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

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

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)

PETCT

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

The patient was sheduled for neo-adjuvant therapy

Q2.2 what neo-adjuvant therapy? Chemotherapy Chemoradiotherapy

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

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

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

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

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