title: Surgery in oesophago-gastric cancer with metastatic disease: Treatment, prognosis and preoperative patient selection.
abstract: BACKGROUND
  The role of surgical resection in metastatic oesophago-gastric adenocarcinomas (EGA) is not defined and regularly discussed in interdisciplinary tumour boards. Primary objective of this retrospective study was the outcome of patients after surgery. We additionally evaluated our preoperative prognostic score (PPS) based on tumour grading, clinical response to chemotherapy and presumed R-status.
  
  
  METHODS
  123 of 811 EGA patients were evaluated as cM1, either confirmed intraoperatively or by imaging. Response evaluation after chemotherapy was performed by endoscopy, CT-scan and histopathologically. The prospectively documented patient and outcome data were analysed retrospectively.
  
  
  RESULTS
  70 patients with adenocarcinoma of the oesophago-gastric junction and 53 patients with gastric cancer were included. The majority had one M1 site (n = 102). 72 received preoperative chemotherapy (CTx) and 51 underwent primary resection. 11 were explored without resection. 49/112 (40%) had multivisceral resections and 63/112 (56%) were completely resected (R0). 26/72 (36%) were clinical responders and 30 patients had a favourable PPS. Median survival was 20.0 months. Survival was significantly prolonged by resection, especially complete resection, and by preoperative CTx (all p = 0.001). Multivisceral resection, type or number of metastases, or primary tumour localization had no impact on survival. In patients undergoing preoperative CTx, clinical response and the PPS influenced survival significantly. In R0 resected patients, preoperative CTx, clinical response and the PPS remained prognostic.
  
  
  CONCLUSIONS
  Primary resection without preoperative CTx is not appropriate for metastatic EGA. Subgroups of patients with a favourable PPS with response to CTx may be good candidates for surgical resection in metastatic oesophago-gastric cancer.
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University of Heidelberg, 69120 Heidelberg, Germany. Electronic address: Thomas.Schmidt1@med.uni-heidelberg.de.
authors.forename: T
authors.initials: T
authors.lastname: Schmidt
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University of Heidelberg, 69120 Heidelberg, Germany.
authors.forename: I
authors.initials: I
authors.lastname: Alldinger
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University of Heidelberg, 69120 Heidelberg, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Blank
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University of Heidelberg, 69120 Heidelberg, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Klose
authors.affiliation: Department of Medical Oncology, University Hospital Heidelberg, 69120 Heidelberg, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Springfeld
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University of Heidelberg, 69120 Heidelberg, Germany.
authors.forename: L
authors.initials: L
authors.lastname: Dreikhausen
authors.affiliation: Department of Pathology, University of Heidelberg, 69120 Heidelberg, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Weichert
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany.
authors.forename: L
authors.initials: L
authors.lastname: Grenacher
authors.affiliation: Institute of Medical Biometry and Informatics IMBI, University of Heidelberg, 69120 Heidelberg, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Bruckner
authors.affiliation: University Cancer Center Leipzig (UCCL), University of Leipzig, 04103 Leipzig, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Lordick
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University of Heidelberg, 69120 Heidelberg, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Ulrich
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University of Heidelberg, 69120 Heidelberg, Germany.
authors.forename: M W
authors.initials: MW
authors.lastname: Büchler
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University of Heidelberg, 69120 Heidelberg, Germany. Electronic address: Katja.Ott@med.uni-heidelberg.de.
authors.forename: K
authors.initials: K
authors.lastname: Ott
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy; D004943:Esophagogastric Junction / Q000473:pathology / Q000601:surgery*; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary*; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D020360:Neoadjuvant Therapy; D018579:Patient Selection; D010534:Peritoneal Neoplasms / Q000556:secondary*; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*
keywords: Gastric cancer; Metastasis; Oesophageal cancer; Prognosis; Surgery