Journal of Clinical Case Reports

da Vinci Single-port Robotic-assisted Cervical Approach for Left Nodal Recurrence Dissection in Esophageal Cancer: An Innovative Surgical Management

Abstract

Martina Milazzo, Vladimir J. Lozanovski, Chiara Zandonella Necca, Pablo Ruiz Garcia, Alessandro F. Armienti, Edin Hadzijusufovic and Peter P. Grimminger*

Background: Esophageal cancer is one of the most prevalent cancers globally. Despite advancements in treatment, including systemic therapy and surgical resection, the recurrence rate remains high, with 35% to 50% of patients experiencing recurrence after complete Resection (R0). These recurrences, often occurring within two years, are a primary factor contributing to the poor survival rates associated with esophageal cancer. While new treatment modalities, including targeted therapy and immunotherapy, have improved survival, disease relapse continues to be a significant challenge.

Case presentation: This case report presents a 62-year-old male diagnosed with Siewert type II adenocarcinoma of the Esophagogastric Junction (EGJ), who underwent Ivor-Lewis esophagectomy with preoperative chemotherapy. Despite achieving a partial response to chemotherapy, the patient developed an isolated regional recurrence in the left recurrent laryngeal nerve lymph nodes, two years post-surgery. Given his prior chemotherapy-related toxicity, the patient was not considered eligible for systemic therapy. A minimally invasive resection of the recurrent lymph nodes was performed using the da Vinci Single-Port Robotic-Assisted system (SP) through a cervical approach. Postoperative recovery was uneventful and the patient was discharged in good clinical condition.

Conclusion: This case demonstrates the feasibility and safety of a minimally invasive robotic-assisted approach for managing regional recurrence of esophageal cancer in patients with limited treatment options. The procedure allowed for an oncologically radical resection and the patient experienced a short recovery. This approach may offer a valuable alternative in the management of regional recurrences, especially in patients who are not candidates for further systemic therapies, contributing to the ongoing exploration of personalized treatment strategies in esophageal cancer.

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