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Combined one-stage esophagectomy and duodeno-pancreatectomy for synchronous cancers of the esophagus and pancreatic ampulla in an elderly patient

2019; Taylor & Francis; Volume: 121; Issue: 1 Linguagem: Inglês

10.1080/00015458.2019.1631628

0001-5458

Matilde de Garcia de la Vega, Bernard Faber, Claude Schalbar, Alain Foxius, Hélène Groot-Koerkamp, Georges Decker,

Esophageal and GI Pathology

Background We report the case of a 77-year-old patient, who underwent multi-modality treatment including single-stage radical oesophagectomy and duodeno-pancreatectomy for a synchronous adenocarcinoma of the distal oesophagus and adenocarcinoma of the ampulla of Vater.Methods The ampulloma was diagnosed incidentally during the work-up of the symptomatic esophageal cancer. After induction chemo-radiation of the oesophageal cancer (CROSS regimen), a single-stage radical resection of the esophagus, total gastrectomy and a cephalic duodeno-pancreatectomy was performed. Intestinal reconstruction was done by a right coloplasty with esophago-colic anastomosis in the upper chest and distally to the Roux-en-Y (Child) used for reconstruction of the hepato-biliary tract. Adjuvant chemotherapy was proposed due to the unexpectedly advanced stage of the ampullary cancer (pT4N1M0) and was completed uneventfully despite the magnitude of the preceding surgery.Results According to our literature review, this is the first report of a successfully completed tri-modality treatment with combined single-stage oesophagectomy and Whipple procedure in an elderly (>75 years). Functional and metabolic outcome was satisfactory until cancer recurrence due to liver metastasis of bilio-pancreatic origin. The patient is alive 2 years post-operatively.Conclusion Single-stage radical resection of the oesophagus and a cephalic duodeno-pancreatectomy can be more considered for synchronous cancers even in elderly patient.