Salvage robotic-assisted subtotal esophagectomy after chemoradiotherapy for unresectable locally advanced esophageal...

Esophageal sarcoma is an extremely rare tumor, and a recommended treatment strategy remains unestablished. The present report describes, to the best of our knowledge, the first reported case of unresectable esophageal sarcoma treated with chemoradiotherapy (CRT) followed by salvage robot-assisted minimally invasive esophagectomy (RAMIE). An 82-year-old man presented with dysphagia for solid foods. An esophagogastroduodenoscopy revealed an elevated tumor in the middle thoracic esophagus at a distance of 30-35 cm from the incisors, with preserved endoscopic passage and no additional lesions in the stomach or duodenum. A biopsy demonstrated sarcoma. Enhanced computed tomography showed a middle thoracic esophageal mass, with bulky mediastinal lymph nodes (nos. 101R and 106recR) invading the trachea. No distant metastases were detected, and tumor marker levels remained within normal limits. The patient was diagnosed with esophageal sarcoma with mediastinal lymph node metastases. As the metastatic nodes demonstrated airway invasion, definitive CRT (dCRT) was selected. The regimen consisted of radiotherapy (50.4 Gy in 28 fractions) and fluorouracil plus cisplatin. Following dCRT, the tumor and lymph nodes decreased in size, and a partial response was achieved, making the tumor resectable. Salvage RAMIE with two-field lymphadenectomy, including cervical lymph node dissection of stations 101R and 101L and upper mediastinal dissection, including station 106recR, was subsequently performed, followed by gastric tube reconstruction via the posterior mediastinal route. Pathological examination of the resected specimen revealed no residual tumor. Although a therapeutic effect was observed, a limitation remains in that a definitive diagnosis could not be fully established. A total of 14 months have passed since the initiation of treatment, with no evidence of recurrence. In conclusion, this patient with unresectable locally advanced esophageal sarcoma achieved a complete pathological response after multidisciplinary treatment, with no recurrence observed during the short-term follow-up period.