Radical esophagectomy for esophageal squamous cell carcinoma with active pulmonary tuberculosis: a five-case series with perioperative anti-tuberculosis bridging and concurrent adjuvant therapy

Abstract Background Esophageal squamous cell carcinoma (ESCC) complicated by active pulmonary tuberculosis (PTB) confronts the surgeon with two opposing risks: resection cannot be delayed indefinitely, yet operating on a patient with active PTB invites dissemination, and rifamycin–chemotherapy interactions complicate adjuvant treatment. Evidence to guide perioperative management is scarce. Methods We retrospectively reviewed five patients with ESCC and active PTB confirmed by bronchoalveolar lavage fluid (BALF) PCR and Xpert MTB/RIF who underwent radical esophagectomy at our tuberculosis-specialty center between June 2021 and April 2024. All followed a uniform pathway: 3 weeks of preoperative anti-tuberculosis treatment (ATT), McKeown esophagectomy with intravenous-to-oral ATT bridging, and adjuvant chemotherapy from postoperative week 3 concurrent with 12-month ATT. Results All five patients (4 men, 1 woman; median age 68 years, range 66–73) completed surgery and six cycles of nanoparticle albumin-bound paclitaxel plus cisplatin during ATT; two also received adjuvant radiotherapy. No anastomotic leakage, pneumonia, TB dissemination, drug-induced liver injury, or grade ≥ 3 myelosuppression occurred. Repeat bronchoscopy at 12 months showed negative BALF PCR and Xpert MTB/RIF in all patients; at 2 years, no tumor recurrence or TB relapse was observed. Conclusions A structured perioperative ATT pathway with intravenous-to-oral bridging permits timely radical esophagectomy and concurrent adjuvant therapy with acceptable safety in patients with ESCC and BALF-confirmed active PTB. The referral model linking general hospitals to tuberculosis-specialty centers is replicable in endemic regions.