What happened, in summary

A man in his 70s developed vomiting and was diagnosed with Siewert type II cancer of the oesophagogastric junction, with the center of the tumor 1.5 cm below the junction. He underwent total gastrectomy through an abdominal approach with removal of part of the lower oesophagus. Pathology described SS, N0 disease with marked lymphatic and vascular invasion. He did not attend regular follow-up visits.

Three years and 11 months later, vomiting after meals returned. Testing showed a mediastinal paraoesophageal recurrence that appeared to involve the descending aorta and left inferior pulmonary vein. He could not eat and began tube feeding. The disease was initially considered unresectable, so he received 2 cycles of S-1 plus cisplatin. His swallowing improved enough for soft foods, and CT showed the tumor had shrunk to 3 cm.

Four weeks after the last S-1 dose, he underwent extended surgery. The tumor could be separated from the aorta but had invaded the left inferior pulmonary vein. Complete removal required lower oesophagectomy, reconstruction of the oesophagojejunostomy, and removal of the left lower lung lobe. He resumed eating on postoperative day 7 and left hospital on day 20. Two years later, he remained well without recurrence.