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Lymph node dissection with cervical approach as a salvage surgery for locoregional failure after definitive chemoradiotherapy in a patient with recurrent esophageal carcinoma: report of a case

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Abstract

Salvage surgery is one important therapeutic option after locoregional failure of definitive chemoradiotherapy (dCRT) in patients with advanced or recurrent esophageal carcinoma. We have performed cervical lymph node dissection as a salvage surgery after chemoradiotherapy in a patient with recurrent esophageal carcinoma. A 54-year-old Japanese man was admitted to our hospital because of multiple lymph node metastases after endoscopic submucosal dissection (ESD) for early-stage esophageal carcinoma. The patient underwent a circumferential ESD of early-stage esophageal carcinoma in another hospital. The esophageal carcinoma, measuring 75 × 60 mm in size, was a superficial spreading type located in the middle portion of the thoracic esophagus. Histology of the resected specimen revealed a moderately to poorly differentiated squamous cell carcinoma, and the depth of invasion was limited within the mucosal layer associated with a small area being attached to the muscularis mucosae. Five months after ESD, lymph node metastases in the regions of right recurrent nerve and the left tracheobronchus were found, for which dCRT was performed. These metastatic lymph nodes disappeared in the chest CT scan images. Lymph node metastasis in the region of the right recurrent nerve then reappeared 8 months after the completion of CRT. Considering the solitary lymph node metastasis and surgical invasiveness, lymph node dissection using a cervical approach was selected as a salvage surgery. Cervical approach for the lymph node dissection in the region of right recurrent nerve may be one feasible option as a minimally invasive salvage surgery for patients with recurrent esophageal carcinoma after dCRT.

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Authors and Affiliations

  1. Department of Surgery, Fujita Health University School of Medicine, 1-98 Dengakugakubo Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan

    Fumihiro Yoshimura, Yoichi Sakurai, Shinpei Furuta, Risaburo Sunagawa, Kazuki Inaba, Jun Isogaki, Yoshiyuki Komori & Ichiro Uyama

  2. Department of Surgery, Ban Buntane Houtokukai Hospital, Fujita Health University, Aichi, Japan

    Soji Ozawa

Authors
  1. Fumihiro Yoshimura
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  2. Yoichi Sakurai
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  3. Shinpei Furuta
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  4. Risaburo Sunagawa
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  5. Kazuki Inaba
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  6. Jun Isogaki
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  7. Yoshiyuki Komori
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  8. Ichiro Uyama
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  9. Soji Ozawa
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Corresponding author

Correspondence to Yoichi Sakurai.

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Yoshimura, F., Sakurai, Y., Furuta, S. et al. Lymph node dissection with cervical approach as a salvage surgery for locoregional failure after definitive chemoradiotherapy in a patient with recurrent esophageal carcinoma: report of a case. Esophagus 6, 55–61 (2009). https://doi.org/10.1007/s10388-008-0178-4

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  • DOI: https://doi.org/10.1007/s10388-008-0178-4

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