title: Perforation of intramural gastric metastasis during preoperative chemotherapy in a patient with thoracic esophageal squamous cell carcinoma.
abstract: BACKGROUND
  Perforation of intramural metastasis to the stomach (IMS) from esophageal cancer during chemotherapy has not been reported.
  
  
  METHODS
  A 68-year-old male consulted our hospital due to appetite loss. He was diagnosed with advanced esophageal squamous cell carcinoma in the lower thoracic esophagus along with a large IMS in the upper stomach. The patient received preoperative chemotherapy of docetaxel, cisplatin, and 5-fluorouracil (DCF). During the second cycle of DCF, he had upper abdominal pain and was diagnosed with gastric perforation. Omental implantation repair for the perforation, peritoneal drainage, tube-gastrostomy, and tube-jejunostomy were performed. At 24 days after emergency surgery, he underwent thoracoscopic radical esophagectomy with total gastrectomy and reconstruction with colonic interposition. Pathological findings in the esophagus demonstrated complete replacement of the tumor by fibrosis. The gastric tumor was replaced by scar tissue with multinucleated giant cells along with a small amount of viable cancer cells. The patient was alive and healthy at 14 months after the radical operation, without tumor recurrence.
  
  
  CONCLUSIONS
  The gastric perforation occurred due to rapid regression of the IMS which had involved the whole gastric wall before chemotherapy. Close monitoring to detect rapid tumor shrinkage during chemotherapy in patients with IMS may be warranted. A two-step operation was proposed to achieve safe curative treatment in patients with perforation of IMS during preoperative chemotherapy.
  
  
  CONCLUSIONS
  We describe the first reported case of a patient with esophageal squamous cell carcinoma who showed perforation of IMS during preoperative chemotherapy.
authors.affiliation: Department of Surgery and Science, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama 2630 Sugitani, Toyama City, Toyama 930-0194, Japan. Electronic address: okumura@med.u-toyama.ac.jp.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Okumura
authors.affiliation: Department of Nanobio Drug Discovery, Graduate School of Pharmaceutical Sciences, Kyoto University 46-29 Yoshida-Shimo-Adachi-cho, Sakyo-ku, Kyoto 606-8501, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Shimada
authors.affiliation: Department of Surgery and Science, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama 2630 Sugitani, Toyama City, Toyama 930-0194, Japan.
authors.forename: Shozo
authors.initials: S
authors.lastname: Hojo
authors.affiliation: Department of Surgery and Science, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama 2630 Sugitani, Toyama City, Toyama 930-0194, Japan.
authors.forename: Shinich
authors.initials: S
authors.lastname: Sekine
authors.affiliation: Department of Surgery and Science, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama 2630 Sugitani, Toyama City, Toyama 930-0194, Japan.
authors.forename: Katsuhisa
authors.initials: K
authors.lastname: Hirano
authors.affiliation: Department of Surgery and Science, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama 2630 Sugitani, Toyama City, Toyama 930-0194, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Moriyama
authors.affiliation: Department of Diagnostic Pathology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama2630 Sugitani, Toyama City, Toyama 930-0194, Japan.
authors.forename: Shigeharu
authors.initials: S
authors.lastname: Miwa
authors.affiliation: Department of Surgery and Science, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama 2630 Sugitani, Toyama City, Toyama 930-0194, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Nagata
authors.affiliation: Department of Surgery and Science, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama 2630 Sugitani, Toyama City, Toyama 930-0194, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Tsukada
keywords: Esophageal cancer; Intramural gastric metastasis; Neoadjuvant chemotherapy