Long-Term Survival After Salvage Resection of Recurrent Esophageal Cancer with Anterior Mediastinal Lymph Node Involvement: Report of a Case

Abstract

A 55-year-old man underwent subtotal esophagectomy with extended three-field lymph node dissection for squamous cell carcinoma of the middle thoracic esophagus (histological stage pT3N4(3b)M0, pStage IVa). About 9 months later, contrast-enhanced computed tomography showed recurrence in several lymph nodes in the anterior mediastinum and the right side of the neck. We treated the recurrence by dissecting the affected nodes, followed by chemoradiotherapy. At the time of writing, 5 years later, the patient was well, without any further evidence of recurrence. Although the indications for resection of recurrent esophageal cancer are controversial and we cannot generalize about the best treatment for these patients, this case highlights the possibility of using salvage surgical resection to treat recurrent esophageal cancer with anterior mediastinal lymph node involvement in selected patients.

Prognosis and Treatment After Diagnosis of Recurrent Esophageal Carcinoma Following Esophagectomy with Curative Intent

“…The benefit of a surgical resection of recurrent esophageal carcinoma is not yet completely elucidated. A few reports showed improved survival after surgical resection; 11 , 19 , 20 however, in most studies the resection was combined with either chemotherapy or radiotherapy and was performed in only a small number of patients. Also in this study, a small group of patients ( n = 13) underwent resection of their recurrence, the majority ( n = 9) of whom had an oligometastasis.…”

The use of minimally invasive surgery for lymph node recurrence after endoscopic mucosal resection of superficial esophageal cancer

“…If recurrence is solitary or localized, which occurs in very few patients, a salvage operation is indicated. PDG-PET is useful in judging whether recurrence is solitary or multiple [8,9].…”

Clinical usefulness of18F-FDG PET/CT in the restaging of esophageal cancer after surgical resection and radiotherapy

“…The possibility of a survival benefit, however, can be deduced indirectly from results obtained in our previous study with early detection of recurrence in asymptomatic post-operation patients with gastric cancer, indicating a survival benefit of nine months [20] . The available therapeutic modalities in recurrent esophageal cancer are radical re-resection, palliative resection and bypass, laser thermocoagulation, stenting, chemotherapy, brachytherapy, and radiotherapy, alone or in combination [21,22] . The choice of a specific therapeutic modality depends on the extent of the recurrence.…”