1. 2nd Interactive Case Lieven Depypere, Willy Coosemans, Georges Decker,
Hans Van Veer, Philippe Nafteux
Department of thoracic surgery, University Hospitals Leuven, Belgium

2. Male, 79 y Medical History: Arterial hypertension
Hiatus hernia with short segment Barrett
Cervical laminoforaminotomt C7-Th1 right.
Brother died from pancreatic cancer

3. Clinical presentation:
ASA 2, 177cm, 106kg
August 2014: dysphagia for solid food
Work up:
Diagnosis of EG-juction carcinoma cT3N1M0, adeno with signet cell differentiation
(upper GI endoscopy, endoscopic US with punction of lymph node, CT thorax/abdomen, FDG-PET)

4. PETCT

5. Q2.1 Would you do a staging laparoscopy as part of the diagnostic work-up?
Yes
Yes, with insertion of a feeding jejunostomy No

6. The patient was sheduled for neo-adjuvant therapy

7. Q2.2 what neo-adjuvant therapy?
Chemotherapy
Chemoradiotherapy

8. Q2.3 functional assessment
Before neo-adjuvant therapy
After neo-adjuvant therapy
Before and after neo-adjuvant therapy

9. Shortly after start of TPN: fever
with diagnosis of catheter sepsis with acineto-bacter sp, staphylococcus epidermidis, capitis and schleiferi. CVL was removed, vancomycine-piperacilline-tazobactam started and nasoduodenal feeding tube placed.
After 3 weeks vancomycine-piperacilline
Tazobactam: still fever:
Blood culture negative, urine culture negative,
BAL: candica, rare

10. Transthoracic heart ultrasound:
adjacent structure on the aortic valve without hemodynamic problems: endocarditis?

11. Q2.5 Next step? Antibiotics further
Stop antibiotics and start eventually after new cultures
Switch antibiotics
Cardiac surgery

12. …curious about the evolution?
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