Multidisciplinary Management of Esophageal SCC and Post-Esophagectomy Delayed Gastric Emptying

9 Oct 2024 15:00 16:30
Hong Kong
Philip W.Y.  Chiu  Host

Case 1: Multidisciplinary Management of Esophageal SCC

Initial Presentation & Diagnostic Evaluation

  • Referral: Patient referred for solitary esophageal lesion for ESD.

  • Endoscopic Findings: Repeated endoscopy found multi-focal early tumors from the cervical esophagus at the level of the cricopharyngeus extending to the abdominal esophagus.

  • Cervical Lesion: The cervical cancer appeared as endoscopic T1a cancer.

  • Distal Lesion: Suspicious SM invasive cancer was observed in the distal portion.

  • PET-CT: No distant metastasis.

Treatment Strategy

  • Cervical Esophageal ESD: After discussion, cervical esophageal ESD was performed to resect the proximal lesions.

  • Pathology: Pathology confirmed T1a cancer with clear margin.

  • Esophagectomy: The patient then underwent 3-stage esophagectomy with extended two-field LN dissection.

  • Final Pathology: Multifocal cancers. The most advanced one was T1sm, N1 disease with 2 out of 3 lymph node involvement at the left recurrent laryngeal nerve chain.

Imaging Findings

  • Upper esophageal nodular lesion.

  • PET-CT scan.

  • Upper thoracic esophageal mural thickening and metabolic uptake.

  • Synchronous cervical esophageal tumor with esophageal wall thickening and metabolic uptake.

Case 2: Management of Post-Esophagectomy Delayed Gastric Emptying

  • Initial Presentation: Starting 1 week after surgery, the patient had delayed gastric emptying.

  • Endoscopic Treatment: Required two episodes of endoscopic dilation, the second one with Botox injection.

  • Clinical Response: Symptoms then resolved.

  • Recurrence: Five months later, symptoms recurred.

  • Latest Treatment: The patient just received another endoscopic dilation and Botox injection.

  • Planned Management: G-POEM is planned as long-term management of recurrent delayed gastric emptying after esophagectomy.

Multi-disciplinary Panel

Prof. Philip Chiu (Hong Kong) | Prof. Richard van Hillegersberg (Utrecht) | Prof. Noriya Uedo (Osaka)

Topics for Discussion

  1. Multidisciplinary management of SCC of the esophagus

  2. Management of post-esophagectomy delayed gastric emptying