Department of Surgery, Keio University School of Medicine, 35-banchi, Shinano-machi, Shinjuku-ku, Tokyo, Japan.
World J Surg. 2022 Sep;46(9):2270-2279. doi: 10.1007/s00268-022-06608-8. Epub 2022 Jun 16.
One of the difficulties in the treatment of esophageal cancer surgery is the high rate of postoperative recurrence. After esophagectomy, distant metastatic recurrence frequently occurs in the lung. This study aimed to determine the clinical features of a recurrence pattern with lung metastasis.
The current study analyzed data from 138 patients who had postoperative recurrence of esophageal cancer after a radical esophagectomy. According to the recurrence pattern at the time of initial diagnosis, the patients were classified into two groups as follows: those with lung metastasis and those without.
Twenty-three of the 138 investigated patients had a recurrence pattern with lung metastasis. Salvage surgery and postoperative pneumonia (p = 0.041 and 0.030, respectively) were identified as risk factors for recurrence pattern with lung metastasis in multivariate analysis. When we compared the sites of primary esophageal tumors, we found that the frequencies of distant metastases, such as lung and liver metastases, as well as pleural/peritoneal dissemination, were higher in the mid and distal esophageal tumors. Patients with a recurrence pattern showing lung metastasis alone had a better overall and post-recurrence survival than those with other recurrence patterns (p < 0.001 and p < 0.001).
In patients who had postoperative recurrence after esophagectomy for thoracic esophageal cancer, salvage surgery, and postoperative pneumonia were significantly related to recurrence pattern with lung metastasis. Postoperative recurrence with lung metastasis alone had a better prognosis than other recurrence patterns; therefore, when pulmonary recurrence is suspected, performing intensive examinations for early diagnosis is critical.
食管癌手术后治疗的难点之一是术后复发率高。食管切除术后，远处转移性复发常发生在肺部。本研究旨在确定以肺转移为特征的复发模式的临床特征。
本研究分析了 138 例根治性食管癌术后复发的食管癌患者的资料。根据初次诊断时的复发模式，将患者分为两组：有肺转移组和无肺转移组。
138 例患者中有 23 例存在肺转移的复发模式。多因素分析显示，挽救性手术和术后肺炎（p=0.041 和 0.030）是肺转移复发模式的危险因素。当我们比较原发食管肿瘤的部位时，发现中、下段食管肿瘤的远处转移部位（如肺、肝转移及胸膜/腹膜播散）更高。仅出现肺转移复发模式的患者的总生存和复发后生存均优于其他复发模式（p<0.001 和 p<0.001）。
在接受胸段食管癌根治性手术后出现术后复发的患者中，挽救性手术和术后肺炎与肺转移的复发模式显著相关。单纯肺转移的术后复发比其他复发模式的预后更好；因此，当怀疑肺部复发时，进行密集检查以早期诊断至关重要。
