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Lymphadenectomy via a cervical approach for upper mediastinal lymph node recurrence of esophageal cancer: Report of a case

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Abstract

Although there have been several reports about salvage esophagectomy after definitive chemoradiotherapy (CRT), the effectiveness of lymphadenectomy for lymph node recurrence after CRT has not been fully evaluated. Radiation-induced tissue injury and fibrosis make lymphadenectomy after CRT difficult, therefore the choice of surgical approach should be considered carefully. We performed lymphadenectomy via a cervical approach in a 76-year-old man with upper mediastinal lymph node recurrence. He had previously undergone subtotal esophagectomy for squamous cell carcinoma of the upper thoracic esophagus. At 33 months after the operation, left upper mediastinal lymph node recurrence occurred. After localized CRT with docetaxel plus 60 Gy radiation, the tumor disappeared. However, at 1 year after CRT a lymph node recurrence, measuring 10 mm in size, was found in the same position on a computed tomography (CT) scan and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) without other recurrences. Lymphadenectomy was performed via a left cervical approach using a Kent retractor to extend the surgical view of the cervicothoracic region. The patient was discharged without complications, and a postoperative CT scan and FDG-PET revealed complete resection of the tumor. In conclusion, our surgical procedure provides a good surgical view, and decreases surgical stress and the incidence of postoperative complications.

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Authors and Affiliations

  1. Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan

    Hiroyuki Tada, Atsushi Shiozaki, Hitoshi Fujiwara, Daisuke Ichikawa, Kazuma Okamoto, Shuhei Komatsu, Yasutoshi Murayama, Hisashi Ikoma, Yoshiaki Kuriu, Masayoshi Nakanishi, Toshiya Ochiai, Yukihito Kokuba, Teruhisa Sonoyama & Eigo Otsuji

Authors
  1. Hiroyuki Tada
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  2. Atsushi Shiozaki
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  3. Hitoshi Fujiwara
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  4. Daisuke Ichikawa
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  5. Kazuma Okamoto
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  6. Shuhei Komatsu
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  7. Yasutoshi Murayama
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  8. Hisashi Ikoma
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  9. Yoshiaki Kuriu
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  10. Masayoshi Nakanishi
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  11. Toshiya Ochiai
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  12. Yukihito Kokuba
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  13. Teruhisa Sonoyama
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  14. Eigo Otsuji
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Tada, H., Shiozaki, A., Fujiwara, H. et al. Lymphadenectomy via a cervical approach for upper mediastinal lymph node recurrence of esophageal cancer: Report of a case. Surg Today 41, 1562–1566 (2011). https://doi.org/10.1007/s00595-010-4521-8

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  • DOI: https://doi.org/10.1007/s00595-010-4521-8

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