International Surgery Journal | March 2021 | Vol 8 | Issue 3 Page 1060 International Surgery Journal Sharma J et al. Int Surg J. 2021 Mar;8(3):1060-1062 http://www.ijsurgery.com pISSN 2349-3305 | eISSN 2349-2902 Case Report Oligometastatic recurrence in radically treated stage II lower thoracic ca oesophagus at two drain sites: a treatment challenge? Jyoti Sharma*, Lalit Chandrakant INTRODUCTION Ca oesophagus is an aggressive malignancy with very less cure rate. Globocan data updated in December 2020 suggests ca oesophagus as 3.1% (604,100 new patients) of all cancers accounting for 5.5% of cancer deaths. Eastern Asia accounts for highest age standardized incidence rate of 12.3 per 100,000 and mortality rates of 10.7 per 100,000. Oligometastatic is defined as a state of limited number of metastatic burden. 1 Hellman and Weichsel Baum in 1995 defined that oligometastases are mets that are limited in number, site and metastatic potential with a possible chance of cure by radical treatment. They can be synchronous i.e. detected at the time of primary cancer diagnosis or metachronous, which occur following treated primary cancer site. There have been few studies regarding ca oesophagus with unusual sites of metastasis like skin, eye, muscle, heart, isolated bones, breast etc but there have been limited number of case reports with oesophageal squamous cell carcinoma seeding to a chest drain site post operatively. 2 Drain site seeding has been reported in few case series of head and neck primaries with percutaneous endoscopic gastrostomy tube (PEG) but only one report of drain site mets post hybrid Ivor Lewis oesophagectomy with laparoscopic gastric mobilisation done for adenocarcinoma of ca oesophagus has been reported. 3-5 CASE REPORT 66-year-old male presented with 15-20 days history of difficulty in swallowing solids. However patient could consume semisolids and liquids. There was history of weight loss (undocumented). No history of vomiting, haematemesis, melena. There was history of consumption of red meat, history of smoking since past 50 years and history of alcohol intake for past 30 years. ABSTRACT Ca oesophagus is a dreaded malignancy with less than 15 % cure rate and majority of the patients presenting with advanced unresectable disease. Prognosis remains poor despite advances in combined modality treatments. Most common sites of loco-regional recurrence after surgery remains the mediastinal lymph node clearance area while other common sites are lung liver and bone. Unexpected sites of metastasis have been reported like skin, muscle, eyes etc. We report a case of 66-year-old male patient diagnosed with stage II poorly differentiated squamous cell carcinoma lower oesophagus radically treated with neoadjuvant chemotherapy, trans hiatal esophagectomy followed by adjuvant chemotherapy, who subsequently developed oligometastatic recurrences at two drain sites. Patient was treated with surgical excision followed by radiotherapy and chemotherapy. Keywords: Oligometastatic ca oesophagus, Drain site recurrence, Trans hiatal esophagectomy Department Radiation Therapy and Oncology IGMC Shimla. Himachal Pradesh, India Received: 12 January 2021 Accepted: 11 February 2021 *Correspondence: Dr. Jyoti Sharma, E-mail: jyotisharma217@gmail.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: https://dx.doi.org/10.18203/2349-2902.isj20210952