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症例は72歳の女性で,2005年6月頸部食道癌,cT2N0M0,stage IIAと診断され,根治的化学放射線療法(chemoradiotherapy;以下,CRT)を施行された.完全奏功状態(complete response;以下,CR)を維持していたが,約10か月後に再発した.上部消化管内視鏡検査で頸部食道に原発巣の再燃を認め,さらにCTで右頸部リンパ節転移を診断した.Endoscopic mucosal resection(以下,EMR)とphotodynamic therapy(以下,PDT)で食道病変の局所治療を行い,47日後に右頸部リンパ節郭清を行った.術後2日目に頸部食道穿孔を認め,保存的加療行うも改善なく,大胸筋皮弁による瘻孔閉鎖術を行い閉鎖した.本邦では頸部食道癌再発に対してPDTと頸部郭清を施行し,食道が穿孔したとする報告はなく,文献的考察を加え報告する.
We report a case of esophageal perforation following photodynamic therapy (PDT) and cervical lymph node dissection for recurrent cervical esophageal cancer. A 72-year-old woman diagnosed with cervical esophageal cancer (cT2N0M0, stage II) had an initial "complete cure" response after definitive chemoradiotherapy. About 10 months later, however, she was diagnosed with locoregional failure and cervical lymph node metastasis, undergoing endoscopic mucosal resection and PDT for the primary site and cervical lymph node dissection 47 days later as salvage treatment. On postoperative day (POD) 2, she was diagnosed with esophageal perforation refractory to conservative therapy, necessitating pectoralis major myocutaneous flap surgery. The possibility of esophageal perforation after PDT for esophageal cancer should thus be considered even more than 1 month later.
