Abstract
Recently we have experienced two cases of esophageal (gastric tube) fistula developed after six years or more following radiation therapy for esophageal cancer. Case 1 involved a man in his sixties who underwent radical radiochemotherapy for UtCe Stage IV a esophageal cancer that resulted in a complete response (CR). He had repeatedly received dilatation technique for cicatrical stricture until six years had elapsed, when an abscess which penetrated to the dorsal aspect of the neck invaded the cervical vertebrae. Then neuropathy of the lower extremities appeared. We performed laryngo pharyngectomy with cervical esophagectomy and ante-thoracic bypass operation using a gastric tube leaving thoracic esophagus. Case 2 involved a man in his fifties who underwent endoscopic submucosal dissection (ESD) with a diagnosis of AeLt Stage 0 esophageal cancer. Pathological study revealed cancer infiltration into the submucosal layer, and we performed subtotal esophagectomy, lymph node dissection and reconstruction of esophagus using a gastric tube via posterior mediastinal route. The histopathological diagnosis revealed multiple lymph node metastases, and adjuvant chemoradiotherapy was done. In the seventh year after the operation when the patient had been free from recurrence, a fistula between the gastric tube and the trachea associated with gastric tube ulcer was found. Esophagojejunal bypass operation via ante-thoracic route was performed. This paper deals with two cases of esophageal (gastric tube) fistula, a late radiation injury, successfully treated by surgical operation, together with a review of the literature.
