A surgical case of radiotherapy induced esophageal perforation accompanying pyogenic spondylodiscitis: a case report

BACKGROUND: Stereotactic body radiotherapy has been a treatment choice for lung cancer, especially in medically inoperable patients. However, the acute and late toxicity to adjacent organs have been reported as an uncommon but severe adverse effect. CASE PRESENTATION: A 65-year-old male was presented with his back pain and pyrexia. He had been followed up for non-small-cell lung cancer, which was treated by the stereotactic body radiotherapy 4 years prior to the current visit. The endoscopy revealed an esophageal perforation on its left side in the upper thoracic locus. Because of his poor lung function, he was managed by the conservative treatment. After 3 months, his back pain recurred with developing paraplegia in the lower extremities. The MRI revealed an abscess formation at the posterior side of the upper thoracic esophagus which destroyed the vertebral body and compressed the spinal cord. Laminectomy and two-stage operation—the first stage, nontransthoracic esophagectomy, cervical and transhiatal approach using mediastinoscope and laparoscope, and the second stage, esophageal reconstruction—were performed. CONCLUSION: This complex disease status was successfully managed by the orthopedic surgery followed by a two-stage esophagectomy without transthoracic approach.