Upper Gastrointestinal (lips to ileocecal valve, including esophagus and stomach)
Elliott J. Yee, MD (he/him/his)
General Surgery Resident
University of Colorado - Anschutz, CO
Denver, Colorado, United States
Ioannis A. Ziogas, MD, MPH
Resident - General Surgery
University of Colorado Anschutz Medical Campus
Aurora, Colorado, United States
Sumaya Abdul Ghaffar, MD
Research Fellow
University of Colorado, United States
Otto N. Thielen, MD
General Surgery Resident
University of Colorado, United States
Andrii Khomiak, MD
Resident - General Surgery
University of Colorado Anschutz Medical Campus, United States
Jakob A. Durden, MD
General Surgery Resident
University of Colorado, United States
Sunnie Kim, MD
Associate Professor
University of Colorado - Anschutz, CO, United States
Richard D. Schulick, MD, MBA
Chair of Surgery and Cancer Center Director
University of Colorado, Department of Surgery, United States
Ana L. Gleisner, MD, PhD
Associate Professor of Surgery
University of Colorado, United States
Martin D. McCarter, MD
Professor of Surgery
University of Colorado, Department of Surgery, United States
Benedetto Mungo, MD
Assistant Professor of Surgery
University of Colorado, Department of Surgery, United States
The role of metastasectomy in patients with liver-only metastases from gastroesophageal cancer remains controversial, and the limited body of literature on this topic consists of small single-center series. Therefore, we performed a national registry analysis comparing surgical treatment options for patients with gastroesophageal cancers and liver-only metastases.
Methods:
In this retrospective National Cancer Database (2010-2019) study, adults (≥18 years) with esophageal or gastric cancer and liver-only metastases (no brain, bone, or lung metastases) were included. Patients were stratified into four groups: a) no surgical treatment; b) primary tumor resection (PTR); c) liver metastasectomy; d) PTR and liver metastasectomy. Survival analysis was conducted using the Kaplan-Meier method, log-rank test, and Cox regression.
Results:
23,381 patients were included (esophageal cancer: 8,549; gastric cancer: 14,832). The median age was 65 years, 75.8% were male, and 71.1% White. The most common histology was adenocarcinoma in both tumor site groups (76.6% vs. 74.0%, p< 0.001). The majority (93.5%) underwent no surgical treatment, while 4.3% underwent PTR alone, 0.8% liver metastasectomy alone, and 1.4% both PTR and liver metastasectomy. In patients with esophageal cancer, PTR and liver metastasectomy was associated with superior overall survival (OS) compared to no surgical treatment (hazard ratio [HR]: 2.93, 95% confidence interval [95%CI]: 1.84-4.65, p< 0.001) and to liver metastasectomy alone (HR: 2.14, 95%CI: 1.24-3.71, p=0.01), but no statistically significant difference compared to PTR alone (HR: 1.51, 95%CI: 0.91-2.50, p=0.11) (Fig. A). In patients with gastric cancer, PTR and liver metastasectomy was associated with superior OS compared to no surgical treatment (HR: 3.44, 95%CI: 2.93-4.04, p< 0.001), liver metastasectomy alone (HR: 3.00, 95%CI: 2.37-3.81, p< 0.001), and PTR alone (HR: 1.69, 95%CI: 1.42-2.02, p< 0.001) (Fig. B). The outcomes remained unchanged when limiting analyses to only patients with esophageal or gastric adenocarcinoma, respectively.
Conclusions:
The addition of liver metastasectomy to PTR may be associated with improved OS in very selected patients with gastroesophageal cancer and liver-only metastases.