Cardioesophageal Cancer in Liver Cirrhosis and PV Thrombosis – Case Report

Abstract Background Liver cirrhosis is often a concomitant condition in oncological patients. This paper concerns surgical patients with non-hepatobiliary gastrointestinal tumors complicated with liver cirrhosis and portal hypertension. The challenge of comorbidity is significant and requires the involvement of a multidisciplinary team of surgeons, hepatologists, radiologists and oncologists. Chronic liver injury manifests with fibrosis, and in late stages liver cirrhosis. It is an alteration of liver architecture, with nodule formation and blood flow impairment. The decompensated stage of liver cirrhosis develops ascites, variceal bleeding, hepatorenal syndrome and encephalopathy. Despite advances in surgical technique and intensive care, patients with liver cirrhosis undergoing major surgery are at a high risk of mortality or significant complications. Case presentation Our patient is a 52 years old man post COVID-19, with Diabetes Mellitus, liver cirrhosis, portal vein thrombosis and bleeding esophageal varices. He was diagnosed with cardi-esophageal cancer and biopsy confirms adenocarcinoma. The patient was consulted by the oncologists, who decide in favour of surgery prior to chemo-radiotherapy, given the serious comorbidities. After a consensus was reached, the patients underwent the Ivor-Lewis procedure successfully and was discharged in good health. Discussion Current studies and meta-analyses highlight the importance of Child-Turcotte-Pugh classification of cirrhotic patients in estimating the post-operative complications. Child A and B liver cirrhosis may in itself not contraindicate surgical esophagectomy, but patient selection is paramount as esophageal cancer is associated with a high rate of early post-operative complications. Child A patients with an adequately compensated liver cirrhosis may respond to radio-chemotherapy similarly to patients with esophageal cancer without cirrhosis. Conversely, Child B patients do not tolerate well the appropriate chemo-radiotherapy protocols, and are at risk of serious systemic complications. Conclusion In conclusion, patients undergoing major surgery with concomitant liver cirrhosis are at a greater risk of developing serious complications, such as hepato-renal syndrome, ascites, haemorrhage, anastomotic fistula and have a high mortality rate. The multidisciplinary team should thoroughly assess the patient and provide a mature decision in the selection of surgery as a treatment modality for esophageal and gastric cancer, especially in cirrhotic patients of various degrees.