Abstract Background Although esophageal perforation caused by malignancy is a rare and life-threatening condition, no standardized treatment protocol exists. We experienced a two-stage surgical approach, involving an initial emergency thoracotomy for drainage and palliative local tumor resection, followed by a radical mediastinoscopic esophagectomy with lymphadenectomy. Methods A 59-year-old female presented anorexia and one-month epigastric pain. She was raced to our hospital in critical condition with respiratory failure and shock vital sign, and was diagnosed with esophageal perforation and right-sided massive pleural effusion. We performed emergent right thoracotomy for chest drainage, and revealed the perforation and wall thickness of the middle esophagus, suggesting esophageal cancer perforation. Palliative local resection of esophagus was performed for life-saving and an enteral feeding tube placement were performed. Results We planned a two-stage radical surgery after diagnosing as an esophageal cancer by pathology. Pathological diagnosis confirmed esophageal squamous cell carcinoma (ESCC). Eighteen days later after intensive care treatments, radical mediastinoscopic esophagectomy with lymphadenectomy were performed.The patient was discharged on postoperative day 29 without any complication, and was diagnosed as ESCC, pT3N2 (5/49) M0 stage IIIB and well followed as an outpatient. Conclusion Although emergency thoracotomy for the perforation due to esophageal cancer is imperative, the thoracotomy adversely affects the following two-stage thoracic surgery because of adhesion. Radical mediastinoscopic esophagectomy is an effective technique following emergency thoracotomy for the perforation of esophageal cancer.
Ito et al. (Fri,) studied this question.
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