INFLUENCE OF RADIOLOGICALLY AND CYTOLOGICALLY ASSESSED DISTANT METASTASES ON THE SURVIVAL OF PATIENTS WITH ESOPHAGEAL AND GASTROESOPHAGEAL JUNCTION CARCINOMA

Background. Distant metastasis in carcinoma of the esophagus and gastr oesophageal junction is associated with a poor survival after resectio n. To improve the selection of patients for surgical and nonsurgical t reatment, this study determined the influence on survival of distant m etastases, as assessed on radiologic studies or proven on cytologic st udies. Methods. During the period 1989-1990,135 patients were referred to the institution in this study. On ultrasonographic or computed tom ographic studies, distant metastases were suspected in 62 patients and were absent in 73 patients. In 33 patients, metastases were proven cy tologically; 32 of these patients subsequently were excluded from surg ery. Twelve other patients were unfit for surgery because of their gen eral condition. The remaining 91 patients had surgery; 77 patients had transhiatal esophagectomy, and the tumor was unresectable in 14 patie nts. Results. The 2-year survival rate for all patients in whom distan t metastases were suspected on radiologic studies was 11.2%, and it wa s 44.3% for patients without metastases on these studies (P < 0.001). For patients with cytologically proven metastases, the 2-year survival rate (3%) was lower than for patients in whom distant metastases were suspected on radiologic studies but not cytologically confirmed (21.1 %) (P < 0.001). There was no statistically significant difference in s urvival between this last group of patients and those without metastas es identified by radiologic studies (P = 0.87). After resection, the 2 -year survival rate decreased from 53.9% to 0% when distant metastases were present on histopathologic studies of the resected specimen (P = 0.04), and there was no significant difference in survival between pa tients with distant metastases suspected or absent on preoperative rad iologic studies (P = 0.47). Conclusions. Surgery should be avoided in patients with cytologically proven distant metastases because the expe cted survival rate is low and surgery does not seem to be a life-prolo nging procedure in these patients; however, patients should not be exc luded from surgery on the basis of metastases identified by radiologic studies alone.