Successful treatment of post chemotherapy esophageal cicatricial atresia in a pediatric patient with anaplastic large cell lymphoma through minimally invasive esophagectomy: a case report

Background Anaplastic large cell lymphoma (ALCL) is a CD30-positive T-cell lymphoma, which is a rare type of non-Hodgkin lymphoma. ALCL rarely presents in the gastrointestinal tract, and the esophageal involvement in of ALCL is extremely rare. Case presentation An 11-year-old boy who complained of abdominal pain and cough was diagnosed with ALK-positive ALCL on the basis of systemic lymphadenopathy findings and immunohistochemistry results of pleural effusion. Although remission was observed after chemotherapy at 5 months after diagnosis, dysphagia persisted, and esophagoscopy revealed a severe stricture in the middle thoracic esophagus. At 9 months after diagnosis, allogeneic bone marrow transplantation was performed to ensure that complete remission was maintained; however, dysphagia and saliva retention did not improve. Approximately 10 months after diagnosis, esophagoscopy revealed a blind end in the middle thoracic esophagus, similar to that in congenital esophageal atresia. Subsequently, we performed minimally invasive subtotal esophagectomy under thoracoscopy and laparoscopy and gastric conduit reconstruction via the retrosternal route more than 2 years after allogeneic bone marrow transplantation. The final pathological diagnosis was esophageal atresia with esophagitis, with no malignancy. During postoperative evaluation, the patient required swallowing training for a few months, although no major complications were noted. Oral intake was possible, and complete remission was maintained at 14 month post-surgery. Conclusions Oncologists must consider the possibility of acquired esophageal cicatricial atresia as a complication during chemotherapy for ALCL. If esophageal obstruction or esophageal atresia occur and if remission is maintained, esophagectomy and esophageal reconstruction are useful treatment options for maintaining oral intake.

Application of sorbitol-based infusion preparation for protein-protecting effect in surgery patients with middle breast cancer

Objective. To study the energy effect of infusions of the drug Sorbilact in the body of operated patients with cancer of the middle thoracic esophagus. Materials and methods. Clinical use of the drug Sorbilact was performed in 30 operated patients with cancer of the middle thoracic esophagus (the main group). Sorbilact was administered intravenously immediately after surgery, drip at a rate of 30 drops per minute for 5 days at a dose of 800 ml per day. Plasma urea concentration was determined before infusions on the 1st day after surgery, and on days 2, 3, 5 after Sorbilact infusions. The control group – 25 operated patients – was administered 5 % glucose solution at a dose of 800.0 ml. Results and discussion. In the first days after surgery in patients with cancer of the middle thoracic esophagus an increase in the concentration of urea in blood plasma was revealed. In the main group of operated patients after resection of the middle thoracic esophagus in repeated studies on the 2nd, 3rd, 5th day after infusions a significant decrease in the concentration of urea in blood plasma was showed. It indicates that less endogenous protein is consumed for energy purposes, and the caloric needs of the operated body are covered by intensive absorption of Sorbilact, which reduces the catabolism of internal proteins, resulting in reduced nitrogen production, which is manifested in a decrease in the concentration of urea in blood plasma and its difference. In the control group of operated patients in repeated studies on the 2nd, 3rd, 5th day after infusions an increase in plasma urea was revealed, which indicates insufficient caloric energy expenditure of the operated organism. Conclusions. Intravenous infusions of the drug Sorbilact according to the indicator of increment of urea in blood plasma in operated patients after resection of the middle thoracic esophagus in the early postoperative period show a pronounced energy effect.

P124 LOCALIZED ESOPHAGEAL NEUROENDOCRINE TUMORS. REPORT ON CLINICAL AND TREATMENT PARAMETERS FROM A TERTIARY HOSPITAL

Aim We retrospectively analyzed the medical files of patients treated with neuroendocrine neoplasms (NENs) of the esophagus in our unit. Background & Methods Esophageal NENs are rare and lacking functional symptoms. This results in a delay of diagnosis that may compromise patient survival. Numerous single cases are reported in literature, without a consensus on their management. The true incidence of esophageal NETs is unknown but evidence indicated geographic variability while smoking and alcohol abuse are the major risk factors. Men (60-70 years) are most commonly afflicted and usual symptoms include dysphagia and loss of appetite with consequent weight loss. The histologic subtypes reported in the literature include high or low-grade NETs and mixed neuroendocrine neoplasms (MINENs). Central pathology assessment significantly contributes to the accurate diagnosis and management. Personalised treatment depends on the grade, involved anatomic region and stage of disease and most commonly comprises combination chemotherapy and radiotherapy and rarely surgery. Results We report on three cases with localized esophageal NET diagnosed with endoscopic biopsies and staged with FDG or Gallium-PET CT scan. The mean age was 56, two were men and histologies included 1 MINEN (lower thoracic esophagus), 1 NET G3 (upper thoracic esophagus) and 1 NET G2 (middle thoracic esophagus). The patient with MINEN was stage 1b and was treated with complete esophagectomy and lymph nodal dissection without any further adjuvant therapy. Two patients with upper and middle thoracic esophagus were treated with combination chemotherapy and definitive IMRT radiotherapy. All patients remain disease free at 12 months follow up. Conclusion Localized esophageal NET are often diagnosed following endoscopic investigation. Long-term survival may be achieved with excellent quality of life after careful evaluation of the clinicopathologic characteristics by a dedicated multidisciplinary group.

PS01.128: A PROPENSITY SCORE-MATCHED ANALYSIS OF CLINICAL SIGNIFICANCE OF THE SUPRACLAVICULAR LYMPHADENECTOMY FOR SQUAMOUS CELL CARCINOMA LOCATED IN MIDDLE THORACIC ESOPHAGUS

Background Supraclavicular lymph nodes (No 104) were upgraded from group 3 to group 2, which needs to be dissected in D2 surgery, for tumors located in middle thoracic esophagus in the 11th edition of Japanese classification of esophageal cancer. However, it is not based on prospective study and the evidence level remains moderate. Current evidence regarding supraclavicular lymphadenectomy is mainly based on retrospective cohort study of efficacy index without proper control. The aim of this study is to retrospectively investigate the clinical impact of supraclavicular lymphadenectomy for middle esophageal cancer. Methods A total of 240 consecutive patients who underwent R0 esophageal resection for clinical Stage I, II, III (UICC 8th) primary esophageal squamous cell carcinoma from 2005 to 2017 in Kyoto University Hospital were investigated. Patients who underwent salvage surgery after definitive chemoradiotherapy were excluded. Among them, 99 patients had middle esophageal cancer. All patients underwent at least abdominal and mediastinal lymphadenectomy including cervical paraesophageal (No 101) and paratracheal (No 106rec) nodes. After propensity score matching, 42 patients (21 each for with (3F) and without (2F) supraclavicular lymphadenectomy) were selected for comparison. Results In the propensity-matched population (n = 42), the 5-year overall survival of clinical Stage I (n = 15)/II (n = 9)/III (n = 18) was 100%/52%/57%. Though cStage, neoadjuvant therapy, ASA-PS and date of surgery (early, middle and late period) were well matched, the 5-year overall survival in 2F and 3F were 82% and 68%. The hazard ratio (3F/2F) for overall death was 2.6 (95% CI, 0.79–9.97; P = 0.1178). In terms of short term outcomes, postoperative morbidity graded as Clavien-Dindo grade 2 or higher was 48% in the both group, while respiratory complication (Clavien-Dindo grade 2 or higher) was 14% in 2F and 29% in 3F, respectively. The odds ratio was 2.4 (95% CI, 0.51–11.3; P = 0.2593). Conclusion This observational study failed to show any clinical benefit of supraclavicular lymphadenectomy. Given the nature of retrospective study, there might be overlooked confounding factors to select 2F or 3F. Further prospective study is warranted. Disclosure All authors have declared no conflicts of interest.