title: Metachronous pulmonary metastasis after radical esophagectomy for esophageal cancer: prognosis and outcome.
abstract: BACKGROUND
  Few reports discuss the outcome of pulmonary metastasis after radical esophagectomy for esophageal cancer. To clarify the data from such cases, we conducted a retrospective study on the clinical outcome of patients who developed pulmonary metastasis after undergoing radical esophagectomy.
  
  
  METHODS
  We retrospectively reviewed the prognosis and clinical outcome of 25 patients who developed metachronous pulmonary metastasis after esophagectomy for esophageal cancer.
  
  
  RESULTS
  The site of recurrence was pulmonary without extrapulmonary metastasis in 14 patients and extrapulmonary metastasis was observed in 11. Nineteen patients had multiple pulmonary metastasis and 6 had solitary pulmonary metastasis. Twenty-four of patients underwent systemic chemotherapy during initial treatment for metastatic lesions. Pulmonary metastasectomy was indicated in 5 patients with solitary metastasis. The actual 1-, 2- and 4-year survival rates were 60%, 36% and 27%, respectively. Gender, operative procedure, and postoperative morbidity were not significant prognostic factors. However, pathological staging of primary esophageal cancer was a significant prognostic factor. Survival was significantly worse in patients who did not undergo resection than in those who did. The number of pulmonary metastasis, complicated extrapulmonary metastasis and the time of recurrence were also significant prognostic factors.
  
  
  CONCLUSIONS
  Multiple pulmonary metastases or complicated extrapulmonary metastasis were unfavorable prognostic factors for patients with pulmonary metastasis arising from esophageal cancer. Although, surgical intervention is not recommended in such cases, metastasectomy is an acceptable choice of treatment for solitary pulmonary metastasis.
authors.affiliation: Department of Upper Gastrointestinal Surgery, Hyogo College of Medicine, 1-1, Mucogawa-machi, Nishinomiya City, Hyogo 663-8501, Japan. mtake@hyo-med.ac.jp
authors.forename: Masashi
authors.initials: M
authors.lastname: Takemura
authors.forename: Katsunobu
authors.initials: K
authors.lastname: Sakurai
authors.forename: Mamiko
authors.initials: M
authors.lastname: Takii
authors.forename: Kayo
authors.initials: K
authors.lastname: Yoshida
mesh_terms: D000368:Aged; D004938:Esophageal Neoplasms / Q000473:pathology* / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000556:secondary* / Q000601:surgery / Q000628:therapy; D008297:Male; D059146:Metastasectomy; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000556:secondary* / Q000601:surgery / Q000628:therapy; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome