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Superficial thoracic esophageal cancer with a solitary metastasis to a lymph node outside the usual target area of lymphadenectomy is extremely rare. We report a case of superficial esophageal cancer with a solitary, giant metastasis to the right upper deep cervical lymph node that was treated with surgery. A 57-year-old man presented to our institution with a chief complaint of a mass in the right neck. Fine needle cytology showed squamous cell carcinoma. No lesion was found in the pharyngolaryngeal area or the lungs. Upper gastrointestinal endoscopy revealed superficial squamous cell carcinoma of the thoracic esophagus. Detailed examinations showed no other lymph node enlargement or metastasis to distant organs. The patient was diagnosed with esophageal cancer with a solitary lymph node metastasis (N4; No.102upR). Subtotal esophagectomy and 3-field lymphadenectomy were performed. The patient received adjuvant chemotherapy. At 3 years postsurgery, no recurrence has been found. We think this case is extremely rare.

Postoperative chylothorax after surgery for esophageal cancer is a rare but serious complication. Treatment initially consists of conservative therapy and, if it fails to provide improvement, it is important to perform surgical treatment without delay. We report on a recent case of intractable chylothorax. This report describes a 72-year-old man with Stage III esophageal squamous cell carcinoma. Subtotal esophagectomy, through a right thoracoabdominal approach with two-field lymphadenectomy, and cervical esophagogastric anastomosis via the retrosternal route, were performed. On the 12th postoperative day, a diagnosis of chylothorax was made. Conservative treatment was initiated, but it proved to be ineffective. Therefore, ligation of the thoracic duct via a thoracotomy was performed, but this was not effective, either. Lymphangiography undertaken to identify the site of the leak in the thoracic duct enabled a diagnosis of an extremely rare double thoracic duct and identification of the site of the leak in the thoracic duct, thereby allowing curative direct ligation of the site. This case underscores the remarkable usefulness of lymphangiography in dealing with intractable postoperative chylothorax.

Background Neoadjuvant chemotherapy (NAC) with docetaxel, nedaplatin and 5-fluorouracil (5-FU) in esophageal cancer may adversely affect the postoperative clinical course following esophagectomy. Patients and methods We investigated the perioperative white blood cell count (WBC), C-reactive protein (CRP), serum albumin, body temperature (BT), heart rate (HR), respiratory rate (RR), water balance, partial pressure of oxygen in arterial blood (PaO2)/fraction of inspired oxygen (FiO2) ratio, postoperative complications and systemic inflammatory response syndrome (SIRS) in patients who underwent NAC or surgery alone (SA group). Results In the NAC group, the preoperative WBC (p=0.015) and postoperative day (POD) 3 BT (p=0.049), as well as RR (p=0.037) were lower, whereas the POD 2 PaO2/FiO2 ratio was higher (p=0.047), compared to the SA group. No differences in the incidence of postoperative complications and SIRS were observed between the groups. Conclusion NAC using docetaxel, nedaplatin and 5-fluorouracil was tolerated and feasible in esophageal cancer.