Abstract
An 82-year-old Japanese man with alcoholic liver cirrhosis was referred to our hospital for treatment of advanced esophageal cancer. A protruding tumor was endoscopically observed in the middle thoracic esophagus, and pathological findings of the biopsy specimens revealed a squamous cell carcinoma. The clinical tumor staging was stage II (T3N0M0). The patient received two courses of neoadjuvant chemotherapy with 5-fluorouracil and nedaplatin. After the treatments, computed tomography showed significant reductions in the size of the target tumor. However, radical esophagectomy was not performed because the patient refused major invasive treatments. Instead, endoscopic resection was performed using a combination of polypectomy and endoscopic submucosal resection (ESD). To prevent bleeding during endoscopic treatment, we applied a detachable snare to the base of the tumor and cut the stalk using by an SB knife Jr, without hemorrhage. The pathohistology of the resected specimen was positively showed cancer cells on the margin of the esophageal carcinoma stalk. At 4 weeks after the initial operation, an additional ESD was successfully performed, which pathologically led to radical removal. The patient survived for more than 18 months after beginning the initial treatment. We describe a successful treatment using endoscopic resection after chemotherapy for advanced esophageal cancer with high surgical treatment risks.
Similar content being viewed by others
References
Bartels H, Stein HJ, Siewert JR. Preoperative risk analysis and postoperative mortality of oesophagectomy for resectable oesophageal cancer. Br J Surg. 1998;85:840–4.
Mariette C. Is there a place for esogastric cancer surgery in cirrhotic patients? Ann Surg Oncol. 2008;15:680–2.
Ando N, Kato H, Igaki H, et al. A randomized trial comparing postoperative adjuvant chemotherapy with cisplatin and 5-fluorouracil versus preoperative chemotherapy for localized advanced squamous cell carcinoma of the thoracic esophagus (JCOG9907). Ann Surg Oncol. 2012;19:68–74.
Katano A, Yamashita H, Nakagawa K. Successful definitive concurrent chemoradiotherapy in a patient with esophageal cancer and Child–Pugh B cirrhosis of the liver. J Cancer Res Ther. 2019;15:255–7.
Lim JH, Lee SA, Kang GE, et al. Esophageal cancer treated by endoscopic submucosal dissection after neoadjuvant chemoradiotherapy: a case report. J Med Case Rep. 2014;8:439.
Suzuki G, Yamazaki H, Aibe N, et al. Endoscopic submucosal dissection followed by chemoradiotherapy for superficial esophageal cancer: choice of new approach. Radiat Oncol. 2018;13:246.
Griffin SM, Shaw IH, Dresner SM. Early complications after Ivor Lewis subtotal esophagectomy with two-field lymphadenectomy: risk factors and management. J Am Coll Surg. 2002;194:285–97.
Tachibana M, Kinugasa S, Yoshimura H, et al. Clinical outcomes of extended esophagectomy with three-field lymph node dissection for esophageal squamous cell carcinoma. Am J Surg. 2005;189:98–109.
Dagnini G, Caldironi MW, Marin G, et al. Laparoscopy in abdominal staging of esophageal carcinoma. Report of 369 cases. Gastrointest Endosc. 1986;32:400–2.
Tachibana M, Kotoh T, Kinugasa S, et al. Esophageal cancer with cirrhosis of the liver: results of esophagectomy in 18 consecutive patients. Ann Surg Oncol. 2000;7:758–63.
Trivin F, Boucher E, Vauleon E, et al. Management of esophageal carcinoma associated with cirrhosis: a retrospective case-control analysis. J Oncol. 2009;2009:173421.
Ando N, Iizuka T, Ide H, et al. Surgery plus chemotherapy compared with surgery alone for localized squamous cell carcinoma of the thoracic esophagus: a Japan Clinical Oncology Group Study–JCOG9204. J Clin Oncol. 2003;21:4592–6.
Kosugi S, Kanda T, Nakagawa S, et al. Efficacy and toxicity of fluorouracil, doxorubicin, and cisplatin/nedaplatin treatment as neoadjuvant chemotherapy for advanced esophageal carcinoma. Scand J Gastroenterol. 2005;40:886–92.
Eguchi T, Nakanishi Y, Shimoda T, et al. Histopathological criteria for additional treatment after endoscopic mucosal resection for esophageal cancer: analysis of 464 surgically resected cases. Mod Pathol. 2006;19:475–80.
Yamashina T, Ishihara R, Nagai K, et al. Long-term outcome and metastatic risk after endoscopic resection of superficial esophageal squamous cell carcinoma. Am J Gastroenterol. 2013;108:544–51.
Hachisu T. A new detachable snare for hemostasis in the removal of large polyps or other elevated lesions. Surg Endosc. 1991;5:70–4.
Hattori S, Muto M, Ohtsu A, et al. EMR as salvage treatment for patients with locoregional failure of definitive chemoradiotherapy for esophageal cancer. Gastrointest Endosc. 2003;58:65–70.
Yano T, Muto M, Hattori S, et al. Long-term results of salvage endoscopic mucosal resection in patients with local failure after definitive chemoradiotherapy for esophageal squamous cell carcinoma. Endoscopy. 2008;40:717–21.
Tsou YK, Liu CY, Fu KI, et al. endoscopic submucosal dissection of superficial esophageal neoplasms is feasible and not riskier for patients with liver cirrhosis. Dig Dis Sci. 2016;61:3565–71.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Human/anima rights
All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
Informed consent
Informed consent was obtained from the patient and patient’s family to be included in the study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Hagiwara, N., Matsutani, T., Haruna, T. et al. Pedunculated esophageal carcinoma endoscopically removed using SB knife Jr with detachable snare after neoadjuvant chemotherapy. Clin J Gastroenterol 13, 1036–1040 (2020). https://doi.org/10.1007/s12328-020-01214-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12328-020-01214-4