To illustrate the consequences of inadequate postoperative surveillance following endoscopic submucosal dissection (ESD) for early esophageal squamous cell carcinoma (ESCC) through a case study and to present a successful multimodal salvage treatment.
Approach:
Patient Case: A 66-year-old man underwent ESD for early ESCC but was lost to follow-up. He returned 17 months later with locally advanced recurrence and received a comprehensive salvage treatment.
Treatment Protocol: The patient received neoadjuvant chemoimmunotherapy followed by radical transthoracic esophagectomy and adjuvant therapy.
Key Findings:
The patient experienced a dramatic progression to locally advanced disease due to loss to follow-up after ESD.
Neoadjuvant chemoimmunotherapy led to marked regression of the tumor and lymph nodes.
Final pathology post-surgery confirmed ypT2N0M0 disease, and the patient remained disease-free at the last follow-up in September 2025.
Interpretation:
This case highlights the critical importance of rigorous postoperative surveillance following ESD to prevent progression to advanced disease.
Limitations:
The case is a single patient report, limiting generalizability.
Financial constraints affected the patient's access to certain diagnostic procedures.
Conclusion:
Timely multimodal salvage strategies can offer the possibility of long-term survival even after surveillance failure.
