Other reports identified postoperative complications of grades 3—4 and adenocarcinoma histology as prognostic factors [ 19 ]. Since the present case had no characteristics predictive of a miserable prognosis, the patient was offered intensive treatment for the recurrences. The diagnosis 3metastases is sometimes difficult.
However, in this case, the histological features of each resected specimen were similar to the primary ESCC, and they were diagnosed as metastases. As explained, the first recurrence was observed in the periphery of the left lung at 3 years after the first operation. This progression was relatively slower than that reported in previous reports [ 8 , 9 , 20 ]. The lung is one of the most common organs to which esophageal cancers metastasize [ 21 ], but lung metastases often occur concurrently with metastases to other organs or involve multiple metastases at both lungs [ 9 ].
Surgical resection for lung metastases is therefore rarely performed [ 16 ]. The general outlook of patients after resection of lung metastases is believed to be extremely poor, with reported mean survival periods ranging from 6 to 10 months [ 22 ]. However, this case showed that pulmonary metastasectomy might provide favorable outcomes in recurrent cases if the extent of disease is limited and the tumor is non-aggressive. Unlike in lung metastases, patients with metastases to the locoregional LNs have been reported to achieve longer survival with multidisciplinary treatment, which included resection of the involved nodes [ 9 , 22 , 23 ].
The standard of therapy for recurrent LN metastases has not been defined owing to variations in recurrence patterns, and clear recommendations on the use of chemoradiation or surgery are not available [ 1 ]. In our practice, locoregional LN recurrences are resected upfront if operable, followed by chemotherapy to ensure no further recurrences. If surgical resection is not feasible owing to poor performance status, organ dysfunction, or inoperability of metastatic lesions, radiation therapy is administered as appropriate.
Nakamura et al. In the present case, the metastatic mediastinal, intra-abdominal, and hilar LN posed difficulties for complete resection, requiring combined chemotherapy and radiation. Past reports have discussed the efficacy of multidisciplinary treatment for recurrences after curative surgery in esophageal cancer. Iitaka et al. Their patient received combined chemotherapy, radio-frequency ablation, and surgery for the recurrences in the liver and lung after curative esophagectomy. Consequently, the patient survived for 29 months after the primary operation.
Suzuki et al. He survived for about 6 years after the primary esophagectomy with these multidisciplinary treatments. In a case series described by Chen et al. These patients had metastases from esophageal carcinoma after curative esophagectomy [ 16 ]; the median overall survival was 24 months range 13—90 months. The authors suggested that patients with solitary pulmonary metastases were good candidates for surgery and had a favorable prognosis. The present case demonstrates long-term survival with multidisciplinary treatment for sequential recurrences in the lung and LNs, and supports the efficacy of multimodal and intensive therapy for multiple recurrences in the LNs and lungs.
The patient outcomes of the cases in which intensive or local treatments are particularly effective is a matter of interest. A report by Ghaly et al. They studied patients with recurrence after R0 esophagectomy; 56 patients received definitive treatment for isolated esophageal cancer EC recurrences, of whom 31 were treated surgically, and 25 patients received definitive chemoradiotherapy alone. The median survival after recurrence in the former group was Among the 56 patients who had definitive treatments for recurrence, 31 patients In a case series of 42 patients, Kato et al described the treatment of recurrent or residual esophageal SCC with resection, after definitive chemoradiotherapy or surgery [ 28 ].
A total of 33, 6, and 3 patients underwent resections of LNs, lung, and other recurrent tumor sites, respectively. Among them, 9 survived more than 3 years, of whom 4 had undergone salvage abdominal lymphadenectomy, 3 underwent resection for solitary lung recurrence, and 2 had undergone surgery at other sites. The authors concluded that surgery for abdominal LN recurrences, LN recurrences outside the radiation field, and solitary lung recurrence was effective.
Considering these reports, the numbers of cases with good outcomes to intensive treatment may vary according to the organs involved with recurrence, and the treatment modality offered. LN and lung recurrences are easy to treat intensively; these patients may achieve longer survival. The interval between each recurrence plays an important role in deciding the therapeutic strategy.
To date, only a few studies have investigated the interval between each recurrence, as long-term survival after repeated surgeries or other forms of definitive therapy in cases of recurrent esophageal cancer, is rare.
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In the present case, the first recurrence was recognized in the third year after primary resection. However, the interval between each of the treated recurrences was within 1 year. Recurrences occurring within 1 year after surgery are common in clinical practice, but in this case, each recurrent lesion was solitary or locoregional, which allowed intensive multidisciplinary treatment. In summary, we speculate that intensive and multimodality treatment is likely to be particularly effective if the recurrent lesion is solitary or locoregional, and slowly progressive; in cases selected for resection, surgery is particularly effective if the tumor is easy to approach surgically [ 27 ].
