Esophageal extirpation after ineffective stenting

Introduction. Esophageal cancer and benign stricture in a number of cases lead to the development of progressive dysphagia and marked disturbances in the nutritional status of the patient. In older patients with a long list of concomitant diseases, stenting allows to adequately solve the nutritional problem and avoid radical traumatic surgery with unpredictable outcome. However, stent dislocation or its failure in case of lumen closure by tumor or excessive granulation leads to recurrence of progressive dysphagia. An individualized approach to the assessment of functional parameters of the patient's condition allows planning radical surgical treatment.
Clinical case. The patient is 82 years old, who underwent esophageal endoprosthesis at the hospital of his place of residence. In August 2023, he came to a medical institution with complaints of difficulty in passing solid food and discomfort in the chest. A complex examination revealed a grade III stenosis of the distal esophagus. A decision was made to endoprosthetize the esophagus. On the background of the treatment the patency of the esophagus was restored. However, a month later difficulties in passing solid food, regurgitation with blood streaks, weakness, he lost 10 kilograms of weight during the last month appeared again. He was hospitalized to clarify the diagnosis and decide on the treatment tactics.
Purpose of the study. Demonstration of successful performance of radical surgical treatment of progressive dysphagia in esophageal tumor stricture after ineffective stenting.
Conclusion. Esophageal extirpation with its one-stage gastric stalk plasty is the operation of choice in the surgical treatment of malignant stenosing esophageal diseases when endoscopic methods cannot be applied or become ineffective. Naturally, it is performed taking into account the individuality of each clinical case and requires a multidisciplinary approach.

1. Frolova E.V., Bogdanov D.Iu., Kurganov I.A., et al. Endoscopic esophageal stenting in patients with strictures of different etiology. Endoscopic Surgery, 2019, № 25(2), pp. 52–59. (In Russ.) https://doi.org/10.17116/endoskop20192502152

2. Spaander M.C., Baron T.H., Siersema P.D., Fuccio L., Schumacher B., Escorsell À., Garcia-Pagán J.C., Dumonceau J.M., Conio M., de Ceglie A., Skowronek J., Nordsmark M., Seufferlein T., Van Gossum A., Hassan C., Repici A., Bruno M. J. Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy, 2016, № 48(10), pp. 939–948. https://doi.org/10.1055/s-0042-114210

3. Kim E.S., Jeon S.W., Park S.Y., Cho C.M., Tak W.Y., Kweon Y.O., Kim S.K., Choi Y.H. Comparison of double-layered and covered Niti-S stents for palliation of malignant dysphagia. Journal of Gastroenterology and Hepatology, 2009, № 24(1), pp. 114–119. https://doi.org/10.1111/j.1440-1746.2008.05674.x

4. López S.P., Alberdi A.N., Fuertes F.I., Sáenz B.J. An updated review of the TNM classification system for cancer of the oesophagus and its complications. Radiologia, 2021, № 63(5), pp. 445–455. https://doi:10.1016/j.rxeng.2020.09.004

5. Chernousov A.F., Khorobrykh T.V., Vetshev F.P., Osminin S.V., Chesarev A.A. Surgical treatment in patients with locally advanced and metastatic esophageal cancer. P.A. Herzen Journal of Oncology, 2018, № 7(4), pp. 15–19. (In Russ.) https://doi.org/10.17116/onkolog20187415

6. Khat’kov I.E., Izrailov R.E., Domrachev S.A., Kononec P.V., Vasnev O.S., Koshkin M.A. Thoracolaparoscopic simultaneous operations on esophagus. Pirogov Russian Journal of Surgery, 2014, № 10, pp. 45–51. (In Russ.)

7. Palanivelu C., Prakash A., Senthilkumar R., Senthilnathan P., Parthasarathi R., Rajan P.S., Venkatachlam S. Minimally invasive esophagectomy: thoracoscopic mobilization of the esophagus and mediastinal lymphadenectomy in prone position – experience of 130 patients. Journal of the American College of Surgeons, 2006, № 203(1), pp. 7–16. https://doi.org/10.1016/j.jamcollsurg.2006.03.016