A case of advanced hypopharyngeal cervical esophageal cancer with management of tracheoesophageal fistula and complete resection

Abstract

Background: Advanced esophageal cancer with tracheal invasion is fatal due to airway narrowing, and due to the possibility of tracheoesophageal fistula formation during the treatment process. If a tracheoesophageal fistula develops, palliative care is often chosen, and curative resection is very rarely achieved.Case Presentation: A 71-year-old man presented with dysphagia. He was diagnosed hypopharyngeal and cervical esophageal cancer with severe airway stenosis (cT4b [main bronchus, thyroid] N3 M0 cStageIIIC); we initially created a tracheostomy. He received induction chemotherapy (docetaxel, nedaplatin and S-1: DGS). After one course of DGS therapy, he developed a tracheoesophageal fistula due to tumor shrinkage. We managed both the airway route and nutrition strictly under continuous suctioning over the cuff of the tracheal cannula, prohibited swallowing saliva, and provided enteral nutrition using a nasogastric tube. Three courses of DGS therapy were performed. A clinical complete response was achieved. We then performed pharyngo-laryngo-esophagectomy. The postoperative course was uneventful. His response was evaluated as a pathological complete response (pretreatment effect grade 3) and we achieved R0 resection. Two courses of DGS therapy were administered as adjuvant chemotherapy. He is currently alive without recurrence at 9 years after treatment.Conclusions: In the case of upper tracheoesophageal fistula caused by advanced hypopharyngeal cervical esophageal cancer, chemotherapy under strict airway and nutritional management after tracheostomy may facilitate radical surgery.