PS02.163: A CASE OF SEPARATION SURGERY WITH DRAINAGE TUBE-LESS (DRESS) ESOPHAGOSTOMY FOR ADVANCED CANCER WITH A RESPIRATORY FISTULA

Abstract

Abstract Background Esophagorespiratory fistulas including esophagopulmonary fistulas occur in 5–10% patients with esophageal cancer with invasion to adjacent organs. With an esophagorespiratory fistula, saliva and food flow into the respiratory tract through the fistula and severe pneumonia or lung abscess can develop. Alternatively, whether chemoradiotherapy can be performed for patients with esophagorespiratory fistulas affects the further outcomes of treatment in these patients. An esophageal cancer patient with an esophagopulmonary fistula who underwent separation surgery with drainage tube-less (DRESS) esophagostomy and whose inflammation from the esophagorespiratory fistula could be effectively controlled, which facilitated the prompt administration of definitive chemoradiotherapy, is reported. Methods Case report: A 79-year-old man visited a clinic with a month-long history of dysphagia. Esophageal cancer at the middle thoracic esophagus was detected, and invasion of the left main bronchus and lower lobe of the right lung was seen on contrast-enhanced computed tomography (CT). Three weeks later, urgent CT showed a lung abscess in the lower lobe of the right lung that continued into the adjacent esophageal cancer, infiltrative shadows in the peripheral lung field, and a pleural effusion. Due to the esophagopulmonary fistula, the patient underwent emergency surgery that consisted of esophageal separation surgery and double bilateral esophagostomy on the right and left supraclavicular region and enterostomy (drainage tube-less esophageal separation surgery). Results Antibiotic drug therapy for pneumonia and lung abscess achieved a favorable outcome. Definitive chemoradiotherapy for the esophageal cancer was started from postoperative day 25. Radiotherapy could not be completed because of sepsis due to aspiration pneumonia, though the aspiration pneumonia improved with intensive treatment. At six-month follow-up, the patient had achieved relapse-free survival and is currently symptom-free. Conclusion Separation surgery with a drainage tube-less (DRESS) esophagostomy is the less invasive operative procedure, which allows prompt initiation of chemoradiotherapy. In many cases of esophageal surgeries, an external esophagostomy is made with a drainage tube, and drainage tubes sometimes cause trouble and affect the quality of life of patients after surgery. However, our drainage tube-less (DRESS) esophagostomy might improve patient's quality of life. In addition, evaluation of esophageal cancer by endoscopic examination through the esophagocutaneostomy can be easily performed. Disclosure All authors have declared no conflicts of interest.