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Complications after oesophagectomy with possible contribution of neoadjuvant therapy including an EGFR-antibody to a fatal outcome.

Knauer M, Haid A, Ammann K, Lang A, Offner F, Türtscher M, Cerkl P, Wenzl E - World J Surg Oncol (2007)

Bottom Line: Administration is said to be safe and well tolerated with common, usually mild dermatologic side effects.So far we have never observed this fatal combination of drain erosion of the stomach with fibrinous pleurisy and unmanageable progressive tracheal defect before.Clinicians should be aware of the possibility of fatal side effects and careful recording of all complications is necessary in ongoing and planned studies to obtain more evidence about safety and tolerance of targeted therapies.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of General and Thoracic Surgery, General Hospital of Feldkirch, Academic Teaching Hospital, Feldkirch, Austria. knaui@gmx.at.

ABSTRACT

Background: Different molecular therapies like the EGFR-inhibiting antibody cetuximab have come into clinical practice. Cetuximab is EMEA-approved for metastatic colorectal cancer and advanced squamous-cell head and neck cancer. Administration is said to be safe and well tolerated with common, usually mild dermatologic side effects.

Case presentation: We present the case of a patient with fatal complications after oesophagectomy and neoadjuvant chemotherapy including cetuximab for squamous-cell esophageal cancer. A transthoracic en-bloc oesophagectomy was performed. Few days later the patient died due to gas exchange dysfunction and circulation instability after a previously unseen combination of drain-erosion of the stomach with subsequent pleurisy and air leak of the left main bronchus.

Conclusion: So far we have never observed this fatal combination of drain erosion of the stomach with fibrinous pleurisy and unmanageable progressive tracheal defect before. The role of cetuximab in the multifactorial aetiology of damages of stomach and trachea after oesophagectomy remains unclear since we are not able to link the complication directly to cetuximab or definitely exclude it as a sole surgical complication. Clinicians should be aware of the possibility of fatal side effects and careful recording of all complications is necessary in ongoing and planned studies to obtain more evidence about safety and tolerance of targeted therapies.

No MeSH data available.


Related in: MedlinePlus

Autopsy results: inflammatory trachea (white arrow), tracheal leak in left main bronchus (black arrow), fibrinous pleurisy (white triangle).
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Figure 3: Autopsy results: inflammatory trachea (white arrow), tracheal leak in left main bronchus (black arrow), fibrinous pleurisy (white triangle).

Mentions: The autopsy showed massive fibrinous pleurisy, mediastinitis, left-sided bronchitis and bronchopneumonia in addition to the 2 cm tracheal defect of the membranous part of the left main bronchus. Histological complete tracheal wall destruction was observed with fibrin, necrotic areas and focal formation of granulation tissue without evidence of residual tumour (figure 3).


Complications after oesophagectomy with possible contribution of neoadjuvant therapy including an EGFR-antibody to a fatal outcome.

Knauer M, Haid A, Ammann K, Lang A, Offner F, Türtscher M, Cerkl P, Wenzl E - World J Surg Oncol (2007)

Autopsy results: inflammatory trachea (white arrow), tracheal leak in left main bronchus (black arrow), fibrinous pleurisy (white triangle).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2147013&req=5

Figure 3: Autopsy results: inflammatory trachea (white arrow), tracheal leak in left main bronchus (black arrow), fibrinous pleurisy (white triangle).
Mentions: The autopsy showed massive fibrinous pleurisy, mediastinitis, left-sided bronchitis and bronchopneumonia in addition to the 2 cm tracheal defect of the membranous part of the left main bronchus. Histological complete tracheal wall destruction was observed with fibrin, necrotic areas and focal formation of granulation tissue without evidence of residual tumour (figure 3).

Bottom Line: Administration is said to be safe and well tolerated with common, usually mild dermatologic side effects.So far we have never observed this fatal combination of drain erosion of the stomach with fibrinous pleurisy and unmanageable progressive tracheal defect before.Clinicians should be aware of the possibility of fatal side effects and careful recording of all complications is necessary in ongoing and planned studies to obtain more evidence about safety and tolerance of targeted therapies.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of General and Thoracic Surgery, General Hospital of Feldkirch, Academic Teaching Hospital, Feldkirch, Austria. knaui@gmx.at.

ABSTRACT

Background: Different molecular therapies like the EGFR-inhibiting antibody cetuximab have come into clinical practice. Cetuximab is EMEA-approved for metastatic colorectal cancer and advanced squamous-cell head and neck cancer. Administration is said to be safe and well tolerated with common, usually mild dermatologic side effects.

Case presentation: We present the case of a patient with fatal complications after oesophagectomy and neoadjuvant chemotherapy including cetuximab for squamous-cell esophageal cancer. A transthoracic en-bloc oesophagectomy was performed. Few days later the patient died due to gas exchange dysfunction and circulation instability after a previously unseen combination of drain-erosion of the stomach with subsequent pleurisy and air leak of the left main bronchus.

Conclusion: So far we have never observed this fatal combination of drain erosion of the stomach with fibrinous pleurisy and unmanageable progressive tracheal defect before. The role of cetuximab in the multifactorial aetiology of damages of stomach and trachea after oesophagectomy remains unclear since we are not able to link the complication directly to cetuximab or definitely exclude it as a sole surgical complication. Clinicians should be aware of the possibility of fatal side effects and careful recording of all complications is necessary in ongoing and planned studies to obtain more evidence about safety and tolerance of targeted therapies.

No MeSH data available.


Related in: MedlinePlus