Abstract
BackgroundEsophageal carcinomas are highly malignant tumors with a high frequency of lymph node and distant organ metastasis. Treatment for recurrent tumors is generally decided on an individual basis. Although multidisciplinary treatments involving chemotherapy, surgical resection, and radiation are performed, the prognosis remains poor. Here, we report a case of prolonged recurrence-free survival (38 months) after esophageal carcinoma surgery and subsequent laparoscopic adrenalectomy for right adrenal metastasis.Case presentationAn 83-year-old man was diagnosed with type 3 esophageal squamous cell carcinoma (T3N1M0, cStage IIIA, UICC-7), spreading from the lower thoracic esophagus to the abdominal esophagus. He underwent thoracoscopic esophagectomy with a two-field lymph node dissection followed by substernal gastric tube reconstruction. The final diagnosis was moderately differentiated squamous cell carcinoma (T3N2M0, fStage IIIB). Adjuvant chemotherapy was not administered because of the advanced age and postoperative condition of the patient. Computed tomography (CT) at 14 months postoperatively showed a mass with a 2-cm diameter at the right adrenal gland. Positron emission tomography (PET)/CT revealed a high fluorodeoxyglucose (FDG) uptake in the mass. It was suspected that the mass was a metastatic lesion secondary to the primary esophageal carcinoma. No metastases to lymph nodes or other distant organs were identified. The patient underwent laparoscopic right adrenalectomy. The histopathological examination revealed moderately differentiated squamous cell carcinoma, suggesting metastasis from the primary esophageal carcinoma. He has survived without recurrence for 38 months since laparoscopic adrenalectomy to remove the right adrenal metastastic mass after the esophageal carcinoma surgery.ConclusionsWe describe a very elderly male who survived laparoadrenalectomy for right adrenal metastasis following esophageal cancer surgery without recurrence for 38 months postoperatively. Therefore, surgical resection might be an option for solitary adrenal recurrence.
Highlights
Esophageal carcinomas are highly malignant tumors with a high frequency of lymph node and distant organ metastasis
Surgical resection might be an option for solitary adrenal recurrence
We report a case of a 38-month recurrence-free survival after laparoscopic adrenalectomy for right adrenal metastasis after esophageal carcinoma surgery
Summary
Distant recurrence after curative esophageal carcinoma surgery is one of the most difficult complications to treat. The prognosis of the patients with recurrence is very poor, with a reported survival of 4–7 months [8, 9]. Some reports indicated that lymphadenectomy or chemoradiotherapy might improve survival in patients with lymph node recurrence in the neck or mediastinum after curative resection [4, 5]. Patients with lung metastasis reportedly show relatively good prognosis, with a median survival of 9.8 months [8].Whereas, patients with liver metastasis reportedly exhibit poor prognosis because of the high frequency of multiple metastases [6]. The adrenal mass was found on a follow-up CT and FDG-PET/CT in the absence of other primary lesions. Tumor markers such as SCC and CEA were elevated. Age Sex Location Histology fStage Location Size of AM (cm) Interval from the EC Prognosis of the EC of the AM
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