Esophageal cancer is one of the most aggressive gastrointestinal malignancies, often presenting late and requiring a multimodal approach for effective management. With the advent of minimally invasive and thoracoscopic techniques, surgical outcomes have improved, offering patients quicker recovery and reduced post-operative complications.
This case highlights the successful management of a patient with advanced esophageal cancer through a McKeown’s total thoracolaparoscopic (VATS) esophagectomy with two-field lymph node dissection following neoadjuvant chemoradiotherapy.
Case Presentation
A 55-year-old female presented with complaints of progressive difficulty in swallowing solid foods. On clinical and diagnostic evaluation, she was diagnosed to have squamous cell carcinoma of the esophagus, staged as cT3N1M0.
The patient was planned for neoadjuvant concurrent chemoradiotherapy (CTRT) based on the CROSS protocol to achieve tumor downstaging and improve surgical outcomes.
Surgical Management
Following completion of CTRT and after reassessment, the patient was taken up for surgery. She underwent a McKeown’s total thoracolaparoscopic esophagectomy with two-field lymph node dissection.
Approach: Video-assisted thoracoscopic surgery (VATS) combined with laparoscopic mobilization.
Goal: Complete oncological resection with lymphadenectomy while minimizing surgical trauma.
Course: The procedure was completed uneventfully, and the patient tolerated surgery well.
Post-operative Outcome
The patient recovered smoothly, with early ambulation, adequate pain control, and restoration of oral intake. She was successfully discharged on post-operative day 7 in stable condition.
Histopathology examination revealed a pathological complete response (pCR), meaning there was no residual tumor detected—a strong indicator of favorable long-term oncological outcomes.
Discussion
Multimodal management: Neoadjuvant chemoradiotherapy followed by surgery remains the gold standard for locally advanced esophageal cancer.
Minimally invasive advantage: Thoracolaparoscopic (VATS) approach reduces surgical morbidity, improves visualization, and facilitates precise lymph node dissection.
pCR significance: Achieving a pathological complete response is associated with excellent survival outcomes and reduced recurrence risk.
This case demonstrates how a well-planned treatment strategy, combining evidence-based protocols with advanced minimally invasive techniques, can offer patients the best possible outcomes in complex esophageal cancers.
Conclusion
Esophageal cancer continues to pose significant challenges in oncology, but advances in multimodality care and minimally invasive surgery are changing the outlook for patients. In this case, a stage cT3N1M0 squamous cell carcinoma of the esophagus was successfully treated with neoadjuvant therapy followed by thoracolaparoscopic esophagectomy, achieving a complete pathological response—a result that underscores the effectiveness of precision oncology and modern surgical techniques.