[A Case of Salvage Lymphadenectomy with a Median Sternotomy after Definitive Chemoradiotherapy for Esophageal Cancer].

A 73-year-old man with middle thoracic esophageal squamous cell carcinoma(SCC)underwent definitive chemoradiotherapy( dCRT)with cisplatin and 5-fluorouracil(CF)concurrently administered with 60 Gy radiotherapy. Clinical complete response was achieved, but thoracic tracheal lymph node metastases(No. 106recL and No. 106pre)were detected 19 months after the completion of dCRT. Following 2 courses of CF therapy, salvage lymphadenectomy was performed via median sternotomy. Combined partial resection of tracheal cartilage and the left recurrent laryngeal nerve ensued due to suspected tumor invasion. Histopathological analysis confirmed the SCC metastases in the No. 106recL and No. 106pre lymph nodes, affirming R0 resection. Adjuvant chemotherapy with S-1 was administered for 24 months. Despite the emergence of multiple lung and left supraclavicular lymph node metastases 24 months after surgery, no local recurrence within the surgical field was noted. A durable response to CF therapy combined with pembrolizumab was achieved, and the patient remains under treatment, exhibiting no signs of disease progression. In the context of salvage lymphadenectomy, attainment of R0 resection within an optimal surgical field holds paramount importance for effective local disease control.