Surgical resection for solitary oligo-recurrence of the abdominal lymph node in the hepatoduodenal ligament after surgery for non-small-cell lung cancer - A case report

Introduction : The rate of abdominal lymph node metastasis in the hepatoduodenal ligament is relatively low (0.95%) in patients with non-small-cell lung cancer (NSCLC). Moreover, solitary oligo-recurrence of the abdominal lymph node in the hepatoduodenal ligament after surgery for NSCLC is very rare. The definitive local therapy (DLT) for lung cancer oligo-recurrence is radiation therapy. However, surgical treatment can be prioritized under certain circumstances. Case presentation : A 75-year-old woman was referred to our hospital due to left lower lung cancer, and video-assisted thoracic surgery left lower lobectomy with lymph node dissection (ND2a-2) was performed. The pathological diagnosis was papillary adenocarcinoma, pT2a, pN2, pM0, Stage IIIA. She underwent adjuvant chemotherapy with cisplatin and Vinorelbine. Three years after the initial surgery, a CT scan found a significantly enlarged lymph node in the hepatoduodenal ligament without any tumors in the gastrointestinal tract. However, she refused chemotherapy for the lung cancer recurrence. Two years later, the CEA value got above the normal limit, 8.1 ng/ml. A PET scan revealed high FDG uptake at this abdominal lymph node (SUV-max, 15.6). No other metastasis was detected. Exploratory laparotomy with lymph node dissection was performed. She was discharged on postoperative day 5 without any postoperative complications. The pathology of the enlarged lymph node was papillary adenocarcinoma stained positively for TTF-1. Two years after the second surgery, she had no recurrence without adjuvant therapy. Conclusion : We present a rare case of solitary oligo-recurrence of an abdominal lymph node after surgery for NSCLC being surgically resected. DLT alone can achieve long-term recurrence free survival without chemotherapy in case of solitary oligo-recurrence.