Abstract
A constitutional indocyanine green (ICG) excretory defect is a rare liver disease, in which histopathological findings indicate no obvious abnormality in the liver; however, excretion of ICG is severely impaired. A 57-year-old man was referred to our department for surgical treatment of advanced esophageal cancer with mediastinal lymph node metastasis. A pretreatment ICG test revealed an abnormally high ICG retention rate of 72.1% at 15 min. 99m-Tc-galactosyl-human serum albumin liver scintigraphy also indicated decreased liver reserve. Conversely, a blood test indicated Grade A in the Child-Pugh classification. The patient was treated with three courses of docetaxel, cisplatin, and 5-fluorouracil as preoperative chemotherapy with appropriate dose adjustment. Liver biopsy performed after the chemotherapy led to histopathological diagnosis of a constitutional ICG excretory defect with no obvious hepatitis or liver fibrosis. We selected radical surgery, and performed robot-assisted thoracoscopic esophagectomy with mediastinal lymph node dissection and thoracic duct preservation, and posterior mediastinal route gastric conduit reconstruction. Intraoperative morphological findings revealed an almost normal liver. No serious chemotherapy-induced adverse events or postoperative complications were observed. We report this rare case as an example of successful treatment of advanced esophageal cancer with a constitutional ICG excretory defect using multidisciplinary radical therapy.
