Two-stage Operation Performed for a Patient with Synchronous Triple Primary Cancer Comprising Esophageal Carcinosarcoma, Gastric Cancer, and Colonic Cancer

Abstract

The patient was a 67-year-old man. He was underweight (the body mass index : 12.09 kg/m²) and had a history of diabetes. In November 2019, he presented with difficulty in swallowing and body weight loss. An esophagogastroduodenoscopy revealed an about 8-cm huge tumor lesion from the middle to lower thoracic esophagus. At the same time, early gastric cancer and advanced sigmoid colon cancer were detected. He was diagnosed with synchronous triple primary cancer comprising esophageal carcinosarcoma, gastric cancer, and sigmoid colon cancer. We selected two-stage operation to safely achieve curative resections for all cancers. In the first stage of the operation, we performed thoracoscopic esophagectomy, laparoscopic total gastrectomy, laparoscopic sigmoidectomy, cervical esophagostomy, and jejunostomy. Thirty-five days later, we reconstructed with the right colon via retrosternal route. The patient had an uncomplicated postoperative course. Histopathological findings showed esophageal carcinosarcoma (pT3N0M0, pStage II), gastric cancer (pT1aN0M0, pStage I a), and sigmoid colon cancer (pT3N1bM0, pStage III b).

We experienced curative resection for rare synchronous triple cancer by using two-stage operation that lessened the surgical stress. The laparoscopic two-stage operation is a useful surgical strategy for high-risk patients.