tumor board hypopharyngeal ca - dr ken liao liu
DESCRIPTION
Hypopharyngeal carcinoma post total laryngectomy with gastric pull-up reconstruction. T-E fistula , medistinal LN metastasis.TRANSCRIPT
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ENT R1 許朝淵VS Ken Liao Liu 劉耿僚
六月光田腫瘤聯合討論Tumor Board
Otolaryngology-Head & Neck Surgery , KTGH,
Taiwan
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Basic data
• Name: 李 x 全• Age/Sex: 45/Male
• Address:台中沙鹿• Marital status: Married.
• Occupation ： None.
• ECOG : 0
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Basic data
• Cigarette smoking ： 4 PPD for 20 years.
• Betel nuts ： sometimes.
• Alcohol ： sometimes
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Past history
• Hypopharyngeal cancer (cT3N1M0) s/p total laryngectomy
• Esophageal cancer (cT1N0M0) s/p total esophagectomy, with pulled-up gastric tube reconstruction on Nov.20,2008.
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Intra-op: Into Laryngopharynx2008-11-20
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Specimen : Total laryngopharyngectomy
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After Total Laryngopharyngectomy
Esophagus (cut end)
Oropharynx (cut end)
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Gastric Pull-up Reconstruction
Gastric pull-up anastomosis with oropharynx
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Past history
• RT dose----4500cGy/25fx to
tumor bed and lower neck since Dec.17,2008 ~ Jan.20,2009.
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Patient history
Excisional biopsy : Metastatic SCC
Salvage RT PET/CT:2.4x2.7x2.3 cm at the mediastinum.
PET/CT: mediastinum mass
2009/07/01 2009/07/14 2009/08/05 ~ 2009/09/08
2010/09/01
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2010-06-18
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Head & Neck : No finding
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Patient history
Salvage CCRT
RTdose:5400cGy/30fx
C/T: cisplatin + 5-FU
subcarinal, biopsy : Metastatic SCC
2010/09/17
2010/10/04 ~ 2010/12/24
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2010-10-22Posterior neck mass: excision pathology: benign
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Patient history
• 2010/12/31 ENT OPD
• C.C.:Chest wall pain with mild dyspnea for days.
• Fiberscope: susp. T-E fistula
refer to CS OPD and admission
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Patient history
• 2011/01/03 CHEST CT:
• ----A fistula formation noted between left main bronchus and the gastric tube noted.
• ----left lower lung aspiration pneumonia.
• ----Suspicious residual tumor in right side of carinal region.
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Patient history
• 2011/01/04 bronchus, biopsy :
Inflammatory exudate and fibrous tissue, consistent with fistula
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Patient history
• 2011/01/06 ： • Endoesophageal intubation with stent of
T-E fistula
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Patient history
• 2011/03/02 Chest CT :
4 x 2 cm mass in right side of the gastric tube, from above carina level to below carina level, consistent with residual tumor.
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Thanks for your attention~!