A Case of Thoracic Esophageal Cancer with Severe Right Pectus Excavatum Treated by Bilateral Thoracoscopic Esophagectomy

Abstract

A 57-year-old woman presenting with dysphagia was referred to our hospital. Following detailed assessment, the patient was diagnosed with esophageal cancer [MtLt] cT3r(AD)N1M0 cStage IIIA (Japanese Classification of Esophageal Cancer, 12th edition). Preoperative chemotherapy was considered difficult due to difficulty in oral intake, severe wasting, and decreased renal function. Therefore, surgery was indicated. Since esophagectomy using a right thoracic approach only was considered difficult due to the presence of a severe pectus excavatum, bilateral thoracoscopic esophagectomy was performed. The surgery was completed without any intraprocedural complications. Suture failure occurred after surgery but was cured conservatively. Thirty-five days after surgery, metastasis to the second lumbar vertebra was detected, prompting a posterior lumbar fusion on postoperative day 40. However, multiple liver metastases and increased bone metastases were observed, and her general condition deteriorated. On postoperative day 67, the patient passed. The patient developed distant metastases in the early postoperative period and died from the primary disease, but a safe esophagectomy with a good visual field was possible using a bilateral approach. Bilateral thoracoscopic esophagectomy may be a useful option for patients with esophageal cancer and severe pectus excavatum.