Esophageal Cancer — Surgical

A 62-year-old man with a 40-year history of smoking presents with progressive dysphagia to solids for 3 months and unintentional weight loss of 8 kg. Endoscopy reveals a 5 cm ulcerated lesion in the mid-esophagus. Biopsy confirms squamous cell carcinoma. CT chest/abdomen shows no distant metastases, but there is invasion into the adjacent aorta. Which of the following is the most appropriate treatment strategy?

A 62-year-old woman with a history of achalasia presents with progressive dysphagia and weight loss over 8 months. Upper endoscopy reveals a narrowed esophageal lumen with a nodular, ulcerated lesion at the gastroesophageal junction. Biopsy confirms adenocarcinoma. CT staging shows a 5 cm tumor with invasion into the cardia and fundus of the stomach, with no distant metastases (T4aN0M0). The patient is medically fit. What is the most appropriate surgical approach?

A 58-year-old man from rural India presents with progressive dysphagia to solids for 6 months, followed by dysphagia to liquids. He has lost 8 kg. He is a chronic tobacco and alcohol user. Upper endoscopy reveals a fungating lesion in the mid-esophagus. Biopsy confirms squamous cell carcinoma. CT chest shows a 4 cm tumor with invasion into the adjacent mediastinum but no distant metastases. Endoscopic ultrasound (EUS) shows T3N1M0 disease. The patient is fit for surgery. What is the most appropriate surgical management?

A 62-year-old man from rural India presents with progressive dysphagia to solids for 4 months, weight loss of 8 kg, and retrosternal chest pain. He is a chronic tobacco chewer and alcohol user. Upper endoscopy reveals a 4 cm ulcerated lesion in the mid-esophagus with irregular borders. Biopsy confirms squamous cell carcinoma. CT chest shows the tumor invades the mediastinum but does not involve the aorta or tracheobronchial tree. There is no evidence of distant metastasis. What is the most appropriate surgical approach for this patient?

A 58-year-old woman undergoes Ivor Lewis esophagectomy for mid-esophageal adenocarcinoma. On postoperative day 5, she develops acute onset fever (38.8°C), tachycardia (110 bpm), left-sided chest pain, and subcutaneous emphysema in the left neck. Chest X-ray shows left pleural effusion and mediastinal widening. What is the most likely complication and what is the immediate next step?