Clinical Outcomes and Risk Factor Analysis of Surgical Resection of Pulmonary Metastases after Esophagectomy_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANGJin-dong ¹ ,  LIHe-fei ² , ZHANGKe ² , HANDong ¹ , YANWen-jun ¹ , YANMin ¹ , YANGChun-sheng ² , WANGWei-lin ¹

1. Department of Thoracic Surgery, First People's Hospital of Xuzhou, Xuzhou 221002, Jiangsu, P. R. China;
2. Department of Thoracic Surgery, Affiliated Hospital of Hebei University, Baoding 071000, Hebei, P. R. China;

Corresponding author：

LIHe-fei, Email: wangjd165@163.com

Keywords：

Esophgeal carcinoma; Pulmonary metastasis; Surgery; Prognosis

DOI：

10.7507/1007-4848.20140143

Video：

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Objective To investigate clinical outcomes and prognostic factors of surgical resection of pulmonary metastases after esophagectomy. Methods Clinical data of 15 patients who underwent surgical resection of pulmonary metastases after esophagectomy from March 1994 to May 2008 were retrospectively analyzed. There were 10 males and 5 females with their age of 43-72 (65.0±8.8) years. Surgical procedures included partial lung resection, pulmonary wedge resection, segmental resection and lobectomy. Follow-up duration was 60 months after surgical resection of pulmonary metastases. The influence of number and size of pulmonary metastases, TNM staging of primary esophageal cancer, and disease-free interval (DFI) after esophagectomy on postoperative survival rate after pulmonary metastasectomy was analyzed. Results Twelve, 24 and 60 months survival rates after pulmonary metastasectomy were 80.0%, 66.7% and 6.7%, respec-tively. Median DFI was 30 months. Survival rate after pulmonary metastasectomy of patients whose DFI was longer than 24 months was significantly longer than that of patients whose DFI was shorter than 24 months (χ²=5.144, P=0.023). Survival rate after pulmonary metastasectomy of patients with solitary pulmonary metastasis was significantly longer than that of patients with multiple pulmonary metastases (χ²=3.990, P=0.046).The size of pulmonary metastases and TNM staging of primary esophageal cancer didn't have significant impact on survival rate after pulmonary metastasectomy (P > 0.05). Cox proportional hazards model showed that DFI after esophagectomy was the main factor affecting survival rate after pulmonary metastasectomy (P=0.026). Conclusion Surgical resection is a therapeutic strategy for the treatment of pulmonary metas-tases after esophagectomy, and may achieve good clinical outcomes for patients with solitary pulmonary metastasis and patients whose DFI is longer than 24 months.

Citation： WANGJin-dong, LIHe-fei, ZHANGKe, HANDong, YANWen-jun, YANMin, YANGChun-sheng, WANGWei-lin. Clinical Outcomes and Risk Factor Analysis of Surgical Resection of Pulmonary Metastases after Esophagectomy. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(4): 507-510. doi: 10.7507/1007-4848.20140143 Copy

1.	Liu JF, Wang QZ, Hou J. Surgical treatment for cancer of the oesophagus and gastric cardia in Hebei, China. Br J Surg, 2004, 91 (1):90-98.
2.	Stein HJ, von Rahden BH, Siewert JR. Survival after oesophagectomy for cancer of the oesophagus. Langenbecks Arch Surg, 2005, 390 (4):280-285.
3.	Posner MC, Forastiere AA, Minsky BD. Cancer of the esophagus. In:De Vita VT Jr, Hellman S, Rosenberg SA, editors. Cancer principles and practice of oncology. 7th ed. Philadelphia:Lippincott Williams & Wilkins, 2005. 861-909.
4.	陈龙奇.食管癌国际TNM国际分期第7版解读与评价.中华肿瘤杂志, 2010, 32 (3):237-240.
5.	谢博雄, 丁嘉安, 姜格宁, 等.直肠癌术后转移性肺癌的外科疗效.肿瘤, 2002, 22 (1):59-60.
6.	张轶, 丁嘉安, 谢博雄, 等.肺转移瘤的外科治疗.中华肿瘤杂志, 2005, 27 (3):177-179.
7.	Pastorino U, Buyse M, Ffiedel G, et al. Long-term results of lung metastasectomy:prognostic analyses based on 5206 cases. The International Registry of lung metastasesa. J Thorac Cardiovasc Surg, 1997, 113 (1):37-49.
8.	Otani Y, Shomura H, Aiyama T, et al. Prognostic factors affecting the surgical treatment of metastatic lung tumor from colorectal cancer. Kyobu Geka, 2013, 66 (4):279-283.
9.	Malthaner RA, Wong RK, Rumble RB, et al. Neoadjuvant or adjuvant therapy for resectable esophageal cancer:a systemic review and meta-analysis. BMC Med, 2004, 2:35.
10.	Hulscher JB, Van Sandick JW, Tijssen JG, et al. The recurrence pattern of esophageal carcinoma after transhiatal resection. J Am Coll Surg, 2000, 191 (2):143-148.
11.	Law SY, Fok M, Wong J. Pattern of recurrence after oesophageal resection for cancer:clinical implications. Br J Surg, 1996, 83 (1):107-111.
12.	Chen F, Sato K, Sakai H, et al. Pulmonary resection for metastasis from esophageal carcinoma. Interact Cardiovasc Thorac Surg, 2008, 7 (5):809-812.
13.	Oparka J, Yan TD, Ryan E, et al. Does video-assisted thoracic surgery provide a safe alternative to conventional techniques in patients with limited pulmonary function who are otherwise suitable for lung resection? Interact Cardiovasc Thorac Surg, 2013, 17 (1):159-162.
14.	余国祥, 杨祉雷, 曹建军, 等.电视胸腔镜手术治疗转移性肺肿瘤.中国微创外科杂志, 2005, 5 (8):619-620.
15.	郭刚, 李高峰, 张继朋, 等.电视胸腔镜手术治疗肺转移瘤.中国医师杂志, 2012, 14 (2):195-196.
16.	Cerfolio LJ, Bryant AS, McCarty TP, et al. A prospective study to determine the incidence of non-imaged malignant pulmonary nodules in patients who undergo metastasectomy by thoracotomy with lung palpation. Ann Thorac Surg, 2011, 91 (6):1696-1701.
17.	Long H, Zheng Y, Situ D, et al. Hand-assisted thoracoscopic surgery for bilateral lung metastasectomy through sternocostal triangle access. Ann Thorac Surg, 2011, 91 (3):852-858.

