Published online Jul 14, 2019. doi: 10.3748/wjg.v25.i26.3438
Peer-review started: March 15, 2019
First decision: April 5, 2019
Revised: May 1, 2019
Accepted: May 31, 2019
Article in press: June 1, 2019
Published online: July 14, 2019
Esophageal cancer is well known for its lethality and poor prognosis when treated with modalities other than surgery. Esophageal cancer shares many risk factors with other gastrointestinal tract and solid organ neoplasms, a fact which explains why the malignancies may coexist with other tumors of the stomach, colon, liver, pancreas, lung and kidney. This phenomenon is both rare and underreported and when encountered by a treating physician it creates confusion and uncertainty as to what treatment course should be employed, given the lack of relevant practice guidelines. In the present study, by employing a systematic literature review protocol, we sought to elucidate the role of surgical therapy is these patients, the operative techniques applicable in each case and the perioperative and postoperative outcomes that are to be expected.
Summing all available studies concerning patients with coexisting neoplasms of the esophagus and other organs will hopefuly guide patient care and emphasize the need of better and more accurate reporting of such patients.
To identify the operative approaches utilized when synchronously treating neoplasms of the esophagus and the stomach/pancreas/lung/colon/rectum/liver/kidney, their perioperative safety and postoperative outcomes.
We systematically reviewed all existing literature for studies including patients with esophageal cancer and a second primary neoplasm. Studies that included patients who exhibited a second primary neoplasm in an organ other than the head and neck region were included in the analysis. Afterwards, we extracted information pertaining to the intricacies of the operative technique employed, anastomotic leaks, perioperative deaths and neoplasm recurrences.
A total of 23 eligible studies were identified incorporating 117 patients. Eighty five patients had a second primary neoplassm in the stomach and underwent a total gastrectomy (n = 26) with subsequent reconstruction using a colonic (n = 23) or a jejunal (n = 3) conduit or a gastric preserving resection (n = 59) in which a gastric pull-up was used for reconstruction. One anastomotic leak and 4 deaths were recorded in this patient group, whilst follow-up revealed 35 esophageal cancer recurrences and 8 gastric cancer recurrences. Patients that underwent a combined esophagectomy and whipple procedure (n = 6) were reconstructed either by means of a gastric pull-up (n = 1) or a colon/jejunum conduit (n = 5), with 2 anastomotic leaks recorded and no perioperative deaths. Two cases of pancreatic/ampullary carcinoma recurrence were encountered during follow-up. Finaly, the remaining patients (n = 26) with second primary neoplasms in the lung, colon/rectum, kidney and liver had resections identical to those employed in treating each of these neoplasms seperately. Four anastomotic leaks and one case of perioperative mortality were reported. Follow-up was notable only for one case of esophageal cancer recurrence.
The present systematic review supports the safety, efficacy and applicability of combined resections, although the poor quality of included studies limits the strength and generalizability of the results.
Patients with concurrent esophageal and second primary organ neoplasms are a unique category of patients whose survival depends on quick and decisive surgical action. The lack of surgical and oncologic guidelines is therefore a major impediment in treating these unlucky patients. Better reporting of surgical outcomes in a uniform manner may pave the way for future reseach that will eventually help establish clear-cut clinical protocols and optimize therapeutic strategies.