title: Brain metastases in gastrointestinal cancers: is there a role for surgery?
abstract: About 10% of all cancer patients will develop brain metastases during advanced disease progression. Interestingly, the vast majority of brain metastases occur in only three types of cancer: Melanoma, lung and breast cancer. In this review, we focus on summarizing the prognosis and impact of surgical resection of brain metastases originating from gastrointestinal cancers such as esophageal, gastric, pancreatic and colorectal cancer. The incidence of brain metastases is <1% in pancreatic and gastric cancer and <4% in esophageal and colorectal cancer. Overall, prognosis of these patients is very poor with a median survival in the range of only months. Interestingly, a substantial number of patients who had received surgical resection of brain metastases showed prolonged survival. However, it should be taken into account that all these studies were not randomized and it is likely that patients selected for surgical treatment presented with other important prognostic factors such as solitary brain metastases and exclusion of extra-cranial disease. Nevertheless, other reports have demonstrated long-term survival of patients upon resection of brain metastases originating from gastrointestinal cancers. Thus, it appears to be justified to consider aggressive surgical approaches for these patients.
authors.affiliation: Clinic of General and Visceral Surgery, University Hospital Ulm, Albert-Einstein-Allee 23, Ulm 89071, Germany. johanneslemke@gmx.de.
authors.forename: Johannes
authors.initials: J
authors.lastname: Lemke
authors.affiliation: Clinic of General and Visceral Surgery, University Hospital Ulm, Albert-Einstein-Allee 23, Ulm 89071, Germany. jan.scheele@uniklinik-ulm.de.
authors.forename: Jan
authors.initials: J
authors.lastname: Scheele
authors.affiliation: Clinic of Neurosurgery, University Hospital Ulm, Albert-Einstein-Allee 23, Ulm 89071, Germany. thomas.kapapa@uniklinik-ulm.de.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kapapa
authors.affiliation: UCL Cancer Institute, University College London, 72 Huntley Street, London WC1E 6DD, UK. s.karstedt@ucl.ac.uk.
authors.forename: Silvia
authors.initials: S
authors.lastname: von Karstedt
authors.affiliation: Clinic of Neurosurgery, University Hospital Ulm, Albert-Einstein-Allee 23, Ulm 89071, Germany. rainer.wirtz@uniklinik-ulm.de.
authors.forename: Christian Rainer
authors.initials: CR
authors.lastname: Wirtz
authors.affiliation: Clinic of General and Visceral Surgery, University Hospital Ulm, Albert-Einstein-Allee 23, Ulm 89071, Germany. doris.henne-bruns@uniklinik-ulm.de.
authors.forename: Doris
authors.initials: D
authors.lastname: Henne-Bruns
authors.affiliation: Clinic of General and Visceral Surgery, University Hospital Ulm, Albert-Einstein-Allee 23, Ulm 89071, Germany. marko.kornmann@uniklinik-ulm.de.
authors.forename: Marko
authors.initials: M
authors.lastname: Kornmann
mesh_terms: D001932:Brain Neoplasms / Q000453:epidemiology / Q000556:secondary* / Q000601:surgery; D002277:Carcinoma / Q000453:epidemiology / Q000556:secondary* / Q000601:surgery; D003399:Craniotomy; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000453:epidemiology / Q000473:pathology*; D005770:Gastrointestinal Neoplasms / Q000453:epidemiology / Q000473:pathology*; D006801:Humans; D015994:Incidence; D019635:Neurosurgical Procedures; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000453:epidemiology / Q000473:pathology*; D018579:Patient Selection; D011379:Prognosis; D011788:Quality of Life; D016896:Treatment Outcome