Palliative Esophagectomy in Case of Unexpected Metastatic Disease: Sense or Nonsense?

Lieven P. Depypere, Johnny Moons, Toni E. Lerut, Willy Coosemans, Hans Van Veer, Philippe R. Nafteux

University Hospitals Leuven, Thoracic Surgery Department , LEUVEN, Belgium

Date, time and location: 2018.05.26 17:00, Congress Hall, 2F–C

Abstract

OBJECTIVES: Screening is an important tool in staging esophageal cancer as only patients without suspicion of metastases are considered for surgery-based treatment. Nevertheless unexpected metastatic disease is still found in some patients during surgery. Should then esophagectomy be aborted, or is there a place for palliative resection?

METHODS: Between 2002 and 2015, 681 patients with locally advanced potentially resectable esophageal cancer were scheduled for neoadjuvant therapy and subsequent esophagectomy. In 552 patients potentially curative esophagectomy was performed. In twelve other patients, unexpected metastatic disease was discovered during surgery but esophagectomy was performed with synchronous resection of the metastases. Ten of them were oligometastatic (≤ 4 single organ metastases). In 117 patients esophagectomy was not performed including 50 patients because of disease progression. Fourteen of these patients were also single organ oligometastatic and ten of them received systemic treatment.

Ten single organ oligometastatic patients that underwent esophageal resection (group1) were compared to 10 non-resected - but treated - counterparts (group2) and to 228 patients that underwent a potentially curative esophagectomy with persistent pathological lymph nodes (group3). Clinicopathological data were retrospectively reviewed and survival of the three groups was compared from date of pathological diagnosis.

RESULTS: In the oligometastatic esophagectomy patients, 5 had lung metastases, 1 peritoneal, 2 adrenal, 1 pleural, and 1 pancreatic. In the oligometastatic non-resected patients, 2 had lung metastases, 5 liver and 3 brain metastases.

Median overall survival was 21.4, 12.1 and 20.2 months in the respective groups. (group1 vs group2: p=0.042; group2 vs group3: p=0.002; group1 vs group3: p=0.88).

CONCLUSIONS: Survival is prolonged in patients undergoing palliative esophagectomy in case of unexpected single organ oligometastatic disease during surgery and is comparable to survival of patients with persistent pathological lymph nodes. Palliative resection in unexpected oligometastatic disease seems to be justified.