Salvage surgery for lung cancer with tracheo-oesophageal fistula during concurrent chemoradiotherapy

A 48-year-old man presenting with cough, dysphagia and chest pain was diagnosed with advanced inoperable squamous cell carcinoma located in the right S2 with mediastinal lymph node metastases invading the oesophagus (c-T4N2M0 stage IIIB). Concurrent chemoradiotherapy (66 Gy) was planned, but he developed a tracheo-oesophageal fistula during the chemoradiotherapy course (26 Gy). A right sleeve pneumonectomy with oesophagectomy, cervical oesophagostomy and enterostomy were performed. Although bilateral recurrent nerve palsy occurred, he recovered via enhanced rehabilitation and was discharged 28 days after the salvage surgery. Three months after the initial surgery, staged reconstruction surgery of the stomach was performed. Intensive rehabilitation resulted in restored swallowing ability. He is alive with recurrent disease 12 months after surgery. This is the first report of salvage surgery for advanced lung cancer with tracheo-oesophageal fistula during concurrent chemoradiotherapy.