title: Pulmonary metastasectomy secondary to esophageal carcinoma: long-term survival and prognostic factors.
abstract: BACKGROUND
  Lung metastasectomy has become an effective treatment for selected patients with colorectal cancer, renal cancer, and other malignancies; however, limited experience has been reported regarding pulmonary metastasectomy for esophageal carcinoma. We reviewed 23 patients with esophageal cancer who underwent pulmonary metastasectomy and investigated their long-term prognosis and prognostic factors.
  
  
  METHODS
  A total of 23 patients who underwent 30 curative pulmonary metastasectomies at Toranomon Hospital, Japan, between 2001 and 2011 were included. Four patients underwent repeated metastasectomy. The overall survival rate was examined by the Kaplan-Meier method and various characteristics were assessed by univariate analysis to identify prognostic factors.
  
  
  RESULTS
  The overall 1-, 3-, and 5-year survival rate was 82.6, 46, and 34.1 %, respectively. Median follow-up was 37.4 months (range 1-114 months). Univariate analysis revealed a history of extrapulmonary metastases before pulmonary metastasectomy, poorly differentiated primary esophageal carcinoma, and short disease-free interval (DFI) as unfavorable prognostic factors. Five patients who underwent repeated metastasectomy for recurrent pulmonary metastases survived a mean 58 months (range 24-114 months). The other patients survived a mean 29.4 months (range 1-109 months).
  
  
  CONCLUSIONS
  Pulmonary resection for lung metastases from esophageal carcinoma should be considered in selected patients, and repeated metastasectomy should be encouraged. Extrapulmonary metastases before pulmonary metastasectomy, poor differentiation of primary esophageal carcinoma, and short DFI are unfavorable prognostic factors. Due to poor prognosis, metastasectomy in patients with these factors should be more carefully considered before being indicated.
authors.affiliation: Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan, nao0612@i.softbank.jp.
authors.forename: Nao
authors.initials: N
authors.lastname: Kobayashi
authors.forename: Tadasu
authors.initials: T
authors.lastname: Kohno
authors.forename: Shusuke
authors.initials: S
authors.lastname: Haruta
authors.forename: Sakashi
authors.initials: S
authors.lastname: Fujimori
authors.forename: Hisashi
authors.initials: H
authors.lastname: Shinohara
authors.forename: Masaki
authors.initials: M
authors.lastname: Ueno
authors.forename: Harushi
authors.initials: H
authors.lastname: Udagawa
mesh_terms: D000368:Aged; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D059146:Metastasectomy / Q000401:mortality*; D008875:Middle Aged; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000401:mortality*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate