Esophageal Carcinosarcoma Comprising of Undifferentiated Pleomorphic Sarcoma and Squamous Cell Carcinoma: A Case Report

Introduction: Esophageal carcinosarcoma (ECS) is a rare malignant tumor that often presents as an intraluminal polypoid lesion in the esophageal lumen. Herein we present a case diagnosed as esophageal carcinosarcoma and treated with esophagectomy.Case presentation: A 68-year-old male patient was presented to the thoracic surgery department complaining of dysphagia for about three months. He was diagnosed with ECS and underwent uniport video-assisted thoracic surgery (VATS). Based on the histopathological reports, the patient was finally diagnosed as ECS, clinical T1bN0M0, pathological stage I. 11 days after the surgery, the patient was discharged from the hospital without experiencing any complications.Conclusion: Carcinosarcoma was first described by Virchow in 1865 as a rare malignant neoplasm. The clinical manifestations of ECS includes dysphagia, chest pain and weight loss. IHC analysis indicates carcinoma and the sarcoma occurred independently. Complete resection of the esophagus with lymphadenectomy of locoregional nodes is still recommended as the best potentially curative treatment. For the prognosis of ECS compared to (ESCC), there is a controversy. Here, we reported a case of ECS comprising of squamous cell carcinoma in situ and undifferentiated pleomorphic sarcoma underwent uniport VATS esophagectomy with no serious complications, which indicate that VATS esophagectomy could be applied to ECS patients.

Upper Esophageal Schwannoma: Rare Differential Diagnosis of Dysphagia

Esophageal schwannomas are rare primary sub mucosal tumors, 45 cases have been reported so far. We herein report the 46th case of an esophageal schwannoma from Nepal. A 60-year-old woman presented with progressivedysphagia. Oesophago-Gastro-Duodenoscopy (OGD) showed a sub mucosal mass with mucosal puckering in the upper esophagus; Computed tomography (CT) of the chest showed an upper esophageal mass of size 8x7x6cm3compressing the trachea. Bronchoscopy showed external compression of the mid trachea. The patient under went three incision VATS esophagectomy. Histopathological examination and immunohistochemical (IHC) staining confirmed the diagnosis of schwannoma.

114 VATS ESOPHAGECTOMY: DOES PATIENT OPERATIVE POSITION DURING THORACOSCOPIC MOBILISATION INFLUENCE OUTCOMES? A PROSPECTIVE COMPARATIVE STUDY

VATS esophagectomy can be done in lateral, prone and semiprone positions. Present evidence available comparing semiprone with lateral position is retrospective. We have conducted this study to provide prospective data on perioperative outcomes in patients undergoing Video Assissted Thoracoscopic (VATS) esophagectomy in Semiprone (SP) and Lateral decubitus position (LP) in a single centre. Methods 48 patients (SP =24 & LP =24) undergoing VATS esophagectomy (2017 to 2019) were analysed. Preoperative details (tumor characteristics, preoperative treatment and pulmonary function test), intraoperative details [operative time, blood loss, mean EtCO2, arterial blood gas analysis (ABG) at the end of one lung ventilation(OLV), number of ports used, need for lung reinflation and retraction] and postoperative details [duration of ICU stay, cardiovascular and respiratory complications, pain scores (VAS) and tidal volume improvement (spirometry reading) on first five postoperative days, circumferential resection margin (CRM) status, total and recurrent laryngeal nerve (RLN) nodal yield were noted. Results Preoperative data in both arms were comparable. Ports used (5 vs 3, p < 0.0001), need for lung retraction (22 vs 4patients, p < 0.0001), duration of ICU stay (2 days vs 1 day, p = 0.0327), spirometry readings for POD 1st-5th (p < 0.05) and pain scores (p < 0.05) for POD 1st-5th was significantly less in SP group. There were fewer respiratory complications in SP group (10 vs 4, p = 0.110). LP group had shorter duration of surgery (3.7 vs 4.2 hours, p = 0.0398). There were no differences in tumor characteristics, blood loss, ABG at the end of OLV, mean EtCO2, lung reinflation rate, cardiovascular complications, CRM involvement, total and RLN nodal yield. Conclusion Similar oncological clearance was achieved by both techniques of esophageal mobilization. Semiprone position is associated with lesser postoperative pain and better preservation of respiratory function.