1. Liu JF, Wang QZ, Hou J. Surgical treatment for cancer of the oesophagus and gastric cardia in Hebei, China. Br J Surg, 2004, 91 (1):90-98.
2. Stein HJ, von Rahden BH, Siewert JR. Survival after oesophagectomy for cancer of the oesophagus. Langenbecks Arch Surg, 2005, 390 (4):280-285.
3. Posner MC, Forastiere AA, Minsky BD. Cancer of the esophagus. In:De Vita VT Jr, Hellman S, Rosenberg SA, editors. Cancer principles and practice of oncology. 7th ed. Philadelphia:Lippincott Williams & Wilkins, 2005. 861-909.
4. 陈龙奇.食管癌国际TNM国际分期第7版解读与评价.中华肿瘤杂志, 2010, 32 (3):237-240.
5. 谢博雄, 丁嘉安, 姜格宁, 等.直肠癌术后转移性肺癌的外科疗效.肿瘤, 2002, 22 (1):59-60.
6. 张轶, 丁嘉安, 谢博雄, 等.肺转移瘤的外科治疗.中华肿瘤杂志, 2005, 27 (3):177-179.
7. Pastorino U, Buyse M, Ffiedel G, et al. Long-term results of lung metastasectomy:prognostic analyses based on 5206 cases. The International Registry of lung metastasesa. J Thorac Cardiovasc Surg, 1997, 113 (1):37-49.
8. Otani Y, Shomura H, Aiyama T, et al. Prognostic factors affecting the surgical treatment of metastatic lung tumor from colorectal cancer. Kyobu Geka, 2013, 66 (4):279-283.
9. Malthaner RA, Wong RK, Rumble RB, et al. Neoadjuvant or adjuvant therapy for resectable esophageal cancer:a systemic review and meta-analysis. BMC Med, 2004, 2:35.
10. Hulscher JB, Van Sandick JW, Tijssen JG, et al. The recurrence pattern of esophageal carcinoma after transhiatal resection. J Am Coll Surg, 2000, 191 (2):143-148.
11. Law SY, Fok M, Wong J. Pattern of recurrence after oesophageal resection for cancer:clinical implications. Br J Surg, 1996, 83 (1):107-111.
12. Chen F, Sato K, Sakai H, et al. Pulmonary resection for metastasis from esophageal carcinoma. Interact Cardiovasc Thorac Surg, 2008, 7 (5):809-812.
13. Oparka J, Yan TD, Ryan E, et al. Does video-assisted thoracic surgery provide a safe alternative to conventional techniques in patients with limited pulmonary function who are otherwise suitable for lung resection? Interact Cardiovasc Thorac Surg, 2013, 17 (1):159-162.
14. 余国祥, 杨祉雷, 曹建军, 等.电视胸腔镜手术治疗转移性肺肿瘤.中国微创外科杂志, 2005, 5 (8):619-620.
15. 郭刚, 李高峰, 张继朋, 等.电视胸腔镜手术治疗肺转移瘤.中国医师杂志, 2012, 14 (2):195-196.
16. Cerfolio LJ, Bryant AS, McCarty TP, et al. A prospective study to determine the incidence of non-imaged malignant pulmonary nodules in patients who undergo metastasectomy by thoracotomy with lung palpation. Ann Thorac Surg, 2011, 91 (6):1696-1701.
17. Long H, Zheng Y, Situ D, et al. Hand-assisted thoracoscopic surgery for bilateral lung metastasectomy through sternocostal triangle access. Ann Thorac Surg, 2011, 91 (3):852-858.

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Clinical Outcomes and Risk Factor Analysis of Surgical Resection of Pulmonary Metastases after Esophagectomy

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