Acta chirurgica Belgica · 2019
Combined one-stage esophagectomy and duodeno-pancreatectomy for synchronous cancers of the esophagus and pancreatic ampulla in an elderly patient.
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de Garcia de la Vega Matilde, Faber Bernard, Schalbar Claude, Foxius Alain, Groot-Koerkamp Hélène, Decker Georges
Аннотация
BACKGROUND: We report the case of a 77-year-old patient, who underwent multi-modality treatment including single-stage radical oesophagectomy and duodeno-pancreatectomy for a synchronous adenocarcinoma of the distal oesophagus and adenocarcinoma of the ampulla of Vater.
METHODS: The ampulloma was diagnosed incidentally during the work-up of the symptomatic esophageal cancer. After induction chemo-radiation of the oesophageal cancer (CROSS regimen), a single-stage radical resection of the esophagus, total gastrectomy and a cephalic duodeno-pancreatectomy was performed. Intestinal reconstruction was done by a right coloplasty with esophago-colic anastomosis in the upper chest and distally to the Roux-en-Y (Child) used for reconstruction of the hepato-biliary tract. Adjuvant chemotherapy was proposed due to the unexpectedly advanced stage of the ampullary cancer (pT4N1M0) and was completed uneventfully despite the magnitude of the preceding surgery.
RESULTS: According to our literature review, this is the first report of a successfully completed tri-modality treatment with combined single-stage oesophagectomy and Whipple procedure in an elderly (>75 years). Functional and metabolic outcome was satisfactory until cancer recurrence due to liver metastasis of bilio-pancreatic origin. The patient is alive 2 years post-operatively.
CONCLUSION: Single-stage radical resection of the oesophagus and a cephalic duodeno-pancreatectomy can be more considered for synchronous cancers even in elderly patient.
METHODS: The ampulloma was diagnosed incidentally during the work-up of the symptomatic esophageal cancer. After induction chemo-radiation of the oesophageal cancer (CROSS regimen), a single-stage radical resection of the esophagus, total gastrectomy and a cephalic duodeno-pancreatectomy was performed. Intestinal reconstruction was done by a right coloplasty with esophago-colic anastomosis in the upper chest and distally to the Roux-en-Y (Child) used for reconstruction of the hepato-biliary tract. Adjuvant chemotherapy was proposed due to the unexpectedly advanced stage of the ampullary cancer (pT4N1M0) and was completed uneventfully despite the magnitude of the preceding surgery.
RESULTS: According to our literature review, this is the first report of a successfully completed tri-modality treatment with combined single-stage oesophagectomy and Whipple procedure in an elderly (>75 years). Functional and metabolic outcome was satisfactory until cancer recurrence due to liver metastasis of bilio-pancreatic origin. The patient is alive 2 years post-operatively.
CONCLUSION: Single-stage radical resection of the oesophagus and a cephalic duodeno-pancreatectomy can be more considered for synchronous cancers even in elderly patient.