Successful treatment of esophageal cancer with transhiatal esophagectomy after heart transplantation

Successful treatment of gastric cancer 10 years after heart transplantation: A case report

BACKGROUND

While survival rates among cardiac allograft recipients have improved, there has been a rise in post-transplant malignancies, with gastric cancer being less commonly reported. This study presented a successful treatment of gastric cancer in an individual 10 years after undergoing a heart transplant.

CASE PRESENTATION

A 66-year-old Chinese man presented to the gastrointestinal clinic with a complaint of diagnosis of gastric cancer for 4 months and treated with neoadjuvant therapy for 1 month. He has undergone orthotopic heart transplantation 10 years earlier due to a myocardial infarction. Physical examination and laboratory tests did not reveal any significant abnormalities. Abdominal contrast-enhanced computed tomography (CT) imaging indicated a gastric mass near the greater curvature, with gastroscopy suggesting a carcinoma at the esophagogastric junction, Siewert III. An echocardiogram indicated left atrial enlargement with mild mitral and tricuspid regurgitation. The diagnosis suggested that his gastric cancer at the esophagogastric junction was a consequence of long-term immunosuppressive therapy. A multidisciplinary team (MDT) consultation recommended a proximal radical gastrectomy. Postoperatively, the patient received 4 cycles of adjuvant chemotherapy with XELOX combined with Herceptin, initiated a month after surgery. During the 1-year follow-up, the patient showed commendable recovery, with no signs of tumor recurrence or metastasis.

CONCLUSION

This case underscores the potential risk of malignancy from immunosuppressive agents in transplant recipients. The successful management of this complex scenario underscores the indispensable role of an MDT approach in treating such unique and challenging cases.

Prevalence and Natural History of Barrett's Esophagus in Lung Transplant: A Single-Center Experience

BACKGROUND

Barrett's esophagus (BE)-intestinal metaplasia in the esophagus-may progress to low-grade dysplasia (LGD), high-grade dysplasia (HGD), and ultimately, invasive esophageal adenocarcinoma (EAC). The course of BE in immunosuppressed lung transplant recipients is unknown.

METHODS

This study retrospectively reviewed the records of patients who underwent lung transplant at a single center, Norton Thoracic Institute in Phoenix, Arizona, between January 1, 2010 and October 31, 2016. Pretransplant esophagram, esophagogastroduodenoscopy, 24-hour pH monitoring, high-resolution manometry, and gastric emptying studies were analyzed.

RESULTS

Of the 466 patients who underwent lung transplant during the study period, 54 (11.59%) had BE on pretransplant esophagogastroduodenoscopy. Of these, 1 patient had HGD before lung transplant. The median age of patients was 64 years (interquartile range, 58.25 to 68.75 years); 66.7% were men. Median follow-up duration was 29.48 months (interquartile range, 19.69 to 37.98 months). Sixteen of 54 patients (29.62%) underwent antireflux surgery after lung transplant. LGD or EAC developed in 3 patients during posttransplant surveillance. One patient had a diagnosis of HGD 24 months after retransplant. She underwent complete endoscopic ablation and was dysplasia-free for 5 months, but ultimately the condition recurred, and she underwent esophagectomy for invasive cancer. Two patients had a diagnosis of LGD 7 and 13 months after lung transplant and were successfully treated with radiofrequency ablation. The rate of progression to dysplasia or EAC was 2.3% per patient-year.

CONCLUSIONS

BE seems to be more prevalent in lung transplant recipients than in the general population. The study findings suggest that patients with BE have a higher risk of BE-to-EAC progression after lung transplant and that HGD may progress rapidly in immunosuppressed patients. More intensive surveillance endoscopy may be required in patients with BE after lung transplant.

Successful resection of oesophageal adenocarcinoma 16 years after heart transplantation-a case report

INTRODUCTION

With improving results of heart transplantation and subsequently increasing survival, long-term complications such as neoplastic malignancies are more often being discovered.

PRESENTATION OF CASE

In this report, we present a unique case of successful oesophagus resection with gastric pull-up, on a heart-transplanted patient diagnosed with oesophageal adenocarcinoma.

DISCUSSION

With the growing number of long-term surviving heart transplanted patients, the number of neoplasia in this patient-group will subsequently grow. Since physical condition and quality of life in long-term surviving heart transplanted patients is comparable to the general population, and since surgical treatment remains the mainstay of treatment for localised oesophageal carcinoma in non-heart transplanted patients, a larger subgroup of heart transplanted patients will most likely be considered for cancer surgery.

CONCLUSION

Our case demonstrates the possibility of operating on the heart transplanted patient-group, and supports the option, that well-managed heart transplantation not should be a limiting factor, when deciding whether a patient is a candidate for surgical intervention or not.