Surgical treatment of the patient with locally advanced esophageal cancer and concurrent thymoma after neoadjuvant therapy: a case report

Locally advanced esophageal squamous cell carcinoma (ESCC) can be treated effectively with surgical resection following downstaging <i>via</i> preoperative neoadjuvant therapy. This case report details the successful management of a patient with ESCC complicated by thymoma, who underwent one cycle of neoadjuvant therapy followed by surgery, resulting in improved survival. The patient initially presented with dysphagia and was diagnosed with ESCC at a local hospital, where gastroscopy revealed a neoplasm located 28-30 cm from the incisors. Pathological examination confirmed ESCC, and the clinical stage was cT2N2M0, stage III. The patient received chemotherapy (paclitaxel + cisplatin) combined with toripalimab at the local hospital but developed elevated thyroid hormone levels during treatment. Post-treatment enhanced chest CT scans at our institution showed a malignant tumor in the mid-to-lower esophagus, enlarged mediastinal lymph nodes, and an anterior mediastinal mass suggestive of thymoma, along with emphysema. Barium meal radiography indicated mild stiffness but good dilatation of the esophageal wall, with a normal cardia opening. Endoscopic ultrasound revealed ESCC invading the muscularis propria, chronic atrophic gastritis with erosion, and gastric xanthoma. Following multidisciplinary team (MDT) evaluation, the patient proceeded to thoracoscopic radical esophagectomy and resection of the mediastinal mass. Postoperative pathology showed ypT1bN2M0, stage IIIB, poorly differentiated ESCC with necrosis, measuring 2.5 × 1.6 × 0.4 cm, and invading the submucosa without vascular tumor thrombus or perineural invasion. Surgical margins, including those at the gastric resection site and proximal anastomosis, were free of tumor. Metastases were identified in the right recurrent laryngeal nerve chain and perigastric lymph nodes (2/4). The anterior mediastinal mass was confirmed as thymoma. Postoperative management included oxygen support, nebulization, analgesia, gastrointestinal decompression, antibiotics (piperacillin/cefradine), expectorants, antispasmodics, acid suppression, intravenous and enteral nutrition, and albumin supplementation. The patient recovered well and was discharged on postoperative day 12. Chemotherapy and radiotherapy were administered at the local hospital. During the 10-month follow-up, the patient remained recurrence-free and reported no dysphagia. This case provides valuable insights and therapeutic strategies for managing similar cases.