Partial esophagectomy for a superficial carcinoma arising from the mid-esophageal diverticulum

Abstract

A 69-year-old man presented with epigastralgia at a local hospital. Endoscopy detected a superficial esophageal carcinoma arising from a mid-esophageal diverticulum with intraepithelial spread. The patient was referred to our hospital for further examination and treatment. Esophagography showed irregularity in the mid-esophageal diverticulum. Endoscopic ultrasonography (EUS) revealed invasion of the tumor into the proper mucosal muscle layer. No lymph node metastasis was detected on computed tomography or EUS. Partial esophagectomy and lymph node dissection in the mediastinum was performed through a right thoracotomy. An esophageal end-to-end anastomosis was constructed by circular stapler inserted from the stomach through a small laparotomy. Pathologic findings were a well-differentiated squamous cell carcinoma slightly invading the submucosal layer without lymph node metastasis. Although the patient did not have postoperative complications and was discharged 3 weeks after the operation, he suffered an anastomotic stricture requiring endoscopic balloon dilatation. He has survived more than 4 years after the operation without recurrence.

Direct observation diverticulectomy for Zenker’s diverticulum carcinoma

“…Esophageal diverticulum carcinoma is generally treated with surgery [2,5,6] because the wall of the diverticulum lacks a full muscle layer, which increases the risk of perforation during endoscopy. Zenker's diverticulum carcinoma is usually detected by esophagography, endoscopy, and CT.…”