Successful Treatment of Advanced Esophageal Cancer with a Constitutional Indocyanine Green Excretory Defect Using Multidisciplinary Radical Therapy: A Case Report

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  • Nakasha Yasumasa
    Department of Surgery, Komatsu Municipal Hospital Department of Gastrointestinal Surgery, Kanazawa University Hospital
  • Okamoto Koichi
    Department of Gastrointestinal Surgery, Kanazawa University Hospital
  • Shimada Mari
    Department of Gastrointestinal Surgery, Kanazawa University Hospital
  • Saito Hiroto
    Department of Gastrointestinal Surgery, Kanazawa University Hospital
  • Yamaguchi Takahisa
    Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital
  • Moriyama Hideki
    Department of Gastrointestinal Surgery, Kanazawa University Hospital
  • Kinoshita Jun
    Department of Gastrointestinal Surgery, Kanazawa University Hospital
  • Nakamura Keishi
    Department of Gastrointestinal Surgery, Kanazawa University Hospital
  • Ninomiya Itasu
    Department of Surgery, Fukui Prefectural Hospital
  • Ikeda Hiroko
    Department of Diagnostic Pathology, Kanazawa University Hospital
  • Inaki Noriyuki
    Department of Gastrointestinal Surgery, Kanazawa University Hospital

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  • 体質性indocyanine green排泄異常症を伴う進行食道癌に対して集学的治療により治癒切除を遂行できた1例

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<p>A constitutional indocyanine green (ICG) excretory defect is a rare liver disease, in which histopathological findings indicate no obvious abnormality in the liver; however, excretion of ICG is severely impaired. A 57-year-old man was referred to our department for surgical treatment of advanced esophageal cancer with mediastinal lymph node metastasis. A pretreatment ICG test revealed an abnormally high ICG retention rate of 72.1% at 15 min. 99m-Tc-galactosyl-human serum albumin liver scintigraphy also indicated decreased liver reserve. Conversely, a blood test indicated Grade A in the Child-Pugh classification. The patient was treated with three courses of docetaxel, cisplatin, and 5-fluorouracil as preoperative chemotherapy with appropriate dose adjustment. Liver biopsy performed after the chemotherapy led to histopathological diagnosis of a constitutional ICG excretory defect with no obvious hepatitis or liver fibrosis. We selected radical surgery, and performed robot-assisted thoracoscopic esophagectomy with mediastinal lymph node dissection and thoracic duct preservation, and posterior mediastinal route gastric conduit reconstruction. Intraoperative morphological findings revealed an almost normal liver. No serious chemotherapy-induced adverse events or postoperative complications were observed. We report this rare case as an example of successful treatment of advanced esophageal cancer with a constitutional ICG excretory defect using multidisciplinary radical therapy.</p>

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