Background. Distant metastasis in carcinoma of the esophagus and gastroesophageal junction is associated with a poor survival after resection. To improve the selection of patients for surgical and nonsurgical treatment, this study determined the influence on survival of distant metastases, as assessed on radiologic studies or proven on cytologic studies.
Methods. During the period 1989-1990,135 patients were referred to the institution in this study. On ultrasonographic or computed tomographic studies, distant metastases were suspected in 62 patients and were absent in 73 patients. In 33 patients, metastases were proven cytologically; 32 of these patients subsequently were excluded from surgery. Twelve other patients were unfit for surgery because of their general condition. The remaining 91 patients had surgery; 77 patients had transhiatal esophagectomy, and the tumor was unresectable in 14 patients.
Results. The 2-year survival rate for all patients in whom distant metastases were suspected on radiologic studies was 11.2%, and it was 44.3% for patients without metastases on these studies (P <0.001). For patients with cytologically proven metastases, the 2-year survival rate (3%) was lower than for patients in whom distant metastases were suspected on radiologic studies but not cytologically confirmed (21.1%) (P <0.001). There was no statistically significant difference in survival between this last group of patients and those without metastases identified by radiologic studies (P = 0.87). After resection, the 2-year survival rate decreased from 53.9% to 0% when distant metastases were present on histopathologic studies of the resected specimen (P = 0.04), and there was no significant difference in survival between patients with distant metastases suspected or absent on preoperative radiologic studies (P = 0.47).
Conclusions. Surgery should be avoided in patients with cytologically proven distant metastases because the expected survival rate is low and surgery does not seem to be a life-prolonging procedure in these patients; however, patients should not be excluded from surgery on the basis of metastases identified by radiologic studies alone.
|Nummer van het tijdschrift||1|
|Status||Published - 1-jul-1993|