OGC P33 Prognostic significance of tumour burden and operative technique for metachronous pulmonary metastasis from oesophageal cancer: a systematic review and meta-analysis

Abstract

Abstract Background Disease recurrence following treatment for oesophageal cancer (OC) remains common despite incremental gains from neoadjuvant chemotherapy. The lung is a common site of distant metastasis following definitive OC treatment. Tumour burden influences the surgical approach utilised in the treatment of pulmonary metastasis from OC. 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 OC. Methods 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 OC. Results Seven non-randomised studies comprising 142 patients undergoing pulmonary metastectomy for metastatic oesophageal cancer 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 OC (Risk Ratio = 1.33; 95% Confidence Interval: 0.81–2.19; p = 0.26). Conclusions Tumour burden and surgical technique utilised does not impact upon the prognosis of patients undergoing pulmonary metastectomy for metastatic oesophageal cancer. However, current evidence from smaller non-randomised studies remains weak owing to variation in the clinicopathological features of the primary OC and pulmonary metastasis, limiting outcome assessment.