Abstract
The patient was a 73-year-old female who had been diagnosed with squamous cell carcinoma of the lower thoracic esophagus in the clinical stage of cT3N0M0 cStage II A (UICC TNM classification of malignant tumors, 6th eddition). As the definitive chemoradiotherapy (dCRT), she received 2 courses of systemic chemotherapy with nedaplatin and 5-fluorouracil, and concomitantly a total of 60Gy of irradiation. And 2 courses of the same chemotherapy regimen were added. After dCRT and additional chemotherapy, endoscopy and CT scan revealed disappearance of the primary lesion and we judged the outcome as complete response (CR).
Five years and one month after the initial therapy, abdominal CT scan revealed swelling of abdominal lymph node in the lesser curvature of the stomach. PET-CT also revealed high FDG uptake in the same region. No abnormal uptake of FDG to other regions was seen. Solitary metastasis of the esophageal cancer to the abdominal lymph node was thus diagnosed. Furthermore, endoscopy revealed a 0-II b type new early esophageal cancer in the upper thoracic esophagus, which was diagnosed as squamous cell carcinoma in-situ histologically. We performed laparoscopic abdominal lymphadenectomy for the metastatic lymph node as salvage surgery and endoscopic submucosal dissection (ESD) for the upper thoracic esophageal lesion, simultaneously. Treatment of recurred lesions of esophageal cancer is debatable. We here report a case of laparoscopic abdominal lymphadenectomy for lymph node recurrence as salvage surgery following dCRT for esophageal cancer.
