Da Vinci Single-Port Robot-Assisted Cervical Esophagectomy as a Salvage Strategy in Esophagogastric Junctional Adenocarcinoma with Severe Right Fibrothorax: A Case Report

Martina Milazzo, Vladimir J. Lozanovski, Pablo Ruiz Garcia, Chiara Zandonella Necca, Alessandro F. Armienti, Edin Hadzijusufovic and Peter P. Grimminger*

Department of General and Upper G.I. Surgery, Ospedale Maggiore “Borgo Trento” Verona, University of Verona, Verona, Italy Department of General, Visceral and Transplantation Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany Department of General Surgery, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy

^*Correspondance to: Peter P. Grimminger 

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Abstract:

Background: The incidence of esophagogastric junction (EGJ) adenocarcinoma, particularly Siewert type II tumors, has markedly increased in Western countries. While Ivor Lewis esophagectomy remains a standard approach for curative treatment, it may not be feasible in patients with hostile thoracic anatomy. This paper illustrates the successful management of Siewert II adenocarcinoma using a minimally invasive alternative when conventional thoracic access was not possible. Case Presentation: A 65-year-old male with multiple comorbidities was diagnosed with a Siewert II EGJ adenocarcinoma (cT2N2M0). After four cycles of neoadjuvant FLOT chemotherapy, imaging showed partial response. Planned robotic-assisted minimally invasive esophagectomy (RAMIE) was initiated, but extensive right pleural adhesions and fibrothorax prevented thoracic access and single-lung ventilation. A transhiatal resection was considered oncologically inadequate due to limited lymphadenectomy and the inability to achieve an optimal control of the proximal margin, risking a non-curative resection (R+ resection). The operation was completed via da Vinci Single- Port Robot-Assisted Cervical Esophagectomy (SP RACE), allowing oncologic radicality without thoracic entry. Postoperative recovery was uneventful aside from minor complications — such as macrohematuria, urinary tract infection and atrial arrhythmia — managed pharmacologically. The patient was discharged in good clinical condition. Conclusion: This case highlights the necessity of intraoperative flexibility and the value of advanced robotic platforms in achieving safe and radical outcomes under unexpected conditions in patients with esophageal cancer. SP RACE may be a viable and oncologically radical alternative in selected patients with contraindications to standard transthoracic approaches. Further studies are warranted to evaluate its role in complex esophageal cancer cases.

Keywords:

Esophagogastric junction cancer; Esophageal cancer; Esophagectomy; Robotic surgery; Single port; RAMIE; RACE

Cite the Article:

Milazzo M, Lozanovski VJ, Garcia PR, Necca CZ, Armienti AF, Hadzijusufovic E, et al. Da Vinci Single-Port Robot- Assisted Cervical Esophagectomy as a Salvage Strategy in Esophagogastric Junctional Adenocarcinoma with Severe Right Fibrothorax: A Case Report. Ann Clin Case Rep. 2025; 10: 2764..