부산대학교 도서관

Background Recently it was reported by World Health Organization that over 36 million people are living with HIV globally; for the first time ever life expectancy in people with HIV exceeds the average. This is mainly due to the development of highly active antiretroviral medication that have turned AIDS from a life threatening disease to a chronic condition. HIV patients are as prone as the general population to developing esophageal cancer. We aim to describe our experience and factors for consideration whilst treating HIV patients with esophageal cancer. Methods In 2017, 77 cases were surgically treated for esophageal and gastroesophageal junction cancer in our tertiary referral centre. n = 2 (2.5%) were HIV positive. Their disease, demographic and surgical characteristics were analyzed and the outcomes are presented. Results A 62 and 65-year-old HIV male patients had 2-stage esophagectomy for gastro-esophageal junction adenocarcinoma. They both had similarities with locally advanced tumours and late presentation with dysphagia and > 10% total body weight loss. Clinical staging revealed T3N2M0 tumours in both cases. Viral load was low (< 40 copies/mL) and both had neoadjuvant chemotherapy as first line of treatment. Both had a 2-stage esophagectomy; one had laparoscopic-assisted and the other had totally minimally invasive. Histological staging was ypT3N1 and ypT3N3 respectively. Antiretroviral medications were in both started enterally on day 1; in the first case via a triple-lumen nasojejunal feeding tube and in the second via a single-lumen nasogastric tube. No feeding jejunostomies were placed. No immediate post-operative complications were noted. Length of stay was 14 and 8 days respectively. Conclusion AIDS patients with esophageal cancer can present late, with advanced tumors, as dysphagia is common due to fungal esophagitis and tends to be underestimated. Where indicated, this cohort of patients should receive full multimodality treatment, like the general population, as results are no different. Multidisciplinary approach with involvement of an HIV specialist doctor from the beginning of treatment planning is of paramount importance as optimization prior to surgery is commonly necessary. Antiretroviral medications are needed immediately post-operatively in all cases and a clear plan for enteral route administration should be in place. Disclosure All authors have declared no conflicts of interest. [ABSTRACT FROM AUTHOR]