PS01.245: COMPARISON OF ONCOLOGIC RESECTION OF LAPROSCOPIC VERSUS ROBOTIC VATS ESOPHAGECTOMY FROM A REGIONAL CANCER CENTER IN INDIA

Background Robotic surgery being a new technology in developing countries little is known about its oncological safety and outcome in esophageal surgeries. Methods We evaluated 46 consecutive patients of esophageal cancer who underwent laproscopic (n = 30) and Robotic VATS (Video Assisted Thoracic Surgery) (n = 16) esophagectomy, both with cervical anastomosis. All cases were operated by a single surgeon over a period of 2 years. Results 30 patients (18 male, 12 female), average age 54 years underwent laproscopic VATS procedure and 16 patients (8 male, 8 female), average age 57 years underwent Robotic VATS esophagectomy. Compared to laproscopic group, Robotic VATS procedure averaged a slightly longer operative time (190 mins versus 168 mins) with almost similar blood loss (160 ml versus 150 ml). Lymph node yield for Robotic procedure was slightly better than laproscopic group (18 versus 14.3). None of the patients in both groups had positive margins. 8 patients in laproscopic group and 4 in Robotic arm underwent Neo-adjuvant therapy. Clinical and pathologic staging was similar in both groups. Average hospital stay was better for Robotic arm (8 days versus 11 days). Conclusion Laproscopic and Robotic VATS esophagectomy yield almost similar peri-operative oncologic results with Robotic surgery taking slightly longer operative time but yielding better lymph nodes and shorter hospital stay in comparison to laproscopic arm. Shifting from laproscopic to Robotic surgery is easy and is non-inferior in terms of immediate oncologic outcomes. Disclosure All authors have declared no conflicts of interest.

PS02.230: CLOSURE OF POSTESOPHAGECTOMY GASTROTRACHEAL FISTULA FOLLOWING MINIMALLY INVASIVE ESOPHAGECTOMY THROUGH THE STOMACH CONDUIT OPENING

Background The prevalence gastro-tracheal fistula following esophagectomy is rare, however, very difficult to cure, and often results in fatal outcomes. We experienced surgical repair of gastro-tracheal fistula after minimally invasive esophagectomy, thereby reported here. Methods A 66 year-old male patient had undergone VATS esophagectomy combined with cervical esophagogastrostomy through posteromediastinal route for his esophageal cancer (pT2N2M0). After concurrent chemo-radiation therapy for local recurrence in subcarinal area, gastro-tracheal fistula was developed between the posterior membranous wall of trachea just above carina and gastric conduit. Surgical correction was performed through right posterolateral thoracotomy. After longitudinal incision on the gastric conduit near the location of gastro-esophageal fistula, the fistula tract was exposed, and closed using three layer sutures with vicryl 3–0. Results The patient stayed at intensive care unit for only one day. During the periods of nil per os, the nutrition had supported by intravenous administration and jejunostomy. After 2 weeks of nil per os, postoperative bronchoscopy and endoscopy was performed. No remnant fistula was noted on both examinations suggesting successful fistula closure. And, the patient was discharged without any complications on postoperative day 28. Conclusion Conduit-airway fistula could be caused by diverse risk factors such as thermal injury during the dissection, external beam irradiation, and severe malnutrition. Less invasive procedures including endoscopic interventions could be amenable, however, direct surgical repairs might be required for prompt closure of fistula and minimizing further complications. Disclosure All authors have declared no conflicts of interest.