Salvage gastrectomy for perforated gastric intramural metastasis after definitive chemoradiotherapy for distal esophageal squamous cell carcinoma: a case report

Gastric intramural metastasis from esophageal squamous cell carcinoma (ESCC) is rare, and chemotherapy-associated perforation is exceptionally uncommon. We report a case of a 67-year-old man with distal ESCC and a separate cardia squamous cell carcinoma (SCC). He declined esophagectomy and received definitive chemoradiotherapy (dCRT) with paclitaxel, carboplatin, and 50.4 Gy radiotherapy. During the second chemotherapy cycle, the cardia tumor perforated and was treated by emergency omental patch repair. Chemoradiotherapy was subsequently completed. Three months after completion of dCRT, the esophageal lesion showed a clinical complete response, whereas residual cardia disease persisted. Extended total gastrectomy with splenectomy achieved R0 resection; pathology showed a 6-cm pT3 moderately differentiated SCC with partial treatment response and 0/12 positive nodes. Postoperative nivolumab was administered. This case illustrates a staged salvage strategy for persistent gastric intramural disease after definitive chemoradiotherapy.