Survival after Esophagectomy for Metastatic Esophageal Cancer: Should the Role of Surgery be Reconsidered?

Journal: Journal Of Gastrointestinal Surgery : Official Journal Of The Society For Surgery Of The Alimentary Tract
Published:
Abstract

Background: Standard treatment for stage IV esophageal cancer (EC) is systemic therapy, with surgery to the primary tumor considered contraindicated. This study seeks to assess the impact of surgical resection on outcomes for metastatic esophageal cancer patients.

Methods: We reviewed our institution's IRB-approved database of 1408 esophagectomies (1994-2024), identifying 19 patients with distant disease (stage IV) based on AJCC 8 found before or at time of surgical resection. Demographics, clinical characteristics, and survival for metastatic versus non-metastatic patients were compared using Fisher Exact, Wilcoxon rank-sum, and Kaplan-Meier. Metastatic disease sub-analysis was also performed.

Results: Patients with stage IV were younger (57 vs 64 years old; p=0.003) and non-Caucasian (15.8% vs 5.7%; p<0.001). However, most patients in both groups were male (p=0.46) and had adenocarcinoma (p=0.16). Postoperative complication rates were similar between cohorts (57.9% vs 63.8%; p=0.60). In the stage IV sub-analysis, patients receiving surgery >1 year after stage IV diagnosis had better survival than those diagnosed <1 year before or during surgery (p=0.04). For stage IV patients diagnosed >1 year before surgery, shorter OS was observed in those with PD-L1 positivity (18.7 months vs mOS not reached; p=0.94) while neither HER2neu positive nor negative groups reached mOS (p=0.24).

Conclusions: Esophagectomy for highly selected stage IV patients demonstrates similar postoperative complication rates to surgery for locally advanced EC. For stage IV patients, diagnosis-to-surgery intervals >12m demonstrate better outcomes. Surgery's role in treating stage IV esophageal cancer, preferably >1 year after stage IV diagnosis, warrants further study.

Authors
Samir Saeed, Andrew Sinnamon, Jacques Fontaine, Rutika Mehta, Jobelle Baldonado, Luis Pena, Allan A Pereira, Sarah Hoffe, Jessica Frakes, Jose Pimiento
Relevant Conditions

Esophageal Cancer