Minimally invasive resection of synchronous triple primary tumors of the esophagus, lung, and thymus: A case report

Synchronous Thymoma and Esophageal Cancer Treated With Minimally Invasive Unilateral Video-Assisted Thoracoscopic Surgery: A Case Report

The treatment of multi-organ synchronous neoplasms requires a customized strategy for each case. Here, we present our treatment strategy for synchronous double neoplasms involving thymoma and esophageal cancer, which is a rare occurrence in clinical practice. A 68-year-old man was diagnosed with thymoma and advanced esophageal cancer in the middle thoracic esophagus. Following neoadjuvant chemotherapy for esophageal cancer, a concurrent resection of both lesions was performed using minimally invasive unilateral video-assisted thoracoscopic surgery and laparoscopic surgery with gastric conduit reconstruction via the posterior mediastinal route. The patient was discharged on the 14th postoperative day without any adverse events. Minimally invasive, video-assisted unilateral simultaneous surgery for thymoma and esophageal cancer represents a viable therapeutic approach, offering both curative potential and decreased invasiveness. Furthermore, reconstructing the gastric conduit via the posterior mediastinal route was deemed appropriate, as it may help minimize the risk of invasion of the gastric conduit and radiation exposure in the event of thymoma disease progression. Additionally, we propose a treatment strategy flow for synchronous neoplasms located in adjacent multi-organs. This strategy can be applied to various tumor types and may benefit other complex cases.

Bilateral video-assisted thoracic surgery for esophageal cancer with left inferior pulmonary vein invasion following chemoradiation therapy

BACKGROUND

The surgical strategy for thoracic esophageal cancer that invades the lungs is controversial. In particular, invasion of the pulmonary vein is often regarded unresectable. We successfully applied bilateral video-assisted thoracic surgery (VATS) in esophagectomy for esophageal cancer with left inferior pulmonary vein invasion following induction chemoradiotherapy (CRT), with a favorable response.

CASE PRESENTATION

A 64-year-old woman was diagnosed with squamous cell carcinoma of the lower third of the esophagus. Computed tomography (CT) revealed that the tumor was suspected to be invading the main trunk of the left lower pulmonary vein and left lower lung. We initiated induction CRT comprising 5-fluorouracil, cisplatin, and concurrent radiotherapy at 50.4 Gy/28Fr. CT revealed shrinkage of the tumor, and the main trunk of the left inferior pulmonary vein was released from the tumor invasion. We considered the tumor to be completely resectable. VATS esophagectomy is usually performed using a right-sided approach. However, the right-sided approach is inappropriate for evaluating tumors around the left inferior pulmonary vein. We started with left-sided VATS to determine tumor resectability and dissected between the esophagus and the main trunk of the left inferior pulmonary vein. We only needed to perform partial resection of the left lower lobe. We then performed a right-sided VATS esophagectomy and lymphadenectomy with partial en bloc resection of the left lower lobe. Following this, we performed hand-assisted laparoscopic proximal gastrectomy and reconstruction using the gastric remnant. The postoperative course was uneventful. The patient was discharged on postoperative day 14. Histopathological examination of the surgical specimen revealed a complete pathological response without any remnant tumor or lymph node metastasis. There were no signs of recurrence or metastasis at the 1-year follow-up.

CONCLUSIONS

Curative resection for thoracic esophageal cancer that invades the pulmonary vein could be possible via the bilateral VATS approach following induction CRT with a favorable response.

Treatment options for synchronous lung and esophagus tumors: A difficult decision to make

Synchronous lung and esophageal carcinomas are rare clinical entities. Curative resection with lymph node dissection is the most optimal treatment approach for both tumors. However, due to the high potential risk of postoperative complications, the right approach is to make a patient-specific decision via a multidisciplinary approach at all stages. In this article, we present three cases of synchronous lung and esophageal tumors treated with different approaches due to their specific circumstances and discuss their pre-, intra-, and postoperative stages.

Perioperative Outcomes After Combined Esophagectomy and Lung Resection

INTRODUCTION

The impact of concomitant lung resection during esophagectomy on short-term outcomes is not well characterized. This study tests the hypothesis that lung resection at the time of esophagectomy is not associated with increased perioperative morbidity or mortality.

METHODS

Perioperative outcomes for esophageal cancer patients who underwent esophagectomy alone (EA) were compared to patients who had concurrent esophagectomy and lung resection (EL) using the NSQIP database between 2006-2017. Predictors of morbidity and mortality, including combined surgery, were evaluated using multivariable logistic regression.

