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Open Access Research article

Metachronous pulmonary metastasis after radical esophagectomy for esophageal cancer: prognosis and outcome

Masashi Takemura1*, Katsunobu Sakurai2, Mamiko Takii2 and Kayo Yoshida2

Author Affiliations

1 Department of Upper Gastrointestinal Surgery, Hyogo College of Medicine, 1-1, Mucogawa-machi, Nishinomiya City, Hyogo 663-8501, Japan

2 Department of Gastrointestinal Surgery, Osaka City General Hospital, 1-8-20, Nagasu Nishidori, Amagasaki City, Hyogo, 660-0807, Japan

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Journal of Cardiothoracic Surgery 2012, 7:103  doi:10.1186/1749-8090-7-103

Published: 2 October 2012

Abstract

Background

Few reports discuss the outcome of pulmonary metastasis after radical esophagectomy for esophageal cancer. To clarify the data from such cases, we conducted a retrospective study on the clinical outcome of patients who developed pulmonary metastasis after undergoing radical esophagectomy.

Methods

We retrospectively reviewed the prognosis and clinical outcome of 25 patients who developed metachronous pulmonary metastasis after esophagectomy for esophageal cancer.

Results

The site of recurrence was pulmonary without extrapulmonary metastasis in 14 patients and extrapulmonary metastasis was observed in 11. Nineteen patients had multiple pulmonary metastasis and 6 had solitary pulmonary metastasis. Twenty-four of patients underwent systemic chemotherapy during initial treatment for metastatic lesions. Pulmonary metastasectomy was indicated in 5 patients with solitary metastasis. The actual 1-, 2- and 4-year survival rates were 60%, 36% and 27%, respectively. Gender, operative procedure, and postoperative morbidity were not significant prognostic factors. However, pathological staging of primary esophageal cancer was a significant prognostic factor. Survival was significantly worse in patients who did not undergo resection than in those who did. The number of pulmonary metastasis, complicated extrapulmonary metastasis and the time of recurrence were also significant prognostic factors.

Conclusions

Multiple pulmonary metastases or complicated extrapulmonary metastasis were unfavorable prognostic factors for patients with pulmonary metastasis arising from esophageal cancer. Although, surgical intervention is not recommended in such cases, metastasectomy is an acceptable choice of treatment for solitary pulmonary metastasis.

Keywords:
Metachronous pulmonary metastasis; Esophageal cancer; Metastasectomy