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Schizas D, Vailas M, Sotiropoulou M, A Ziogas I, S Mylonas K, Katsaros I, Kapelouzou A, Liakakos T. Surgery for metachronous oligometastatic esophageal cancer: Is there enough evidence? Cir Esp 2021; 99:490-499. [PMID: 34353590 DOI: 10.1016/j.cireng.2021.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/05/2021] [Indexed: 02/07/2023]
Abstract
Esophageal cancer is the sixth most common cause of cancer-related mortality worldwide. Despite advances in diagnostic modalities and treatment options, five-year survival rates are below 20%. Esophagectomy with extended lymph node dissection is the mainstay of treatment. More than 50% of patients experience recurrence within 1-3 years postoperatively. Recurrent disease may present locoregionally at the site of anastomosis or as recurrence through lymphatic spread in lymph node basins, as hematogenic metastasis, or as a combination of these. The standard treatment of recurrence is currently predicated on systemic chemotherapy and/or radiotherapy. Recent evidence suggests that surgical treatment of metachronous oligometastatic disease may be prognostically advantageous over medical management alone. Given the considerably low response rates to chemoradiotherapy, many institutions have adopted surgical treatment strategies for oligo-recurrent disease on a case-by-case basis. The aim of this article is to review the current evidence on the role of surgical treatment for metachronous oligometastases from esophageal cancer.
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Affiliation(s)
- Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma, 11527 Athens, Greece
| | - Michail Vailas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma, 11527 Athens, Greece.
| | - Maria Sotiropoulou
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma, 11527 Athens, Greece
| | - Ioannis A Ziogas
- Department of Surgery, Vanderbilt University Medical Center, 1313 21st Avenue South, Nashville, TN, USA
| | - Konstantinos S Mylonas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma, 11527 Athens, Greece
| | - Ioannis Katsaros
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma, 11527 Athens, Greece
| | - Alkistis Kapelouzou
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma, 11527 Athens, Greece
| | - Theodore Liakakos
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma, 11527 Athens, Greece
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Jindal T, Sarwal A, Pawar P, Dhanalakshmi M, Subedi N. Laparoscopic management of isolated metachronous adrenal metastases in a patient with esophageal cancer: a case report. J Med Case Rep 2021; 15:369. [PMID: 34253234 PMCID: PMC8276374 DOI: 10.1186/s13256-021-02849-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 04/04/2021] [Indexed: 12/05/2022] Open
Abstract
Background The presence of isolated metachronous adrenal metastasis in patients with esophageal cancer is rare. There is significant controversy regarding the management of such patients. Adrenal metastasectomy has been shown to be of benefit in some reports. Minimally invasive approach, although the gold standard for adrenalectomy, has not been used commonly in a postesophagectomy setting owing to the anticipated technical difficulties. We describe one such case wherein this approach helped in early recovery and long-term survival. Case presentation A 59-year-old male of Asian ethnicity presented with an isolated left adrenal nodule, 3 years after an Ivor Lewis esophagectomy for a lower esophageal adenocarcinoma. The biopsy of the nodule was suggestive of metastatic adenocarcinoma. The patient underwent laparoscopic excision of the left adrenal gland. Conclusion Adrenal metastasectomy, in postesophagectomy patients can provide good oncological control. Laparoscopic approach, though technically challenging, can provide results equivalent to those of open surgery, albeit with less morbidity.
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Affiliation(s)
- Tarun Jindal
- Department of Uro-oncology, Tata Medical Centre, Kolkata, India
| | - Ankush Sarwal
- Department of Uro-oncology, Tata Medical Centre, Kolkata, India
| | - Pravin Pawar
- Department of Uro-oncology, Tata Medical Centre, Kolkata, India
| | - M Dhanalakshmi
- Department of Uro-oncology, Tata Medical Centre, Kolkata, India
| | - Neeraj Subedi
- Department of Urology, Nepal Medical College Teaching Hospital, Kathmandu, Nepal.
