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Case Presentation Department of Thoracic Surgery

Case Presentation Department of Thoracic Surgery. R3 黃維立 / VS 賴吾為. Name: 蔡○○ 59-year-old, gentleman Chief complaint: Dysphagia for one month . Intermittent vomiting after intake since 4 months ago Progress to dysphagia ( just swallowing liquid ) for one month

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Case Presentation Department of Thoracic Surgery

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  1. Case PresentationDepartment of Thoracic Surgery R3 黃維立 / VS 賴吾為

  2. Name: 蔡○○ • 59-year-old, gentleman • Chief complaint: • Dysphagia for one month

  3. Intermittent vomiting after intake since 4 months ago • Progress to dysphagia ( just swallowing liquid ) for one month • In Sin-Lau Hospital, 2010/o1 • PES: ulcerative mass 27 cm below incisor, causing esophageal obstruction • Biopsy: malignancy change • Referred to CS department of NCKUH

  4. Past history • Smoking: 1 PPD for 50 years • Alcohol: social • Betel nut: social

  5. Endoscopic ultrasound: • Size: 5.3 * 2.2 * 2.8 cm, 27 cm below incisor • Regional lymphadenopathy: positive • Biopsy: • Squamous cell carcinoma • Clinical staging by EUS: • T3N1Mx, stage III

  6. Chest CT

  7. PET-CT • Tumor: SUV 10.9, about 6.8 * 3.4 * 2.6 cm • Lymph node: SUV 2.1, 1 cm, in AP window • No distant metastasis

  8. Other survey: • Bone scan: no evidence of bone metastasis • Tumor markers: within normal range

  9. Esophageal SqCC, T3N1M0, stage III • Enter clinical trial • Anti-cancer treatment • Paclitaxel ( Taxol ): 35mg/m2 • Cisplatin: 15 mg /m2 • Cetuximab ( Erbitux ) : 250mg/m2 • Radiotherapy • Totally 3600 cGy W1 Paclitaxel 35mg/m2 Cisplatin 15mg/m2 Erbitus 250mg/m2 W2 Paclitaxel 35mg/m2 Cisplatin 15mg/m2 Erbitus 250mg/m2 W3 Paclitaxel 35mg/m2 Cisplatin 15mg/m2 Erbitus 250mg/m2 W4 Paclitaxel 35mg/m2 Cisplatin 15mg/m2 Erbitus 250mg/m2 W0 Erbitus 400mg/m2

  10. PET-CT (3rd week after CCRT)

  11. Operation (4th weekafter CCRT)

  12. Post operation course • ICU stay: 4 days • POD 4: jejunostomy feeding • POD 10: esophagography • No leakage • POD 10: try sip water • POD 12: clear liquid diet • POD 13: soft diet • POD 16: discharge • Final pathology report: • The tumor has invaded through the muscle layer into the adventitia • LN: negative for metastasis • pStage: T3N0M0, IIB

  13. Advance in esophageal cancer surgery in NCKUH • 2008/7 1st VATS esophagectomy+ laparotomy • 2010/2 VATSesophagectomy + laparoscopic gastric tube reconstruction

  14. G E G E • G: gastric tube • E: esophagus stump E G E G G E

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