Takeshi Nagano

Photodynamic therapy for large superficial squamous cell carcinoma of the esophagus

BACKGROUND Photodynamic therapy (PDT) has been found to be safe and effective in patients with small early esophageal squamous cell carcinoma (SCC). However, its efficacy for widespread superficial SCC has not yet been confirmed. OBJECTIVE To assess the long-term survival, complications, and recurrence of PDT for large superficial esophageal SCC. DESIGN Retrospective study. SETTING Tertiary referral center. PATIENTS A total of 38 patients with superficial SCC of the esophagus. All patients had a large unifocal lesion or multifocal lesions that were too large to be resected endoscopically. In addition, all patients were physiologically unfit for esophagectomy or had refused surgery. INTERVENTIONS PDT with porfimer sodium. MAIN OUTCOME MEASUREMENTS Clinical follow-up, long-term survival, complications, and recurrence were evaluated. RESULTS Thirty-one patients (82%) had mucosal cancer (T1m), and 7 (18%) had submucosal cancer (T1sm). No patient had lymph node involvement. Nineteen patients had other primary malignancies. Complete remission was achieved in 33 (87%). At the time of writing, 28 patients (74%) were alive without recurrence. After a median follow-up period of 64 months (range, 7-125 months) after PDT, the overall 5-year survival rate was 76%. There was no treatment-related mortality. LIMITATIONS Retrospective study with a small number of patients. CONCLUSIONS This long-term follow-up study revealed that PDT was a potentially curative treatment for large superficial esophageal SCC. PDT might be a reasonable alternative to esophagectomy or to endoscopic resection for patients with superficial SCC of the esophagus without lymph node metastasis.

Esophagectomy for thoracic esophageal cancer with a double aortic arch: Report of a case

We report the case of a 50-year-old man with a double aortic arch who underwent esophagectomy for cancer in the middle thoracic esophagus at clinical Stage IIA (T3N0M0), based on the TNM classification (UICC 2002). The patient underwent esophagectomy with three-field lymphadenectomy following neoadjuvant chemotherapy. In such a case, it is important to recognize the anatomy in the upper mediastinum, especially the relationship between the right and left aortic arch, and the recurrent laryngeal nerves using computed tomography (CT) and three-dimensional CT. At first, we performed a cervical lymphadenectomy in order to isolate the bilateral recurrent laryngeal nerves, then mediastinal lymphadenectomy through a right thoracotomy. However, we could not confirm the bilateral recurrent laryngeal nerves during mediastinal lymphadenectomy, and were thus unable to resect them. The postoperative course was uneventful. The patient died of multiple liver metastasis 4 years after the surgery, with no evidence of recurrence in any lymph node.

Esophageal stricture with Barrett’s esophagus due to alkaline reflux after total gastrectomy successfully managed by duodenal diversion

A case of esophageal stricture with Barrett’s esophagus after total gastrectomy is reported herein. A 72-year-old woman was referred to our hospital because of dysphagia due to a stricture in the esophagus for 5 years. She had earlier undergone total gastrectomy followed by Billroth II reconstruction consequent to a gastric ulcer at the age of 49 years. She was diagnosed as having an esophageal stricture with Barrett’s esophagus. The 24-h pH monitoring indicated significant reflux of alkaline duodenal contents into the esophagus. The patient underwent duodenal diversion with Roux-en-Y reconstruction. The postoperative course has been uneventful, with no dysphagia and no dilatation. No change in the extent of Barrett’s esophagus has been observed to date at 7 years postoperatively. This case presented with development of Barrett’s esophagus and subsequently of esophageal stricture solely by duodenal reflux. Duodenal diversion was concluded to have been effective for esophageal stricture with Barrett’s esophagus after total gastrectomy.