title: [Surgical treatment of esophago-pleural fistula caused by chemotherapy for lung cancer].
abstract: A 72-year-old woman was admitted for cough and dyspnea. Bronchofiberscopy examination revealed lung cancer at the right main bronchus. Plain chest X-ray and chest CT revealed that the tumor had invaded to the mediastinum and esophagography demonstrated stenosis of the thoracic esophagus without fistula. Because pulmonary resection was contraindicated, chemotherapy for lung cancer was initiated. Complete response was noted, but an esophago-pleural fistula developed as a consequence of chemotherapy. After intrathoracic tube drainage, a permanent endoesophageal tube was inserted through a small incision in the stomach under general anesthesia. However, it migrated into the thoracic empyema after 4-postoperative days. Because the lung cancer was well-controlled, a second operation to reconstruct the esophagus was performed without resection of the thoracic esophagus or fistula. After the operation, thoracic empyema was washed out with povidone iodine and pure alcohol. The chest tube was removed 3 months after the second operation. We conclude that in cases of esophago-pleural fistula caused by chemotherapy for lung cancer, if complete response to chemotherapy is noted, reconstruction of the esophagus should be considered.
authors.affiliation: Department of Thoracic Surgery, Rakuwakai-Otowa Hospital, Kyoto, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Enokibori
authors.forename: A
authors.initials: A
authors.lastname: Katsura
authors.forename: K
authors.initials: K
authors.lastname: Watanabe
authors.forename: H
authors.initials: H
authors.lastname: Kato
authors.forename: A
authors.initials: A
authors.lastname: Mori
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D018288:Carcinoma, Small Cell / Q000188:drug therapy*; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D004937:Esophageal Fistula / Q000139:chemically induced*; D004944:Esophagoplasty; D005047:Etoposide / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005402:Fistula / Q000139:chemically induced*; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy*; D010995:Pleural Diseases / Q000139:chemically induced*
chemical_list: D005047:Etoposide; D002945:Cisplatin