Surgical resection for pulmonary recurrence of esophageal cancer after curative esophagectomy

Aim: To clarify the significance of surgical resection for pulmonary recurrence after curative esophagectomy for esophageal cancer. Methods: Clinical details, such as the recurrence site, timing, and contents of therapies for recurrence, and the prognosis, were examined in 14 patients who underwent surgical resection for pulmonary recurrence that developed after curative esophagectomy. Results: The median disease- free interval after esophagectomy was 17.2 months. Two patients underwent pulmonary resection two times, and in one patient, three times. All pulmonary resections were performed when other extra-pulmonary recurrences had been controlled, and R0 resection was achieved. Chemotherapy and/or radiotherapy were additionally performed for pulmonary metastasis in 13 patients. The median survival time after initial pulmonary resection was 45.5 months, and the 1-, 3-, and 5-year overall survival rates were 93%, 68%, and 43%, respectively. The 5-year overall survival rate after initial pulmonary resection was 13% in patients with Stage III or IV esophageal cancer and 100% in those with Stage I or II disease (P = 0.010). The rate was 56% in patients with tumors < 20 mm in size, while all 5 patients with lesions >= 20 mm in size died within 3 years (P = 0.005). Conclusion: Surgical resection along with systemic therapy is a promising treatment strategy for pulmonary recurrence after curative esophagectomy when it is solitary and localized. Clinical factors, such as the esophageal cancer stage and the size of the pulmonary metastasis, are useful for deciding on the surgical indication.