Abstract
Abstract Disease recurrence following treatment for esophageal cancer (EC) remains common despite incremental gains from neoadjuvant chemotherapy. The lung is a common site of distant metastasis following definitive EC treatment. Tumour burden influences the surgical approach utilised in the treatment of pulmonary metastasis from EC. In turn, this impacts patient prognosis. This systematic review sought to identify the impact of tumour burden and surgical approach on 5-year survival following metastectomy of metachronous pulmonary metastasis from EC. A search of the major reference databases (PubMed, Medline, Cochrane) was performed with no time limits up to March 2022. Results were screened in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies reporting on the number of metastatic pulmonary tumours and operative techniques utilised were included. A random effects meta-analysis model was used to compare the impact of number of metastatic pulmonary deposits (single vs multiple), and operative approach (wedge vs anatomical resection) on the 5 year survival of patients following metastectomy for metachronous pulmonary metastasis from EC. Seven non-randomised studies comprising 142 patients undergoing pulmonary metastectomy for metastatic EC were included. The number of metastatic deposits (single vs multiple) did not affect 5-year survival (Risk Ratio = 1.08; 95% confidence interval 0.58-2.02; p = 0.81). With respect to surgical technique, anatomical resection did not confer a survival benefit compared to wedge resection of pulmonary metastases from EC (Risk Ratio = 1.33; 95% Confidence Interval: 0.81 – 2.19; p = 0.26). Tumour burden and surgical technique utilised does not impact upon the prognosis of patients undergoing pulmonary metastectomy for metastatic EC. However, current evidence from smaller non-randomised studies remains weak owing to variation in the clinicopathological features of the primary EC and pulmonary metastasis, limiting outcome assessment.
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