喉頭切除後に発生した胸部食道癌に対して胸腔鏡下食道切除・胸腔内吻合を施行した1例

Thoracoscopic intrathoracic esophagogastric anastomosis following minimally invasive esophagectomy after total laryngectomy : A case report

◆要旨：喉頭切除後に生じた胸部食道癌に対して胸腔鏡下に切除，胸腔内再建を行った症例を経験したので報告する．患者は76歳，男性．喉頭癌で8年前に放射線治療と喉頭全摘術を受けていた．術後フォロー目的に行われた上部消化管内視鏡検査で胸部食道癌が発見された．Lt, cT1b, N0, M0, cStage Iの術前診断で，胸腔鏡下食道切除および胸腔内吻合を施行した．術後経過は良好で合併症はなく，再発なく生存中である．胸腔鏡下食道切除の再建は頸部創から行われることが多いが，喉頭癌の治療後では頸部操作が困難なことが予想される．胸腔鏡下オーバーラップ法による胸腔内食道胃管吻合は低侵襲で有用と考えられた．

During reconstruction following thoracoscopic esophagectomy to treat esophageal cancer, it is common to perform a cervical esophagogastric anastomosis. However, this procedure is difficult in cases where the patient has previously undergone laryngectomy for the treatment of cervical carcinoma. We experienced a case in which an esophageal cancer patient had undergone a prior laryngectomy. We utilized a thoracoscopic intrathoracic esophagogastric anastomosis following minimally invasive esophagectomy（MIE）. Our case was a 76-year-old man who was found to have lower thoracic esophageal cancer by endoscopy. He had undergone total laryngectomy for laryngeal cancer 8 years earlier, and had a tracheostomy. We diagnosed him with cT1bN0M0 ; stage IA esophageal cancer, and made a thoracoscopic intrathoracic esophagogastric anastomosis following MIE. Postoperatively, there were no complications. We conclude that thoracoscopic intrathoracic anastomosis is a feasible solution for esophageal cancer patients who have previously undergone laryngectomy, and this procedure can reduce the stress of surgery.