Long-term Survival after Sequential Local Treatments for Oligometastatic Esophageal Squamous Cell Carcinoma: A Case Report.

Introduction and importance: Patients with metastatic esophageal cancer generally have a poor prognosis. In patients with oligometastatic disease (OMD), local treatment of metastases may improve overall survival (OS).Case presentation: This case report describes a 57-year-old female with a cT4bN2M1 mid-esophageal squamous cell carcinoma with ingrowth in the aorta and pathologic para-aortic lymph node metastases in the left thorax (i. e. synchronous OMD). The patient first underwent a robot-assisted thoracoscopic para-aortic lymph node dissection (R1, aorta). After response to definitive chemoradiotherapy (ycT4aN1), a salvage robot-assisted minimally-invasive esophagectomy was performed (ypT0N1, R0). During follow-up, metastasectomy and repeated cryoablations for pulmonary metastases were performed (repeat OMD). The patient is currently alive in very good condition without evidence of disease 4.5 years after the first diagnosis of OMD and free of systemic therapy. Discussion: Clinical decision-making, local treatment options, and favorable biological tumor behavior in OMD are discussed. Conclusion: In this case of oligometastatic esophageal squamous cancer with favorable biological behavior, sequential local treatment of OMD (i.e. metastasectomy and cryoablations) combined with primary tumor resection was associated with long-term OS.