Gan To Kagaku Ryoho. 2025 Dec;52(13):1097-1099.
ABSTRACT
The patient was a 79-year-old man diagnosed with thoracic esophageal cancer(cT4[aorta]N1M0, Stage ⅣA)and received preoperative chemoradiotherapy(2 courses of fluorouracil and cisplatin and 40 Gy of radiation). Despite treatment, the aortic invasion did not improve, and an additional 20 Gy of radical radiation was administered. Ten days after treatment completion, the patient presented with hematemesis. An upper gastrointestinal endoscopy demonstrated a suspected aorto- esophageal fistula(AEF). The patient underwent thoracic endovascular aortic repair(TEVAR)urgently. Thirty-five days later, the general condition improved, and he underwent thoracoscope-assisted subtotal esophagectomy, omental patch to the mediastinum, esophagostomy, and gastrostomy. The pathological diagnoses were CRT-pT4b(aorta and trachea), RM1, pN1, M0, and pStage ⅣA. Postoperatively, the patient developed a persistent mediastinal abscess that was relieved with drainage and antibacterial treatment. Chemotherapy was initiated as the residual disease increased, and multiple pulmonary metastases appeared. Ten months after the TEVAR, the patient remained alive. We suggest that TEVAR followed by esophagectomy is effective in treating AEF associated with locally advanced esophageal cancer.
PMID:41546260