Liver metastases from esophageal carcinoma: is there a role for surgical resection?

Abstract

Esophageal cancer recurrence rates after esophagectomy are high, and locally recurrent or distant metastatic disease has poor prognosis. Management is limited to palliative chemotherapy and symptomatic interventions. We report our experience of four patients who have undergone successful liver resection for metastases from esophageal cancer. All underwent esophagectomy and were referred to our unit with metastatic recurrent liver disease, two with solitary metastases and two with multi-focal disease. The patients underwent multidisciplinary assessment and proceeded to a course of neoadjuvant chemotherapy followed by open or laparoscopic liver resection. Three patients were male, and the mean age was 57.5 (range 44-71) years. Response to chemotherapy ranged from partial to complete response. Following liver resection, two patients developed recurrent disease at 5 and 15 months, and both had disease-specific mortality at 10 and 21 months, respectively. The other two patients remain disease free at 22 and 92 months. Recurrent metastatic esophageal cancer continues to have a poor prognosis, and the majority of patients with liver involvement will not be candidates for hepatic resection. However, this series suggests that in selected patients, liver resection of metastases from esophageal cancer combined with neoadjuvant and adjuvant chemotherapy is feasible, but further research is required to determine whether this can offer a survival advantage.

Prognostic Advantage of Docetaxel/Cisplatin/ 5-Fluorouracil Neoadjuvant Chemotherapy in Clinical Stage II/III Esophageal Squamous Cell Carcinoma due to Excellent Control of Preoperative Disease and Postoperative Lymph Node Recurrence

“…For recurrence of distant metastasis alone, a reasonable OS was also attained in the present study. If curative resection could be possible, surgery could be considered a curative option for distant metastasis, as recently proposed in esophageal cancer [26,27] . These findings suggest the novel notion that recurrences after NAC could be managed for cure by optimal multimodality treatments.…”

A case of long-term survival after surgical resection for solitary adrenal recurrence of esophageal squamous carcinoma

“…Patients with lung metastasis reportedly show relatively good prognosis, with a median survival of 9.8 months [8]. Whereas, patients with liver metastasis reportedly exhibit poor prognosis because of the high frequency of multiple metastases [6]. The initial recurrent site could thus contribute to the prognostic heterogeneity of the patients with recurrent esophageal carcinoma.…”

“…Although multidisciplinary treatments are combined with chemotherapy, surgical resection, and radiation, the prognosis remains poor [4, 5]. The role of surgical resection for metastasis from esophageal carcinoma has not been clarified, but some reports have recently described the benefit of resection for oligometastasis from esophageal carcinoma [6, 7]. …”

Management of Liver Oligometastatic Esophageal Cancer: Overview and Critical Analysis of the Different Loco-Regional Treatments

“…The five-year survival rate for patients undergoing surgical resection is now approaching 50% [7,8]. Patients with metastastic disease are usually considered suitable only for palliative therapy with a 5-year estimated survival less than 5% [2,9]. The liver is one of the most common sites of metastases, occurring in 35-40% of patients at the time of EC diagnosis [1,10] and it is the first recurrence site in 6-25% cases after esophagectomy [11][12][13].…”