Successful Staged Surgery for Esophagopulmonary Fistula with Lung Abscess During Neoadjuvant Chemoradiotherapy

Esophagopulmonary fistula (EPF) with lung abscess is a rare but serious complication during neoadjuvant chemoradiotherapy (nCRT) for esophageal squamous cell carcinoma and is often associated with poor prognosis. We report a 52-year-old man with cT3N3M0 esophageal squamous cell carcinoma who developed fever and hemoptysis during the third week of nCRT. Computed tomography showed a newly developed right lower lobe lung abscess adjacent to the primary tumor, suspicious for esophageal perforation with fistulous communication. Because the lesion and infection appeared localized, staged aggressive surgery was undertaken. The patient underwent en bloc esophagectomy and right lower lobectomy with cervical esophagostomy, followed by delayed reconstruction using a laparoscopically created gastric conduit. Final pathology showed marked treatment response with ypT1bN0 disease, and the resected lung showed no malignant involvement. R0 resection was achieved, and the patient remains disease-free at 28 months. This case illustrates a possible management pathway in a highly selected patient with localized EPF and lung abscess during nCRT, suggesting that early staged source control may preserve reconstructive options when systemic deterioration has not yet occurred.