Successful management of aortoesophageal fistula caused by esophageal cancer using thoracic endovascular aortic repair
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CASE REPORT
Successful management of aortoesophageal fistula caused by esophageal cancer using thoracic endovascular aortic repair Jun Iwabu1 · Tsutomu Namikawa1 · Keiichiro Yokota1 · Hiroyuki Kitagawa1 · Kazuki Kihara2 · Nobuyuki Hirose2 · Kazuhiro Hanazaki1 Received: 9 September 2019 / Accepted: 13 May 2020 © Japanese Society of Gastroenterology 2020
Abstract Aortoesophageal fistula (AEF) is a highly life-threatening condition, even when treated promptly. However, little is known about the treatment for AEF in patients with advanced esophageal cancer. We report the case of a 69-year-old man diagnosed with esophageal squamous cell carcinoma (ESCC) that was admitted to our hospital for ESCC treatment. On diagnosis of unresectable ESCC invading the thoracic aorta, chemotherapy was administered. The response to treatment after two courses was evaluated as stable disease. We performed radiation therapy followed by bypass operation for esophageal stenosis. After radiation therapy, AEF was detected. His condition improved after hemostasis using thoracic endovascular aortic repair (TEVAR). He was discharged from our care after treatment with antibiotics; he died due to cancer progression 7 months after TEVAR. AEF with ESCC is a lethal condition that may occur during cancer treatment; however, TEVAR might help improve the patient’s condition. Keywords Aortoesophageal fistula · Esophageal squamous cell carcinoma · Thoracic endovascular aortic repair Abbreviations AEF Aortoesophageal fistula TEVAR Thoracic endovascular aortic repair ESCC Esophageal squamous cell carcinoma CT Computed tomography
Introduction Esophageal cancer with thoracic aorta invasion, categorized as stage T4b according to the American Joint Commission on Cancer/International Union Against Cancer (AJCC/ UICC) classification, is considered to be unresectable [1]. These patients have a high risk of aortoesophageal fistula (AEF), which is a lethal complication. AEF is a rare complication which usually arises in patients with thoracic aortic disease, such as thoracic aortic aneurysm, or following thoracic aortic surgery. However, little is known about the * Tsutomu Namikawa tsutomun@kochi‑u.ac.jp 1
Department of Surgery, Kochi Medical School, Nankoku, Kochi 783‑8505, Japan
Department of Cardiovascular Surgery, Kochi Medical School, Nankoku, Kochi, Japan
2
management of AEF due to unresectable esophageal cancer. Thoracic endovascular aortic repair (TEVAR) has been used in patients with thoracic aortic dissection and has gained popularity as an emerging treatment for AEF. Herein, we present a case of AEF caused by esophageal cancer that was managed using TEVAR.
Case report A 69-year-old Japanese man was referred to Kochi Medical School Hospital to receive treatment for thoracic esophageal squamous cell carcinoma (ESCC) after complaints of back pain and dysphagia. Esophagogastroduodenoscopy revealed a type 3 tumor in the middle thoracic esophagus, located 27 and 35 cm from the incisors (Fig. 1). Enhanced computed tomography (CT) demonstrated
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