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Schizas D, Vailas M, Sotiropoulou M, A Ziogas I, S Mylonas K, Katsaros I, Kapelouzou A, Liakakos T. Surgery for metachronous oligometastatic esophageal cancer: Is there enough evidence? Cir Esp 2021. [PMID: 33894971 DOI: 10.1016/j.ciresp.2021.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Esophageal cancer is the sixth most common cause of cancer-related mortality worldwide. Despite advances in diagnostic modalities and treatment options, five-year survival rates are below 20%. Esophagectomy with extended lymph node dissection is the mainstay of treatment. More than 50% of patients experience recurrence within 1-3 years postoperatively. Recurrent disease may present locoregionally at the site of anastomosis or as recurrence through lymphatic spread in lymph node basins, as hematogenic metastasis, or as a combination of these. The standard treatment of recurrence is currently predicated on systemic chemotherapy and/or radiotherapy. Recent evidence suggests that surgical treatment of metachronous oligometastatic disease may be prognostically advantageous over medical management alone. Given the considerably low response rates to chemoradiotherapy, many institutions have adopted surgical treatment strategies for oligo-recurrent disease on a case-by-case basis. The aim of this article is to review the current evidence on the role of surgical treatment for metachronous oligometastases from esophageal cancer.
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Affiliation(s)
- Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma, 11527 Athens, Greece
| | - Michail Vailas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma, 11527 Athens, Greece.
| | - Maria Sotiropoulou
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma, 11527 Athens, Greece
| | - Ioannis A Ziogas
- Department of Surgery, Vanderbilt University Medical Center, 1313 21st Avenue South, Nashville, TN, USA
| | - Konstantinos S Mylonas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma, 11527 Athens, Greece
| | - Ioannis Katsaros
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma, 11527 Athens, Greece
| | - Alkistis Kapelouzou
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma, 11527 Athens, Greece
| | - Theodore Liakakos
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma, 11527 Athens, Greece
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Schizas D, Lazaridis II, Moris D, Mastoraki A, Lazaridis LD, Tsilimigras DI, Charalampakis N, Liakakos T. The role of surgical treatment in isolated organ recurrence of esophageal cancer-a systematic review of the literature. World J Surg Oncol 2018; 16:55. [PMID: 29540179 PMCID: PMC5853115 DOI: 10.1186/s12957-018-1357-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 03/06/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Despite the improvements in the early detection and treatment of non-metastatic esophageal cancer, more than half of patients undergoing a curative treatment for esophageal cancer will develop recurrence within three years. The prognosis of these patients is poor. However, a wide range in overall survival has been reported, depending on the pattern of recurrence, and no optimal treatment strategy following recurrence has yet been uniformly accepted. AIM In this article, we aimed to systematically review the literature for the role of surgical resection of metachronous distant metastasis following primary treatment of esophageal cancer. Furthermore, we discuss possible factors that could possibly predict which patients may benefit from a surgical approach. A comprehensive literature search was conducted in PubMed using combinations of keywords. RESULTS Patients with recurrence may benefit of a multimodality treatment. Regarding the isolated recurrence of esophageal cancer in solid visceral organs, operative intervention has been proposed as a treatment that may offer a survival benefit in an individual basis. No definitive conclusions regarding the potential survival advantage offered by the surgical treatment of solitary recurrent lesions can be drawn. However, recent improvements in surgical treatment and optimization of perioperative management guarantee an acceptable operative risk, making surgical resection of solitary recurrence lesions a considerable therapeutic option. CONCLUSIONS It can be conferred from the available studies that the surgical treatment of isolated recurrence from esophageal cancer may offer a survival benefit for properly selected patients. Prospective, multicenter studies might be useful to gain a better insight into those factors that affect selection of patients to take benefit from an operative intervention.
