Thoracoscopic Esophagectomy for Metachronous Esophageal Cancer after Heller-Dor Surgery for Achalasia with Marked Esophageal Dilatation: A Case Report.
5 affiliations
- 1Department of Digestive Surgery, Omi Medical Center, Kusatsu, Shiga, Japan.
- 2Department of Surgery, Shiga University of Medical Science, Kusatsu, Shiga, Japan.
- 3Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan.
- 4Department of Gastroenterology, Omi Medical Center, Kusatsu, Shiga, Japan.
- 5Department of Diagnostic Pathology, Omi Medical Center, Kusatsu, Shiga, Japan.
Abstract
Introduction
Achalasia is associated with an increased risk of esophageal squamous cell carcinoma even after definitive surgical treatment. Heller-Dor surgery is an established surgical treatment for achalasia; however, marked esophageal dilatation may persist despite successful symptom control and pose technical challenges during subsequent esophagectomy.Case presentation
A 73-year-old man with a history of Heller-Dor surgery for achalasia and prior endoscopic submucosal dissection (ESD) for esophageal squamous cell carcinoma developed a metachronous lesion at a different esophageal site. Histopathological examination after ESD demonstrated deep submucosal and vascular invasion, warranting additional curative treatment. Preoperative imaging showed predominant upper thoracic esophageal dilatation with a maximum diameter of 56 mm, whereas gastric deformity was minimal. The patient underwent prone-position video-assisted thoracoscopic subtotal esophagectomy with 3-field lymphadenectomy and retrosternal gastric conduit reconstruction. Intraoperatively, venous engorgement required meticulous dissection, while marked upper thoracic esophageal dilatation restricted the operative workspace around the left recurrent laryngeal nerve. An internal organ retractor provided stable esophageal traction with flexible repositioning of the traction point, facilitating adequate exposure. Despite intra-abdominal adhesions from the previous surgery, gastric conduit reconstruction was successfully completed as anticipated from the preoperative assessment of gastric anatomy. Final histopathological examination revealed no residual carcinoma or lymph node metastasis. The postoperative course was uneventful, and the patient remained recurrence-free at 2 years.Conclusions
Long-term endoscopic surveillance remains important after surgical treatment for achalasia. In patients requiring subsequent esophagectomy, preoperative assessment of the degree and distribution of esophageal dilatation may help anticipate technical difficulty, while appropriate repositionable traction may facilitate operative exposure. Careful assessment of gastric anatomy may also help determine the feasibility of gastric conduit reconstruction after Heller-Dor surgery.
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BibTeX
@article{an2026thoracoscopic,
title = {{Thoracoscopic Esophagectomy for Metachronous Esophageal Cancer after Heller-Dor Surgery for Achalasia with Marked Esophageal Dilatation: A Case Report.}},
author = {Byonggu An and Tetsuya Abe and Yasumitsu Oe and Hiromitsu Ban and Toru Imagami and Akira Sogawa and Nobuyuki Takao and Takashi Matsunaga and Akiyoshi Mizumoto and Shizuki Takemura and Atsushi Hirata and Takuma Kawaguchi and Toru Miyake and Takeshi Togawa},
journal = {Surgical case reports},
year = {2026},
month = oct,
doi = {10.70352/scrj.cr.26-0566},
url = {https://europepmc.org/article/MED/42908568},
note = {CC BY},
}
RIS
TY - JOUR
TI - Thoracoscopic Esophagectomy for Metachronous Esophageal Cancer after Heller-Dor Surgery for Achalasia with Marked Esophageal Dilatation: A Case Report.
AU - Byonggu An
AU - Tetsuya Abe
AU - Yasumitsu Oe
AU - Hiromitsu Ban
AU - Toru Imagami
AU - Akira Sogawa
AU - Nobuyuki Takao
AU - Takashi Matsunaga
AU - Akiyoshi Mizumoto
AU - Shizuki Takemura
AU - Atsushi Hirata
AU - Takuma Kawaguchi
AU - Toru Miyake
AU - Takeshi Togawa
PY - 2026
DA - 2026/10/16
JO - Surgical case reports
DO - 10.70352/scrj.cr.26-0566
UR - https://europepmc.org/article/MED/42908568
AB - Introduction Achalasia is associated with an increased risk of esophageal squamous cell carcinoma even after definitive surgical treatment. Heller-Dor surgery is an established surgical treatment for achalasia; however, marked esophageal dilatation may persist despite successful symptom control and pose technical challenges during subsequent esophagectomy.Case presentation A 73-year-old man with a history of Heller-Dor surgery for achalasia and prior endoscopic submucosal dissection (ESD) for esophageal squamous cell carcinoma developed a metachronous lesion at a different esophageal site. Histopathological examination after ESD demonstrated deep submucosal and vascular invasion, warranting additional curative treatment. Preoperative imaging showed predominant upper thoracic esophageal dilatation with a maximum diameter of 56 mm, whereas gastric deformity was minimal. The patient underwent prone-position video-assisted thoracoscopic subtotal esophagectomy with 3-field lymphadenectomy and retrosternal gastric conduit reconstruction. Intraoperatively, venous engorgement required meticulous dissection, while marked upper thoracic esophageal dilatation restricted the operative workspace around the left recurrent laryngeal nerve. An internal organ retractor provided stable esophageal traction with flexible repositioning of the traction point, facilitating adequate exposure. Despite intra-abdominal adhesions from the previous surgery, gastric conduit reconstruction was successfully completed as anticipated from the preoperative assessment of gastric anatomy. Final histopathological examination revealed no residual carcinoma or lymph node metastasis. The postoperative course was uneventful, and the patient remained recurrence-free at 2 years.Conclusions Long-term endoscopic surveillance remains important after surgical treatment for achalasia. In patients requiring subsequent esophagectomy, preoperative assessment of the degree and distribution of esophageal dilatation may help anticipate technical difficulty, while appropriate repositionable traction may facilitate operative exposure. Careful assessment of gastric anatomy may also help determine the feasibility of gastric conduit reconstruction after Heller-Dor surgery.
SN - 2198-7793
ER -