RESULTS

Among the 6,225 study patients, 6,068 (97.5%) underwent EA and 157 (2.5%) underwent EL. There were no differences in baseline characteristics between the two groups. Operating time for EL was longer than EA (median 416 versus 371 minutes, P < 0.01). Median length of stay was 10 d for both groups. Perioperative mortality was not significantly different between EL and EA patients (5.1% versus 2.8%, P = 0.08). EL patients had higher rates of postoperative pneumonia (22.3% versus 16.2%, P = 0.04) and sepsis (11.5% versus 7.1%, P = 0.03), however major complication rates overall were similar (40.8% versus 35.3%, P = 0.16). Combining lung resection with esophagectomy was not independently associated with increased postoperative morbidity (AOR 1.21 [95% CI 0.87-1.69]) or mortality (AOR 1.63 [95% CI 0.74-3.58]).

CONCLUSIONS

Concurrent lung resection during esophagectomy is not associated with increased mortality or overall morbidity, but is associated with higher rates of pneumonia beyond esophagectomy alone. Surgeons considering combined lung resection with esophagectomy should carefully evaluate the patient's risk for pulmonary complications and pursue interventions preoperatively to optimize respiratory function.

Simultaneous resections of left lung cancer and esophageal schwannoma using video-assisted thoracoscopic surgery: A case report

Esophageal schwannomas are extremely rare esophageal submucosal tumors. Herein, we report a case of simultaneous resection of left lung cancer and an esophageal schwannoma with video-assisted thoracoscopic surgery. An asymptomatic 74-year-old woman received a diagnosis of an esophageal submucosal tumor during the preoperative assessment of a left lung cancer. The esophageal submucosal tumor arose in the left wall of the lower esophagus, and the patient was diagnosed as having a schwannoma by endoscopic ultrasound-guided fine needle aspiration. She underwent video-assisted thoracoscopic surgery for the simultaneous removal of both tumors. Her postoperative course was uneventful. Thoracoscopic surgery is less invasive than thoracotomy, and this allowed the patient to undergo simultaneous operations for two tumors.

Simultaneously thoracoscopic resection of lung cancer and anterior mediastinal lesions by video-assisted thoracoscopic surgery

Background

Video-assisted thoracoscopic surgery (VATS) has been widely applied to various types of pulmonary and mediastinal resections in recent years. However, there are still limited experiences of simultaneous thoracoscopic resection for lung cancer and mediastinal tumor. The aim of the study is to investigate the technical safety and feasibility of uniportal VATS for simultaneous resection for concurrent diseases of lung and anterior mediastinum and to compare with multiportal VATS.

Methods

From June 2014 to December 2017, all patients who underwent simultaneously thoracoscopic resection for lung cancer and anterior mediastinal mass under uniportal or multiportal VATS via the same incision were retrospectively reviewed. Study cohort was divided according to surgical approach. Perioperative outcomes, including operative time, intraoperative blood loss, and postoperative hospitalization, were compared between uniportal and multiportal VATS groups.

Results

A total of 51 patients were included in the study, of whom 33 patients had uniportal VATS and 18 patients had multiportal VATS. When compared to multiportal VATS group, uniportal VATS group had similar time of operation (149.1±49.0 vs. 159.1±58.5, P=0.518), intraoperative blood loss (103.0±184.3 vs. 105.6±80.2, P=0.956), and postoperative length of hospital stay (4.7±2.0 vs. 5.5±3.0, P=0.246). No operative deaths occurred in this study.

Conclusions

Uniportal VATS for simultaneously thoracoscopic resection for lung cancer and anterior mediastinal disease is technically safe and feasible and has comparable operative parameters with multiportal VATS.

Clinical treatment of advanced synchronous triple primary malignancies: comprehensive treatment based on targeted therapy

The prevalence of cancer remains high. With the improvement of diagnosis and treatment level and the increase of cancer survivors after treatment, multiple primary tumors are more common than before. The diagnosis and treatment of synchronous multiple primary tumors is more complicated than that of single or metachronous multiple tumors, and patients also suffer more. Because of the different conditions of these patients, lack of large-scale clinical observation data, it is necessary for clinicians to make realistic decisions on the specific conditions of patients. It is a challenge for clinicians to apply the advances of modern medicine to the diagnosis and treatment of such patients so as to prolong their survival time and improve their quality of life. This report describes the survival of an advanced elderly patient with lung, prostate and bladder cancer after receiving targeted therapy-based comprehensive treatment.

Synchronous Esophageal and Lung Cancer

Synchronous lung and esophageal cancers are rare but represent a unique challenge to thoracic surgeons. The literature is limited but series describe long-term survival with curative surgery for concomitant esophageal and lung cancer. Preoperative risk assessment is critical because surgical resection of both cancers requires adequate cardiopulmonary function and performance status. Chemotherapy and radiation are used as adjuvant therapy or as primary treatment of unresectable lesions. Although long-term survival for patients with concomitant lung and esophageal cancer is lower than that of patients with either one alone, survival with curative surgery is higher than that of patients with metastatic disease of either primary.