A Case of Right Thoracoscopic Resection for Recurrent Mediastinal Lymph Node Metastasis after Esophagectomy

Abstract

We report a case of mediastinal lymph node recurrence after esophageal cancer surgery, which was treated with thoracoscopic lymph node dissection, and the patient is currently alive without recurrence more than 3 years after surgery. The patient was a 65-year-old man with cT3N1M0 cStage III esophageal cancer in the middle thoracic region. After preoperative FP chemotherapy, he underwent thoracoscopic subtotal esophagectomy and three-field lymph node dissection. Postoperative pathological examination showed pT3N0M0 Stage II, with a chemotherapy response grade II. One year and seven months after surgery, a 15-mm mass was found to have recurred outside the wall near the anastomosis on a CT scan, and it was diagnosed as recurrence of esophageal cancer by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). After one course of 5-FU+CDDP (FP) chemotherapy, right thoracoscopic resection was performed. The postoperative histopathological findings were lymph node recurrence of esophageal cancer. At the time of re-operation, partial re-anastomosis was also considered, but the lesion was resectable with only a myofascial surface dissection. Adhesions may be less severe after thoracoscopic surgery, and thoracoscopic reoperation may be a treatment option for ipsilateral solitary recurrence. Furthermore, diagnosis using EUS was useful in determining whether resection was feasible.