We present a case of long-term survival with multidisciplinary treatment for multiple sequential recurrences in ESCC after curative esophagectomy. Despite the poor prognosis of recurrent esophageal cancer, this case demonstrates that multidisciplinary management, including aggressive local therapies, can be particularly effective in cases with localized recurrences, appearing gradually. Cumulative accounts of similar cases, with detailed analyses, are necessary to establish the optimal treatment strategy for recurrences in ESCC.
Guidelines for diagnosis and treatment of carcinoma of the esophagus April edited by the Japan Esophageal Society. Multimodal treatment strategy for clinical T3 thoracic esophageal cancer.
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Ann Surg Oncol. Clinical outcomes of extended esophagectomy with three-field lymph node dissection for esophageal squamous cell carcinoma. Am J Surg. Prognostic significance of postoperative complications after curative resection for patients with esophageal squamous cell carcinoma. Ann Surg. Current status of and perspectives regarding neoadjuvant chemoradiotherapy for locally advanced esophageal squamous cell carcinoma. Surg Today. Survival factors in patients with recurrence after curative resection of esophageal squamous cell carcinomas.
Incidence and distribution of distant metastases from newly diagnosed esophageal carcinoma. Patterns and time of recurrence after complete resection of esophageal cancer.
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Recurrence pattern of squamous cell carcinoma of the thoracic esophagus after extended radical esophagectomy with three-field lymphadenectomy. J Am Coll Surg. The role of salvage surgery for recurrence of esophageal squamous cell cancer. Eur J Surg Oncol. The clinical application of 18F-fluorodeoxyglucose positron emission tomography to predict survival in patients with operable esophageal cancer.
Advances in esophageal cancer surgery in Japan: an analysis of consecutive patients treated at a single institute. Close mobile search navigation Article Navigation. Volume 5. Article Contents. Confocal laser endomicroscopy CLE. Cancer screening. Endoscopic eradication therapy. Diagnosis and therapy of esophageal squamous cell dysplasia and early esophageal squamous cell cancer Charumathi Raghu Subramanian.
Oxford Academic. Google Scholar. George Triadafilopoulos. Cite Citation. Permissions Icon Permissions. Abstract Esophageal squamous cell carcinoma ESCC and esophageal adenocarcinoma EAC comprise the majority of esophageal cancers, and they differ from each other in several aspects. One operation used to treat esophageal cancer is esophagectomy.
During esophagectomy, your surgeon removes the portion of your esophagus that contains the tumor, along with a portion of the upper part of your stomach, and nearby lymph nodes. The remaining esophagus is reconnected to your stomach. Usually this is done by pulling the stomach up to meet the remaining esophagus. Surgery to remove the cancer can be used alone or in combination with other treatments.
Operations used to treat esophageal cancer include:. Esophageal cancer surgery carries a risk of serious complications, such as infection, bleeding and leakage from the area where the remaining esophagus is reattached to the stomach.
Surgery to remove your esophagus can be performed as an open procedure using large incisions or with special surgical tools inserted through several small incisions in your skin laparoscopically. How your surgery is performed depends on your individual situation and your surgeon's particular approach to managing it. A metal tube stent can be used to hold open a narrowed portion of the esophagus.
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A stent is usually placed using an endoscope. Chemotherapy is drug treatment that uses chemicals to kill cancer cells. Chemotherapy drugs are typically used before neoadjuvant or after adjuvant surgery in people with esophageal cancer. Chemotherapy can also be combined with radiation therapy. In people with advanced cancer that has spread beyond the esophagus, chemotherapy may be used alone to help relieve signs and symptoms caused by the cancer.
The chemotherapy side effects that you experience depend on which chemotherapy drugs you receive. Radiation therapy uses high-powered X-ray beams to kill cancer cells. Radiation typically will come from a machine outside your body that aims the beams at your cancer external beam radiation. Or, less commonly, radiation can be placed inside your body near the cancer brachytherapy.
Radiation therapy is most often combined with chemotherapy in people with esophageal cancer. It's typically used before surgery, or occasionally after surgery. Radiation therapy is also used to relieve complications of advanced esophageal cancer, such as when a tumor grows large enough to stop food from passing to your stomach. Treatment can last from two to six weeks of daily radiation treatments. Side effects of radiation to the esophagus include sunburn-like skin reactions, painful or difficult swallowing, and accidental damage to nearby organs, such as the lungs and heart.
Combining chemotherapy and radiation therapy may enhance the effectiveness of each treatment. Combined chemotherapy and radiation may be the only treatment you receive, or combined therapy can be used before surgery. But combining chemotherapy and radiation treatments increases the likelihood and severity of side effects.
Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease. Complementary and alternative therapies may help you cope with the side effects of cancer and cancer treatment.