title: Lymphadenectomy via a cervical approach for upper mediastinal lymph node recurrence of esophageal cancer: report of a case.
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 (18)F-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.
authors.affiliation: Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tada
authors.forename: Atsushi
authors.initials: A
authors.lastname: Shiozaki
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Fujiwara
authors.forename: Daisuke
authors.initials: D
authors.lastname: Ichikawa
authors.forename: Kazuma
authors.initials: K
authors.lastname: Okamoto
authors.forename: Shuhei
authors.initials: S
authors.lastname: Komatsu
authors.forename: Yasutoshi
authors.initials: Y
authors.lastname: Murayama
authors.forename: Hisashi
authors.initials: H
authors.lastname: Ikoma
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Kuriu
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Nakanishi
authors.forename: Toshiya
authors.initials: T
authors.lastname: Ochiai
authors.forename: Yukihito
authors.initials: Y
authors.lastname: Kokuba
authors.forename: Teruhisa
authors.initials: T
authors.lastname: Sonoyama
authors.forename: Eigo
authors.initials: E
authors.lastname: Otsuji
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000556:secondary / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008482:Mediastinum; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D049268:Positron-Emission Tomography; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome