Locally Advanced Esophageal Cancer Arising from an Epiphrenic Diverticulum Treated by Curative Esophagectomy Combined with Adjacent Organs Resection

Abstract

A 68-year-old man who had been pointed out having a left epiphrenic esophageal diverticulum at the age of 18 was referred to our hospital following a diagnosis of esophageal cancer with the chief complaints of vomiting and weight loss. Upper gastrointestinal imaging and endoscopy revealed a mainly submucosal tumor 7 cm in diameter in the left anterior wall of the lower thoracic esophagus. Biopsy indicated squamous cell carcinoma, while CT suggested tumor invasion into the pericardium, diaphragm crura, and left lower lung lobe. The epiphrenic diverticulum was not evident due to tumor involvement, but we diagnosed the patient with esophageal cancer arising from the diverticulum for two reasons : (ⅰ) The epicenter of the tumor coincided with the previous diverticulum. (ⅱ) The tumor was large but was located primarily in a submucosal region, and the mucosal lesion of the tumor was localized to the left anterior wall. Middle and lower esophagectomy with left thoracotomy was performed following neoadjuvant chemotherapy. Intraoperative findings revealed the tumor strongly adhered to the left diaphragm, the left lower lung lobe, and lateral segment of the liver. R0 resection was achieved through combined partial resection of each organ. Most of the tumor was under the mucosa in the resected specimen, suggesting a diverticulum origin. The tumor invasion into the diaphragm was evident, but adhesions to the left lung and the liver were inflammatory.