title: Complications after oesophagectomy with possible contribution of neoadjuvant therapy including an EGFR-antibody to a fatal outcome.
abstract: BACKGROUND
  Different molecular therapies like the EGFR-inhibiting antibody cetuximab have come into clinical practice. Cetuximab is EMEA-approved for metastatic colorectal cancer and advanced squamous-cell head and neck cancer. Administration is said to be safe and well tolerated with common, usually mild dermatologic side effects.
  
  
  METHODS
  We present the case of a patient with fatal complications after oesophagectomy and neoadjuvant chemotherapy including cetuximab for squamous-cell esophageal cancer. A transthoracic en-bloc oesophagectomy was performed. Few days later the patient died due to gas exchange dysfunction and circulation instability after a previously unseen combination of drain-erosion of the stomach with subsequent pleurisy and air leak of the left main bronchus.
  
  
  CONCLUSIONS
  So far we have never observed this fatal combination of drain erosion of the stomach with fibrinous pleurisy and unmanageable progressive tracheal defect before. The role of cetuximab in the multifactorial aetiology of damages of stomach and trachea after oesophagectomy remains unclear since we are not able to link the complication directly to cetuximab or definitely exclude it as a sole surgical complication. Clinicians should be aware of the possibility of fatal side effects and careful recording of all complications is necessary in ongoing and planned studies to obtain more evidence about safety and tolerance of targeted therapies.
authors.affiliation: Department of General and Thoracic Surgery, General Hospital of Feldkirch, Academic Teaching Hospital, Feldkirch, Austria. knaui@gmx.at.
authors.forename: Michael
authors.initials: M
authors.lastname: Knauer
authors.forename: Anton
authors.initials: A
authors.lastname: Haid
authors.forename: Karlheinz
authors.initials: K
authors.lastname: Ammann
authors.forename: Alois
authors.initials: A
authors.lastname: Lang
authors.forename: Felix
authors.initials: F
authors.lastname: Offner
authors.forename: Martina
authors.initials: M
authors.lastname: Türtscher
authors.forename: Peter
authors.initials: P
authors.lastname: Cerkl
authors.forename: Etienne
authors.initials: E
authors.lastname: Wenzl