Oligometastatic Gastroesophageal Adenocarcinoma: Molecular Pathophysiology and Current Therapeutic Approach

Abstract

Gastric and esophageal cancers are dreaded malignancies, with a majority of patients presenting in either a locally advanced or metastatic state. Global incidences are rising and the overall prognosis remains poor. The concept of oligometastasis has been established for other tumor entities and is also proposed for upper gastrointestinal tract cancers. This review article explores metastasis mechanisms on the molecular level, specific to esophageal and gastric adenocarcinoma. Existing data and recent studies that deal with upper gastrointestinal tumors in the oligometastatic state are reviewed. Furthermore, current therapeutic targets in gastroesophageal cancers are presented and discussed. Finally, a perspective about future diagnostic and therapeutic strategies is given.

Surgical resection of synchronous liver metastases in gastric cancer patients. A propensity score-matched study

“…In our study longterm survival of gastric cancer patients was only possible when liver metastases were resected. The comparison of results from the LM0 and LMR group might support the claim that liver resections have a positive impact on long-term survival 8,12,[15][16][17] ; however, the retrospective nature of the study carries some risk of biased selection despite the PSM. At least six patients in LM0 group had potentially resectable metastases.…”

“…The perioperative morbidity and mortality in the LMR group was 14.3% and 4.8% that compares favourably to results published in other studies. [1][2][3][4][5][6][7][8][12][13][14][15][16][17] Notably, perioperative morbidity in LMR group was significantly better compared to CG group. This discrepancy in perioperative morbidity could in part be explained in the additional multivisceral resections in the CG.…”

“…The data from the present study is in accordance with the results of studies that show a significant increase in long-term survival in patients with liver resections in gastric cancer patients. [1][2][3][4][5][6][7][8]12,[15][16][17] well differentiated tumour had a significantly better survival compared to patients with moderate and poor tumour differentiation. This difference…”

“…The 5-year survival of LMR patients in our study was 14.3% which was comparable to other studies that reported the 5-year survival of 0% to 42% after liver resection. [1][2][3][4][5][6][7][8]12,[15][16][17] In their seminal multi-centric retrospective analysis of stage IV gastric cancer in Western patients Ministrini et al reported 5-year survival of 11.8%. 22 Although our results compare favourably to results of Ministrini et al, some studies reported better long-term survival of up to 32% to 59%.…”

Primary tumor resection of metastatic gastric cancer in a multimodal era: Two case reports

“…Historically, the presence of metastasis in gastric cancer signified ineligibility for surgical treatment and led to a marked decrease in overall survival [ 1 , 2 ]. Recent advancements in systemic therapies leading to better disease control have motivated a renewed discussion surrounding the role of surgical resection in metastatic gastric cancer [ 3 ]. The following two cases, which illustrate this new paradigm, are reported in line with the SCARE criteria [ 4 ], and illustrate this new paradigm.…”