1 / 18

Case Presentation Department of Thoracic Surgery

Case Presentation Department of Thoracic Surgery. R3 黃維立 / VS 賴吾為. Name: 蔡○○ 59-year-old, gentleman Chief complaint: Dysphagia for one month . Intermittent vomiting after intake since 4 months ago Progress to dysphagia ( just swallowing liquid ) for one month

erelah
Download Presentation

Case Presentation Department of Thoracic Surgery

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Case PresentationDepartment of Thoracic Surgery R3 黃維立 / VS 賴吾為

  2. Name: 蔡○○ • 59-year-old, gentleman • Chief complaint: • Dysphagia for one month

  3. Intermittent vomiting after intake since 4 months ago • Progress to dysphagia ( just swallowing liquid ) for one month • In Sin-Lau Hospital, 2010/o1 • PES: ulcerative mass 27 cm below incisor, causing esophageal obstruction • Biopsy: malignancy change • Referred to CS department of NCKUH

  4. Past history • Smoking: 1 PPD for 50 years • Alcohol: social • Betel nut: social

  5. Endoscopic ultrasound: • Size: 5.3 * 2.2 * 2.8 cm, 27 cm below incisor • Regional lymphadenopathy: positive • Biopsy: • Squamous cell carcinoma • Clinical staging by EUS: • T3N1Mx, stage III

  6. Chest CT

  7. PET-CT • Tumor: SUV 10.9, about 6.8 * 3.4 * 2.6 cm • Lymph node: SUV 2.1, 1 cm, in AP window • No distant metastasis

  8. Other survey: • Bone scan: no evidence of bone metastasis • Tumor markers: within normal range

  9. Esophageal SqCC, T3N1M0, stage III • Enter clinical trial • Anti-cancer treatment • Paclitaxel ( Taxol ): 35mg/m2 • Cisplatin: 15 mg /m2 • Cetuximab ( Erbitux ) : 250mg/m2 • Radiotherapy • Totally 3600 cGy W1 Paclitaxel 35mg/m2 Cisplatin 15mg/m2 Erbitus 250mg/m2 W2 Paclitaxel 35mg/m2 Cisplatin 15mg/m2 Erbitus 250mg/m2 W3 Paclitaxel 35mg/m2 Cisplatin 15mg/m2 Erbitus 250mg/m2 W4 Paclitaxel 35mg/m2 Cisplatin 15mg/m2 Erbitus 250mg/m2 W0 Erbitus 400mg/m2

  10. PET-CT (3rd week after CCRT)

  11. Operation (4th weekafter CCRT)

  12. Post operation course • ICU stay: 4 days • POD 4: jejunostomy feeding • POD 10: esophagography • No leakage • POD 10: try sip water • POD 12: clear liquid diet • POD 13: soft diet • POD 16: discharge • Final pathology report: • The tumor has invaded through the muscle layer into the adventitia • LN: negative for metastasis • pStage: T3N0M0, IIB

  13. Advance in esophageal cancer surgery in NCKUH • 2008/7 1st VATS esophagectomy+ laparotomy • 2010/2 VATSesophagectomy + laparoscopic gastric tube reconstruction

  14. G E G E • G: gastric tube • E: esophagus stump E G E G G E

More Related