Long-term survival of advanced small cell carcinoma of the esophagus after resection: a case report.

BACKGROUND Small cell carcinoma of the esophagus is a rare and rapidly lethal disease. The mean survival for patients with advanced disease is 5.3 months, and only 10% live longer than one year. CASE REPORT We report a very unusual case in which a patient diagnosed with advanced disease is still alive 96 months after being treated by surgery-alone. This patient is a 61-year-old woman who was referred to our hospital with the chief complaints of dysphagia and vomiting. Endoscopy revealed a huge type-3 tumor on the abdominal esophagus invading the gastric cardia. Histopathology established the diagnosis of small cell carcinoma; computed tomography did not detect metastatic cells in the lymph nodes or other distant sites. We therefore performed radical resection, involving a lower esophagectomy, total gastrectomy, and splenectomy with regional lymph node dissection. The initial diagnosis of small cell carcinoma was confirmed, and classified as type-3 (13.8×7.5 cm), T3N1M0, stage III with invasion to the adventitia (T3) and lymph node metastases along the lesser curvature of the stomach (N1). Postoperative adjuvant chemotherapy using tegafur, gimestat, and otastat was discontinued due to poor tolerance, and the patient developed severe anorexia. The patient remains alive at the time of writing eight years and four months post-surgery, with no evidence of tumor. CONCLUSION To our knowledge, this is the longest survival reported for a case of advanced small cell carcinoma of the esophagus treated by surgery-alone.