CA19-9-producing esophagogastric junction cancer with nodal recurrence outside the planned dissection field: a case...

The biological behavior of CA19-9-producing esophagogastric junction cancer (EGJC) remains poorly understood, although some reports suggest that CA19-9 expression reflects a more aggressive subtype.

We report a 64-year-old man with Siewert type II EGJC, presenting with 3.5 cm of esophageal invasion and markedly elevated serum CA19-9 levels (11 630 U/mL). Following neoadjuvant chemoradiotherapy, thoracoscopic Ivor Lewis esophagectomy with lower mediastinal lymphadenectomy was performed. Histopathology confirmed a CA19-9-producing adenocarcinoma. Twenty months postoperatively, a solitary recurrence in the No.109 L mediastinal lymph node, outside the planned dissection field, was identified. Salvage lymphadenectomy via left thoracotomy achieved R0 resection. Adjuvant chemoradiotherapy was subsequently administered. The patient remains recurrence-free 38 months after the salvage surgery.

This case demonstrated nodal recurrence outside the planned dissection field despite limited esophageal invasion. The findings suggest that biological tumor characteristics, including elevated CA19-9 expression, may contribute to recurrence patterns not fully predicted by current lymphadenectomy algorithms. Moreover, timely salvage surgery in cases of solitary nodal recurrence can result in favorable long-term outcomes.

In conclusion, CA19-9-producing EGJC may exhibit biologically aggressive features. This case suggests that elevated CA19-9 expression may represent a factor associated with recurrence beyond the planned dissection field. Further studies are needed to clarify whether tumor biology should be incorporated into surgical decision-making in EGJC.