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Affiliation(s)
- Dimitrios Schizas
- First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, 17 Agiou Thoma Str., Goudi, 11527, Athens, Greece.
| | | | - Demetrios Moris
- First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, 17 Agiou Thoma Str., Goudi, 11527, Athens, Greece
| | - Aikaterini Mastoraki
- Fourth Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Lazaros-Dimitrios Lazaridis
- Hepatogastroenterology Unit, Second Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Theodore Liakakos
- First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, 17 Agiou Thoma Str., Goudi, 11527, Athens, Greece
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Kanaya N, Noma K, Okada T, Maeda N, Tanabe S, Sakurama K, Shirakawa Y, Fujiwara T. A case of long-term survival after surgical resection for solitary adrenal recurrence of esophageal squamous carcinoma. Surg Case Rep 2017; 3:61. [PMID: 28477332 PMCID: PMC5419952 DOI: 10.1186/s40792-017-0337-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 05/01/2017] [Indexed: 01/20/2023] Open
Abstract
Background Esophageal carcinomas are highly malignant tumors with a high frequency of lymph node and distant organ metastasis. Treatment for recurrent tumors is generally decided on an individual basis. Although multidisciplinary treatments involving chemotherapy, surgical resection, and radiation are performed, the prognosis remains poor. Here, we report a case of prolonged recurrence-free survival (38 months) after esophageal carcinoma surgery and subsequent laparoscopic adrenalectomy for right adrenal metastasis. Case presentation An 83-year-old man was diagnosed with type 3 esophageal squamous cell carcinoma (T3N1M0, cStage IIIA, UICC-7), spreading from the lower thoracic esophagus to the abdominal esophagus. He underwent thoracoscopic esophagectomy with a two-field lymph node dissection followed by substernal gastric tube reconstruction. The final diagnosis was moderately differentiated squamous cell carcinoma (T3N2M0, fStage IIIB). Adjuvant chemotherapy was not administered because of the advanced age and postoperative condition of the patient. Computed tomography (CT) at 14 months postoperatively showed a mass with a 2-cm diameter at the right adrenal gland. Positron emission tomography (PET)/CT revealed a high fluorodeoxyglucose (FDG) uptake in the mass. It was suspected that the mass was a metastatic lesion secondary to the primary esophageal carcinoma. No metastases to lymph nodes or other distant organs were identified. The patient underwent laparoscopic right adrenalectomy. The histopathological examination revealed moderately differentiated squamous cell carcinoma, suggesting metastasis from the primary esophageal carcinoma. He has survived without recurrence for 38 months since laparoscopic adrenalectomy to remove the right adrenal metastastic mass after the esophageal carcinoma surgery. Conclusions We describe a very elderly male who survived laparoadrenalectomy for right adrenal metastasis following esophageal cancer surgery without recurrence for 38 months postoperatively. Therefore, surgical resection might be an option for solitary adrenal recurrence.
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Affiliation(s)
- Nobuhiko Kanaya
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Kazuhiro Noma
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
| | - Tsuyoshi Okada
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Naoaki Maeda
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Shunsuke Tanabe
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Kazufumi Sakurama
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.,Department of Surgery, Shigei Medical Research Institute, Okayama, Japan
| | - Yasuhiro Shirakawa
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Toshiyoshi Fujiwara
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
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Hadlich E, Carbonari APC, Assef MS, Araki OM, Nakao FS, Saieg MTA, Rossini LGB. Esophageal adenocarcinoma metastasis in the left adrenal gland diagnosed by endoscopic ultrasound-guided fine needle aspiration. Endosc Ultrasound 2017; 6:142-144. [PMID: 28440242 PMCID: PMC5418969 DOI: 10.4103/2303-9027.204809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Everton Hadlich
- Department of Endoscopy, Santa Casa de São Paulo Hospital and French-ian Center of Endoscopic Ultrasound, São Paulo, Brazil
| | - Augusto P C Carbonari
- Department of Endoscopy, Santa Casa de São Paulo Hospital and French-ian Center of Endoscopic Ultrasound, São Paulo, Brazil
| | - Maurício S Assef
