CASE REPORT article
Front. Oncol.
Sec. Gastrointestinal Cancers: Gastric and Esophageal Cancers
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1560011
This article is part of the Research TopicPrimary and Secondary Chemotherapy Resistance in Gastrointestinal Tumors: Key Mechanisms and Ways to Overcome ResistanceView all 11 articles
Small bowel metastasis during organ preservation in esophageal squamous cell carcinoma patients：case report and literature review
Provisionally accepted
- 1Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
- 2Department of Gastrointestinal surgery, First People's Hospital of Yibin, Sichuan, China
- 3Department of Gastrointestinal surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
- 4Department of Geriatric General Surgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
- 5Department of Radiology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
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Background: For patients with locally advanced esophageal squamous cell carcinoma (ESCC) who achieve a clinical complete response (cCR) after comprehensive treatment, organ preservation and observation-waiting strategies provide a more conservative treatment option that enhances the patient's quality of life. The high cCR rate of chemoradiotherapy combined with immunotherapy is driving the shift in ESCC treatment from traditional radical surgery to organ preservation.We report a case of a 57-year-old male patient diagnosed with esophageal ESCC who underwent combined radiotherapy, chemotherapy, and immunotherapy. After treatment, the patient achieved a cCR, resulting in 15 months of progression-free survival. At this stage, the primary lesion showed no signs of local regrowth or recurrence; however, unexpected metastasis to the small intestine occurred, leading to bowel obstruction. The metastasis at this occult site was not detected by sensitive monitoring methods, and the side effects of the immunotherapy drugs further complicated the diagnosis and differential diagnosis. The tumor metastasis at the unexpected site was not identified early, but following rescue surgery, the patient survived for an additional 6 months.Organ-preserving surgery for esophageal cancer significantly improves patients' short-term quality of life. However, due to incomplete monitoring measures, a cautious approach should be maintained when implementing organ-preserving surgery at this stage. For patients undergoing organ-preserving surgery, continuous active monitoring is essential. Timely intervention should be provided when clinical symptoms arise, and personalized treatment plans should be developed, while remaining vigilant for metastasis at unexpected sites.
Keywords: esophageal squamous cell carcinoma, Small bowel metastasis, clinical complete response, Watch-and-wait, Organ-preserving treatment
Received: 13 Jan 2025; Accepted: 30 Jun 2025.
Copyright: © 2025 Cao, Lu, Niu, Zhao, Li, Liu and Pang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Minghui Pang, Department of Gastrointestinal surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China
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