title: Pattern of postoperative recurrence and hepatic and/or pulmonary resection for liver and/or lung metastases from esophageal carcinoma.
abstract: BACKGROUND
  We assessed the benefit of hepatic and pulmonary resections in patients with liver and lung recurrences, respectively, after resection of esophageal carcinoma.
  
  
  METHODS
  The study population consisted of 138 consecutive patients with recurrent esophageal carcinoma after esophagectomy conducted between 2003 and 2005. The pattern, timing of appearance, and the prognosis of these recurrences were investigated, paying particular attention to those undergoing hepatic and pulmonary resections.
  
  
  RESULTS
  In total, 55 and 92 patients developed locoregional and distant-organ metastases 13 and 6 months (median) after surgery, respectively, including 9 patients with both types of recurrence. The distant-organ metastases were found in the liver (n = 26), lung (n = 27), bone (n = 21), and other organs (n = 29). Patients with pulmonary recurrences had a better overall prognosis (median survival after recurrence detection 13 months) than those with hepatic metastases (5 months) or nonhepatic nonpulmonary metastases. (3 months) Hepatic and pulmonary resections were carried out in patients with oligonodular (n = ≤ 2) isolated liver and lung metastases (n = 5, respectively). Although the survivals of patients with lung metastases who were treated/not treated by pulmonary resection were different (median survival: 48 vs. 10 months, p < 0.01), the difference in the survivals between patients with hepatic metastases who were treated/not treated by hepatic resection reached only borderline statistical significance (13 vs. 5 months, p = 0.06).
  
  
  CONCLUSIONS
  Resection of pulmonary metastases yields a survival benefit in properly selected patients. The benefit of resection for hepatic metastases remains controversial.
authors.affiliation: Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Ichida
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Imamura
authors.forename: Jiro
authors.initials: J
authors.lastname: Yoshimoto
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Sugo
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Kajiyama
authors.forename: Masahiko
authors.initials: M
authors.lastname: Tsurumaru
authors.forename: Kenji
authors.initials: K
authors.lastname: Suzuki
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Ishizaki
authors.forename: Seiji
authors.initials: S
authors.lastname: Kawasaki
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000556:secondary / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000556:secondary / Q000601:surgery; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D016629:Esophagectomy; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008175:Lung Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000601:surgery; D011013:Pneumonectomy; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome