Beyond the common recurrence sites after esophagectomy: colonic metastasis in esophageal cancer

The postoperative recurrence rate of esophageal cancer ranges from 28 to 47%, with recurrences often affecting distant organs such as the lungs, liver, bones, and brain. However, colonic metastasis is rare. This report presents a case of transverse colon metastasis after radical resection of esophageal cancer in a 70-year-old man. The patient underwent neoadjuvant chemotherapy followed by esophagectomy for advanced esophageal cancer 15 months ago. He reported loss of appetite during a routine outpatient visit, and computed tomography revealed bowel obstruction and intussusception with a tumorous lesion in the transverse colon. Positron emission tomography did not reveal any abnormal accumulation in other areas. Based on these findings, a transverse colectomy was performed. Pathological examination of the resected specimen revealed squamous cell carcinoma components in the normal colonic mucosa, which were diagnosed as colonic metastases from the esophageal cancer. Postoperatively, the patient recovered uneventfully and commenced adjuvant therapy with capecitabine monotherapy, which was later discontinued at the patient's request. Four months post-surgery, liver metastasis developed, and the patient underwent immunochemotherapy. Colorectal metastasis from esophageal cancer is relatively rare, making preoperative diagnosis challenging. Nonetheless, a multidisciplinary approach combining surgery and perioperative systemic therapy has the potential to improve patient outcomes.