International Session 8　　Thyroid Cancer

We report a 47-year-old female patient who underwent total thyroidectomy for poorly-differentiated thyroid cancer.Preoperative MRI and upper endoscopy revealed that the cancer deeply invaded the esophageal muscle but not to the mucosa.Intraoperatively, we repaired the defect of esophagus mucosa which occurred with tumor resection.Oral intake started 1 month after surgery and progressed smoothly.Despite prophylactic radiotherapy started postoperatively, locoregional and lung metastases developed 8 months after surgery.Although lenvatinib was initiated thereafter and tumors were reduced 1 month later, we found fistula formation from the esophagus to the neck skin.Two weeks after discontinuing the lenvatinib, we performed reconstruction for esophageal fistula using deltopectoral flap in two-staged surgery.Oral intake and lenvatinib started again 1 and 2 months after the second stage of reconstruction.The patient presently survives with adequate oral intake and no recurrence for approximately 3 years after the diagnosis.Deltopectoral flap reconstruction is a useful procedure not only to close esophageal fistula caused by lenvatinib but to keep the potential of oral intake.