Successful treatment of cervical and upper thoracic esophageal adenocarcinoma using induction chemotherapy followed by surgery: a case report

Abstract BackgroundCervical esophageal adenocarcinoma has a low incidence rate and its treatment involves various strategies. We report a patient with locally advanced cervical to upper esophageal adenocarcinoma, able to undergo induction chemotherapy and radical surgery. We report our case as a valuable clinical experience.Case presentationThe patient complained of throat stuffiness. We found a poorly differentiated adenocarcinoma between the cervical esophagus and the upper thoracic esophagus. The primary lesion had infiltrated into the tracheal membrane and had metastatized into the cervical lymph nodes. The initial diagnosis was T4bN1M0 stage IVA. The lower edge of the tumor was close to the tracheal bifurcation, making it difficult to create a longitudinal tracheal foramen during surgery. Therefore, when biweekly-DCF therapy was performed as induction chemotherapy, the tumor shrank sufficiently. Furthermore, tumor infiltration into the tracheal membrane decreased, allowing us to perform total laryngopharyngoesophagectomy with three-field lymph node dissection and reconstruction using free jejunal grafts and subtotal stomach via a posterior mediastinum route and a permanent tracheal foramen as a radical surgery. The pathological diagnosis was T2/MP, N1, and the effect of chemotherapy was grade 2. The patient is followed-up regularly.ConclusionsCervical esophageal adenocarcinoma was rare, but technically reliable and safe oncologic surgery was possible after induction chemotherapy.