Impact of Perioperative Chemotherapy on Prognosis of Patients with Esophageal Carcinoma Undergoing Pulmonary Metastasectomy

Ann Thorac Cardiovasc Surg. 2019 Oct 20;25(5):253-259. doi: 10.5761/atcs.oa.19-00075. Epub 2019 Jun 12.

Abstract

Purpose: To evaluate prognosis of patients with esophageal carcinoma undergoing pulmonary metastasectomy, and help determine appropriate therapeutic strategies.

Methods: We retrospectively studied 16 patients (15 men and one woman; median age 66.5 years) with esophageal carcinoma, who underwent curative resection of pulmonary metastases. Clinical characteristics and surgical outcomes were analyzed.

Results: In all, 11 patients underwent wedge resection, three segmentectomy, and two lobectomies. The average operating time and blood loss were 147 min and 103 mL, respectively. There were no perioperative deaths or severe complications. Five-year overall survival rate was 40.2% and 2-year disease-free survival rate was 35.2%. All recurrences occurred within 2 years. Univariate and multivariate analyses revealed that absence of adjuvant chemotherapy after therapy for esophageal carcinoma was a significant predictor of poor prognosis and recurrence, respectively (p <0.05). The prognosis of seven patients who underwent esophagectomy with adjuvant chemotherapy was better than that of the other nine patients (p = 0.0166).

Conclusion: Pulmonary metastasectomy in patients with esophageal carcinoma was only one choice of multimodal treatment, and perioperative chemotherapy was important for long-term survival after pulmonary metastasectomy. Pulmonary metastasectomy was effective in patients undergoing esophagectomy with adjuvant chemotherapy.

Keywords: esophageal carcinoma; metastasectomy; perioperative chemotherapy; prognostic factors; pulmonary metastasis.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Carcinoma / mortality
  • Carcinoma / secondary
  • Carcinoma / therapy*
  • Chemotherapy, Adjuvant
  • Cisplatin / administration & dosage
  • Drug Administration Schedule
  • Esophageal Neoplasms / mortality
  • Esophageal Neoplasms / pathology
  • Esophageal Neoplasms / therapy*
  • Esophagectomy* / adverse effects
  • Esophagectomy* / mortality
  • Female
  • Fluorouracil / administration & dosage
  • Humans
  • Lung Neoplasms / mortality
  • Lung Neoplasms / secondary
  • Lung Neoplasms / therapy*
  • Male
  • Metastasectomy / adverse effects
  • Metastasectomy / methods*
  • Metastasectomy / mortality
  • Middle Aged
  • Pneumonectomy* / adverse effects
  • Pneumonectomy* / mortality
  • Progression-Free Survival
  • Retrospective Studies
  • Risk Factors
  • Time Factors

Substances

  • Cisplatin
  • Fluorouracil