Bethany B. Tan, MD, discusses a recent case where she performed an Ivor Lewis esophagostomy, fistula resection, and an intrathoracic esophagojejunal anastomosis to address a mid-to-distal squamous cell carcinoma of the esophagus and an esophageal bronchial fistula.
Hi. I'm Dr Bethany Tandem. A general thoracic surgeon on Did I do a lot of esophageal surgery? I wanted to talk about a interesting case I had recently Ah, 66 year old female with a history of hypertension who was found to have a, uh, mid two distal squamous cell carcinoma of the esophagus. She was treated with chemotherapy and radiation, but unfortunately, as a complication of her disease, also developed a fistula from the esophagus to the lower lobe of her right lung. So she had this esophageal bronchial fiscal. And now, luckily, we were able to control this with placement of an esophageal stent. But we couldn't allow her to eat any longer. She had signs of residual tumor on her re staging studies done extensive work up and, um, ruling out distant, metastatic disease. We started talking to her about doing a definitive reception. She was really struggling to maintain her weight. She is a very slight, petite little lady before she ever was was ill. But she had really lost another £20. So now weighed less than £100 and we were trying to build her up so that we could do this big surgery doing? Ah, soft ejecta me and perhaps even. Ah, right. Lower lobe ectomy at one point asked her if I could just bring her in the hospital for a couple of weeks and really try toe fatten her up through her feeding to I was trying to talk to her about Was it really that bad In the hospital room, she had a TV, etcetera. The rooms are nice and she said, Dr Tan, I could get a lot more channels at my house and my friends can come by any time and and visit me, so I really want to go home. So I couldn't argue with that. Um, we made some changes, allowed her to go home, gain some weight and then ultimately were able to bring her back. Um, do a Ivor Lewis soft ejecta me and reception of her fistula. We did not really need to respect much lung in this circumstances. It turned out, and, um, did a intra thoracic Asaf gastric anastomosis. And she's now back home again. And eyes eating again seems to have a good outcome both on ecologically, um, as well as she's able Thio eat again Her quality of life has improved a lot. She's a very spirited person, very strong. I, uh, really admire her resilience. She's an example of many of my patients. I really enjoy taking care off and getting to know as we're helping them out.