Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Implications of Liver-Directed Therapy for Postoperative Hepatic Metastasis from Esophageal Cancer

  • Urabe, Masayuki (Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo) ;
  • Yagi, Koichi (Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo) ;
  • Shiomi, Shinichiro (Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo) ;
  • Toriumi, Tetsuro (Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo) ;
  • Okumura, Yasuhiro (Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo) ;
  • Setoa, Yasuyuki (Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo)
  • Received : 2022.04.26
  • Accepted : 2022.07.07
  • Published : 2022.10.05
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Abstract

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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References

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