Survival After Surgical Resection of Stage IV Esophageal Cancer.
BACKGROUND
Five-year survival of stage IV esophageal cancer is rare. The treatment of advanced esophageal cancer is typically palliative and the role of surgery remains controversial. We sought to understand the impact of curative surgery on survival and identify any favorable tumor or patient characteristics that might make surgical resection appropriate when treating stage IV esophageal cancer.


METHODS
A retrospective review of 3,500 esophagectomies performed at our institution from 1985 to 2013 identified 52 (1.5%) patients with stage IV esophageal cancer who underwent surgical resection with intent for cure. In 46 (88.5%) patients, M1 disease was discovered at the time of surgery and 6 (11.5%) patients had known M1 disease prior to surgery.


RESULTS
Median age at the time of surgery was 60 years (range, 31 to 81 years). The majority of patients were men (82.7%) with adenocarcinoma (88.5%). Neoadjuvant therapy was used in 18 (34.6%) patients; all patients operated on after 1999 received neoadjuvant therapy. An Ivor Lewis esophagectomy was performed in 39 (75%) patients. Follow-up was complete in all patients for a median of 324 days (range, 4 days to 8.5 years). Overall, 1-year survival was 29% and 5-year survival was 6%. There was no significant difference in survival between patients with known preoperative versus intraoperative discovery of M1 disease. Factors associated with improved survival included neoadjuvant treatment, low T stage, and lack of alcohol use.


CONCLUSIONS
Few patients with stage IV esophageal cancer survive long term after surgical resection, though 5-year survival can occur. Our current recommendation is that esophagectomy should not be performed for stage IV disease.
Division of General Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota.
Sahar A
SA
Saddoughi
Division of General Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota.
J Matthew
JM
Reinersman
Division of General Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota.
Yuriy O
YO
Zhukov
Division of General Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota.
James
J
Taswell
Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
Kristin
K
Mara
Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
S William
SW
Harmsen
Division of General Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota.
Shanda H
SH
Blackmon
Division of General Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota.
Stephen D
SD
Cassivi
Division of General Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota.
Francis
F
Nichols
Division of General Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota.
K Robert
KR
Shen
Division of General Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota.
Dennis A
DA
Wigle
Division of General Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota. Electronic address: allen.mark@mayo.edu.
Mark S
MS
Allen
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D009367:Neoplasm Staging; D011184:Postoperative Period; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends