Implications of Liver-Directed Therapy for Postoperative Hepatic Metastasis from Esophageal Cancer
Background: Distant recurrence of esophageal cancer (EC), even after radical resection, is common, and the most frequent site of EC metastasis is the liver. However, a multidisciplinary treatment strategy for postoperative liver metastasis (LM) from EC has yet to be established; in particular, th...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Korean Society for Thoracic & Cardiovascular Surgery
2022-10-01
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| Series: | Journal of Chest Surgery |
| Subjects: |
| Summary: | Background: Distant recurrence of esophageal cancer (EC), even after radical resection,
is common, and the most frequent site of EC metastasis is the liver. However, a multidisciplinary
treatment strategy for postoperative liver metastasis (LM) from EC has yet to
be established; in particular, the role of liver-directed therapy (LDT) remains uncertain.
We investigated the clinicopathological features and outcomes of patients undergoing
post-esophagectomy LM with versus without LDT to explore its therapeutic implications.
Methods: Among 624 consecutive patients undergoing R0/R1 esophagectomy for EC,
30 were identified in whom LM had developed as the initial recurrence. Their characteristics
were retrospectively reviewed.
Results: Six of the 30 subjects underwent LDT for metachronous LM. Five of those 6 also
received systemic chemotherapy. A comparison between the 6 LDT and 24 non-LDT cases
revealed no significant differences in major clinicopathological and operative factors, except
for concurrent metastasis to extrahepatic organs (1/6 vs. 15/24, p=0.044). Twenty-nine
of the 30 patients died during the study period, whereas 1 who had received multimodal
treatment with LDT remained alive more than 200 months after multiple LM had been
detected. Kaplan-Meier analysis for survival after LM demonstrated significantly prolonged
survival in LDT cases compared to non-LDT cases treated with systemic chemotherapy
alone (p=0.014). Even when the analysis was limited to patients without extrahepatic metastasis,
this significant prognostic advantage of LDT was maintained (p=0.047).
Conclusion: Multimodal treatment combined with LDT might be beneficial for patients
with metachronous LM from EC and should therefore be considered a potential treatment
option. |
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| ISSN: | 2765-1606 2765-1614 |