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Abstract
We report on a case of synchronous carcinomas of the esophagus and stomach. A 68-year-old man was referred to our hospital for an abnormality found during his medical examination. Further evaluation revealed squamous cell carcinoma in the thoracic lower esophagus and gastric adenocarcinoma located in the middle third of the stomach. Thoracoscopic esophagectomy in the prone position (TSEP), laparoscopic total gastrectomy (LTG) with three-field lymph node dissection, and laparoscopically assisted colon reconstruction (LACR) were performed. The patient did not have any major postoperative complications. His pathological examination revealed no metastases in 56 harvested lymph nodes and no residual tumor. He was followed up for 30 months without recurrence. To our knowledge, this is the first report of esophageal and gastric synchronous carcinomas that were successfully treated with a combination of TSEP, LTG, and LACR. These operations may be a feasible and appropriate treatment for this disease.
Highlights
Minimally invasive surgical techniques for malignancy of the alimentary tract have been established as a treatment for esophageal, gastric, and colonic cancers [1,2,3,4,5,6,7,8]
After the upper third of the esophagus was mobilized circumferentially, the esophagus was divided at the level of the arch of the azygos vein by linear stapling, and the esophagus was dissected by exposing the left side of the mediastinal pleura by retracting the anal stump
For esophageal invasive carcinoma, open transthoracic esophagectomy is accepted as the best oncologic operation [15], partly because it allows the most extensive lymphadenectomy [16]
Summary
Invasive surgical techniques for malignancy of the alimentary tract have been established as a treatment for esophageal, gastric, and colonic cancers [1,2,3,4,5,6,7,8]. In the treatment of gastric carcinoma, laparoscopic total gastrectomy (LTG) with lymph node dissection is a minimally invasive surgery mainly for early stage gastric cancer in Japan. The esophagus was retracted by pulling the taped thread around the upper third of the esophagus, and en bloc dissection of the lymph nodes was performed by using scissors to prevent injury to the left recurrent laryngeal nerve below the aortic arch to the inferior border of the thyroid gland - no electrical or heat-producing devices were used. After the upper third of the esophagus was mobilized circumferentially, the esophagus was divided at the level of the arch of the azygos vein by linear stapling, and the esophagus was dissected by exposing the left side of the mediastinal pleura by retracting the anal stump. He was discharged days postoperatively and was followed up for months without any indications of recurrence or distant metastases
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