RBE]/12 fr) for localized esophageal cancer and achieved complete remission after 4 months. Six years after CIRT, follow-up endoscopic examination demonstrated a type 0-IIa + 0-IIc tumor in the previously treated area. In addition, a type 0-IIa lesion located 20–22 cm from the incisors was found. We diagnosed localized ESCC, classified as clinical stage I (T1bN0M0). Salvage thoracoscopic surgery was performed in the prone position with five access ports. Although the esophagus tightly adhered to the thoracic descending aorta and left main bronchus with severe fibrosis, the esophagus could be separated from the surrounding organs with careful forceps manipulation. The operation time and blood loss were 8 h 45 min and 253 mL, respectively. The patient was discharged from our hospital 17 days after the salvage surgery without any complications. Pathological findings revealed two squamous cell carcinomas. Both tumors were localized in the lamina propria mucosa, and lymph node metastasis was not detected. The tumors were diagnosed as pathological stage IA (pT1aN0M0) according to the TNM criteria. Moreover, pathological examinations showed severe fibrosis of the previously irradiated tissues compared to the normal esophagus located outside of the irradiation field. Following the surgery, the patient had no recurrence for 1 year and 6 months. Conclusions Thoracoscopic radical esophagectomy can be performed as salvage surgery. Careful and discreet surgery is integral to perform salvage surgery after CIRT since CIRT may cause severe adhesions and fibrosis in the irradiated field.https://doi.org/10.1186/s40792-022-01372-2Esophageal cancerSalvage surgeryThoracoscopic surgeryCarbon-ion radiotherapy |
| spellingShingle | Kengo Kuriyama Makoto Sohda Hideyuki Saito Yasunari Ubukata Nobuhiro Nakazawa Keigo Hara Makoto Sakai Akihiko Sano Hiroomi Ogawa Takaaki Sano Shigeo Yasuda Hitoshi Ishikawa Ken Shirabe Hiroshi Saeki Salvage thoracoscopic esophagectomy after carbon-ion radiotherapy in a patient with esophageal squamous cell carcinoma: a case report Surgical Case Reports Esophageal cancer Salvage surgery Thoracoscopic surgery Carbon-ion radiotherapy |
| title | Salvage thoracoscopic esophagectomy after carbon-ion radiotherapy in a patient with esophageal squamous cell carcinoma: a case report |
| title_full | Salvage thoracoscopic esophagectomy after carbon-ion radiotherapy in a patient with esophageal squamous cell carcinoma: a case report |
| title_fullStr | Salvage thoracoscopic esophagectomy after carbon-ion radiotherapy in a patient with esophageal squamous cell carcinoma: a case report |
| title_full_unstemmed | Salvage thoracoscopic esophagectomy after carbon-ion radiotherapy in a patient with esophageal squamous cell carcinoma: a case report |
| title_short | Salvage thoracoscopic esophagectomy after carbon-ion radiotherapy in a patient with esophageal squamous cell carcinoma: a case report |
| title_sort | salvage thoracoscopic esophagectomy after carbon ion radiotherapy in a patient with esophageal squamous cell carcinoma a case report |
| topic | Esophageal cancer Salvage surgery Thoracoscopic surgery Carbon-ion radiotherapy |
| url | https://doi.org/10.1186/s40792-022-01372-2 |
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