Cardiac tamponade in a long-term survival esophageal cancer patient after esophageal bypass and chemoradiotherapy: a cas
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CASE REPORT
Cardiac tamponade in a long‑term survival esophageal cancer patient after esophageal bypass and chemoradiotherapy: a case report Tomonori Nakanoko1 · Masaru Morita1 · Kenichi Taguchi2 · Naonobu Kunitake3 · Hideo Uehara1 · Masahiko Sugiyama1 · Yuichiro Nakashima1 · Mitsuhiko Ota1 · Keishi Sugimachi4 · Yasushi Toh1 Received: 10 July 2020 / Accepted: 22 August 2020 © Japanese Society of Gastroenterology 2020
Abstract Esophageal bypass surgery is an effective treatment strategy for esophageal cancer with esophago-tracheobronchial fistula. We herein report an esophageal cancer patient with esophago-pulmonary fistula who achieved a long-term survival but died suddenly because of cardiac tamponade. A 70-year-old male patient with esophago-pulmonary fistula due to esophageal tumor invasion underwent definitive chemoradiotherapy as the initial treatment. Esophageal bypass surgery followed by additional chemotherapy was performed, and the patient survived for a long time. Four years and six months later, a small abscess in an esophago-pulmonary fistula was visualized on computed tomography. One month later, he suffered suddenly severe dyspnea and died. An autopsy suggested that the direct cause of death had been cardiac tamponade due to atriopericardial fistula. Definitive therapy for esophageal cancer with fistula after esophageal bypass is an effective treatment, but close special attention must be paid to the possibility of irradiation-related late toxicity. Keywords Cardiac tamponade · Esophageal cancer · Esophago-pulmonary fistula · Definitive chemoradiotherapy · Pathological autopsy
Introduction Esophago-tracheobronchial fistula is frequently associated with far-advanced esophageal cancer. This type of fistula results in aspiration pneumonia, markedly reducing the quality of life. Esophageal bypass is an effective surgical procedure because it can prevent patients from developing pneumonia and help them restart oral intake. However, while systemic chemotherapy is regarded as a promising definitive treatment * Tomonori Nakanoko [email protected]‑u.ac.jp 1
for unresectable esophageal cancer [1, 2], such treatments cannot be performed under conditions of chronic inflammation, such as refractory pneumonia due to esophageal fistula. Esophageal bypass may be a treatment for pneumonia and improve the nutrition status, facilitating oral intake, and it may also aid in the start of definitive chemotherapy or chemoradiotherapy for patients with esophageal fistula. Definitive chemotherapy or chemoradiotherapy can be expected to result in a long-term survival, but complications can still occur, not only at an early stage but also at a late stage [3]. We, herein, report a case who achieved long-term survival after esophageal bypass surgery followed by additional chemotherapy, however, who died suddenly because of atrio-pericardial fistula and cardiac tamponade without tumor invasion.
Dept. of Gastroenterological Surgery, National Hospital Organization Kyushu Cancer Center, 3‑1‑1, Notame, Minami‑ku, Fuk
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