Abstract
A 66-year-old man with early oropharyngeal cancer was diagnosed with type 1 esophageal cancer with a diameter of 2 cm in the middle thoracic esophagus and a liver tumor with a diameter of 8 cm that extended across S4, S5, and S8 during the pre-treatment screening for early oropharyngeal cancer. Considering the high surgical invasiveness, the patient underwent transoral partial oropharyngectomy, thoracoscopic subtotal esophagectomy, and laparoscopic central bisegmentectomy of the liver with gastric tube reconstruction as the first, second, and third stages of surgery, respectively. In the second-stage surgery, the esophagus was cut at the upper thoracic level, and an esophagostomy was made at the left anterior neck. A distal esophageal stump was made at the lower thoracic level. Four weeks after the esophagectomy, the patient underwent laparoscopic central bisegmentectomy of the liver, followed by hand-assisted laparoscopic gastric tube reconstruction. However, conversion from laparoscopic to open surgery was needed for the gastric reconstruction due to severe adhesion of the esophageal stump at the lower mediastinum surrounding the esophageal stump. It was possible to successfully complete the patient's treatment by planning consecutive three-staged surgery. On further consideration of the interval period between the esophagectomy and hepatectomy, improved treatment of the esophageal stump is necessary to avoid severe adhesion and to complete the three-staged surgery without conversion to open surgery.