- Department of Endoscopy, Santa Casa de São Paulo Hospital and French-ian Center of Endoscopic Ultrasound, São Paulo, Brazil
| | - Osvaldo M Araki
- Department of Endoscopy, Santa Casa de São Paulo Hospital and French-ian Center of Endoscopic Ultrasound, São Paulo, Brazil
| | - Frank S Nakao
- Department of Endoscopy, Santa Casa de São Paulo Hospital and French-ian Center of Endoscopic Ultrasound, São Paulo, Brazil
| | - Mauro T A Saieg
- Department of Pathology, Santa Casa de São Paulo Hospital, São Paulo, Brazil
| | - Lúcio G B Rossini
- Department of Endoscopy, Santa Casa de São Paulo Hospital and French-ian Center of Endoscopic Ultrasound, São Paulo, Brazil
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Okamoto H, Hara Y, Chin M, Hagiwara M, Onodera Y, Horii S, Shirahata Y, Kamei T, Hashizume E, Ohuchi N. An extremely rare case of pancreatic metastasis of esophageal squamous cell carcinoma. World J Gastroenterol 2014; 20:593-597. [PMID: 24574730 PMCID: PMC3923036 DOI: 10.3748/wjg.v20.i2.593] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 11/19/2013] [Indexed: 02/06/2023] Open
Abstract
We report a rare case of a 68-year-old male with metachronous pancreatic metastasis that was resected 2 years after salvage esophagectomy for local recurrence of esophageal squamous cell carcinoma (ESCC). Two years and 8 mo ago, he had undergone definitive chemoradiotherapy for the lower thoracic ESCC and achieved a complete response. Chemoradiotherapy used the protocol of the Japan Clinical Oncology Group trial 9906. Approximately 8 mo later, he developed a local recurrence of the ESCC and underwent thoracoscopic salvage esophagectomy followed by reconstruction with a conduit colon graft via a subcutaneous route. Recently, a tumor of the pancreatic body was found on routine follow-up computed tomography (CT). The tumor diameter was 15 mm on CT, and the maximum standardized uptake value of the lesion was 5.49 at 18F-2-fluoro-2-deoxy-D-glucose positron-emission tomography, strongly suggesting pancreatic cancer. In addition, all tumor markers were within the reference intervals. Therefore, distal pancreatectomy was performed with the resultant histological diagnosis being confirmed as pancreatic metastasis of the ESCC. He was treated with adjuvant chemotherapy, and there has been no evidence of recurrence 9 mo after the surgery. Resection of pancreatic metastasis offers a good prognosis and should be considered for solitary ESCC metastasis.
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Fumagalli U, de Carli S, de Pascale S, Rimassa L, Bignardi M, Rosati R. Adrenal metastases from adenocarcinoma of the esophagogastric junction: adrenalectomy and long-term survival. Updates Surg 2011; 62:63-7. [PMID: 20845103 DOI: 10.1007/s13304-010-0012-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Treatment of adrenal metastases from cancer of the esophagogastric junction (EGJ) is not defined. The aim of the present work is to analyze retrospectively our experience in treating patients with adrenal metastases from EGJ adenocarcinoma. 102 patients with Siewert 1 or 2 EGJ adenocarcinoma underwent esophagectomy between May 2001 and Jan 2009. Five patients were diagnosed an adrenal metastases from EGJ adenocarcinoma, synchronous (s) in one and metachronous (m) in four, in the latter 11 months (mean) after esophagectomy. At diagnosis, three patients had synchronous metastases to mediastinal nodes (1 s and 2 m), 1 (m) had synchronous metastases to bone, and 1 (m) had an isolated adrenal metastasis. Three patients with synchronous node metastasis received chemotherapy followed by adrenalectomy 3, 8 and 16 months (mean 9) after diagnosis; one patient also received postoperative mediastinal radiotherapy. These patients are alive with no evidence of disease 16, 40 and 50 months after diagnosis of adrenal metastasis. The patient with bone metastasis received chemotherapy only and died 12 months after diagnosis of metastatic disease. The patient with isolated metastasis underwent laparoscopic adrenalectomy only, developed early bone metastases and died 15 months after surgery. In conclusion, our experience indicates that patients with adrenal metastases from adenocarcinoma of the EGJ may benefit from adrenalectomy if the gland is the only site of metastasis beyond lymphnodal disease. Chemotherapy should be considered before adrenalectomy to achieve better disease control and identify aggressive disease that would contraindicate adrenalectomy.
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Affiliation(s)
- Uberto Fumagalli
- Department of General and Minimally Invasive Surgery, Istituto Clinico Humanitas IRCCS, Via Manzoni 56, 20089 Rozzano (MI), Italy.
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