Multimodal salvage therapy for locally advanced esophageal cancer recurrence after failed post-ESD surveillance: a...

Endoscopic submucosal dissection (ESD) is the standard curative treatment for early esophageal squamous cell carcinoma (ESCC). However, its long-term success critically depends on rigorous postoperative surveillance to detect recurrence at a curable stage. We report a 66-year-old man who underwent ESD that met the expanded criteria for early ESCC (pT1a-MM with negative margins and no lymphovascular invasion) but was subsequently lost to follow-up. He represented 17 months later with dysphagia and was diagnosed with locally advanced recurrence (cT3N2M0). Following multidisciplinary team assessment, he received two cycles of neoadjuvant chemoimmunotherapy (albumin-bound paclitaxel, cisplatin, and camrelizumab), achieving marked regression of both the primary tumor and regional lymph nodes. He then underwent radical transthoracic esophagectomy, with final pathology confirming ypT2N0M0 disease. After two cycles of adjuvant chemoimmunotherapy, he entered intensive surveillance and remained disease-free at the last follow-up in September 2025. This case delivers two essential lessons: loss to follow-up after curative ESD precludes early detection of recurrence, potentially resulting in rapid progression to life-threatening disease; yet even in this setting, a timely multimodal salvage strategy can still offer the possibility of long-term survival.