Surgery for metachronic metastasized esophageal cancer

Abstract

: Esophageal cancer (EC) is an aggressive type of malignancy which is nowadays responsible for 16,000 deaths solely in the USA region and 400,200 deaths in Western countries. Despite the fact that there have been significant improvements in multimodality therapies, operative and perioperative management, the overall 5-year survival rate ranges from 25–50%, and a significant proportion (30–50%) of patients will develop recurrence within months or few years after esophagectomy. The aim of this article is to review the current evidence on the role of surgical treatment for metachronous oligometastases from EC. A literature search about surgical management of metachronous EC metastases was conducted and the results from the most relevant studies are presented. The types and locations of recurrence considerably differ among individual patients mainly categorized as locoregional at the site of anastomosis, lymphatic and hematogenic metastasis, or a combination of these. The standard treatment for EC patients experiencing recurrence is currently based on systemic chemotherapy and/or radiotherapy. Recent literature shows that in highly selected individuals, surgical resection of oligometastatic disease might lead to improved outcomes as far as survival rates are concerned over medical management alone. Nowadays, only few retrospective studies with small number of patients report the results of surgical treatment in oligometastatic disease. Thus, the low quality of existing scientific data is not yet possible to define the role of surgery as a part of multimodality treatment in patients with isolated distant recurrence in solid organs. However, a well-selected group of patients, especially those with a disease-free interval of more than 12 months with isolated one-field lymph node (LN) metastasis or solitary lesions in organs, might benefit from surgical management. hepatic and pulmonary resections in patients with liver and lung recurrences after resection of esophageal carcinoma, reporting a median overall survival of 13 months in 5 surgically treated patients with liver metastases.