Patients undergoing surgery for oligometastatic oesophageal cancer survive for more than 2 years: bootstrapping systematic review data

Abstract

OBJECTIVES Oesophageal cancer oligometastasis is a state of limited systemic disease characterized by ˂5 metastases. Without surgery average survival is 4–12 months. We sought to estimate patient prognosis following the surgical resection of oligometastatic disease from oesophageal cancer. METHODS Eligible studies were identified through systematic search of PubMed and the Cochrane Library (end-of-search date: 20 November 2019). We estimated cumulative 1-, 3- and 5-year, as well as overall survival using bootstrap methodology with 1 000 000 repetitions per outcome. RESULTS We investigated six studies involving 420 patients who underwent metastasectomy for oligometastasis from oesophageal cancer. Adenocarcinoma [77.3%; 95% confidence interval (CI) 62.8–87.3] was the most prevalent histological type followed by squamous cell carcinoma (22.7%; 95% CI 12.7–37.2). Metastatic lesions were typically synchronous (91.5%; 95% CI 87.5–94.1). Overall, 73.5% (95% CI 67.5–78.6) of the patients underwent resection of the primary and metastatic tumours synchronously. Neoadjuvant chemoradiotherapy was utilized in the majority of the patients (66.7%; 95% CI 49.5–80.3) followed by neoadjuvant chemotherapy (33.3%; 95% CI 19.6–50.5). The mean overall survival was 24.5 months (95% CI 14.4–34.6). One-year survival was 88.3% (95% CI 85.6–90.8). Three-year survival and 5-year survival were 36.3% (95% CI 15.3–7.3) and 23.8% (95% CI 12.0–35.7), respectively. CONCLUSIONS Patients undergoing surgical resection of oesophageal oligometastasis survive for more than 24 months. Therefore, loco-regional control of oligometastatic disease appears to improve survival by at least 100%.

Treatment patterns and survival in advanced unresectable esophageal squamous cell cancer: A population‐based study

“…Most likely, patients with distant metastases who received this type of treatment had oligometastatic disease for whom prolonged survival could be achieved. 20 Twenty-three percent of patients with SCLNM who received chemoradiotherapy and/or had resection were still alive after 3 years. The 3-year survival rate was higher in previous studies of patients with esophageal cancer who had received definitive chemoradiotherapy (36%-46%).…”

“…The survival time among patients who received chemoradiotherapy and/or had resection with SCLNM (16.1 months) or distant metastases (14.0 months) was not significantly different. Most likely, patients with distant metastases who received this type of treatment had oligometastatic disease for whom prolonged survival could be achieved 20 …”

A prospective cohort study on active surveillance after neoadjuvant chemoradiotherapy for esophageal cancer: protocol of Surgery As Needed for Oesophageal cancer-2

“…Also, indications for surgery may expand. For example, in patients with oligometastatic disease there may be room for curative treatment options including esophagectomy as part of an intense multimodality treatment [ 26 ].…”

Oligometastatic Adenocarcinoma of the Esophagus: Current Understanding, Diagnosis, and Therapeutic Strategies

“…Meta-analysis by Jamel et al demonstrated the majority of these studies involve primarily squamous cell carcinoma of the esophagus, with adenocarcinoma representing only 23% of histologic subtypes evaluated [9]. Schizas et al's more recent systematic review identified 420 patients from six studies that primarily included adenocarcinoma (77.3%), followed by squamous cell carcinoma (22.7%) [44]. The variation of subtypes in these studies likely highlights the paucity of available evidence and the increasing incidence of adenocarcinoma in this cohort.…”