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Patients with Isolated Brain Metastases from Esophageal Carcinoma After Minimally Invasive Esophagectomy May Not Have a Dismal Prognosis

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Abstract

Background

After esophagectomy for esophageal carcinoma, 2–13% of patients develop brain metastases (BM) which are associated with a poor prognosis. Further investigation into treatment and prognosis is beneficial given the limited available literature and varying outcomes.

Methods

Case files of all 339 patients who underwent minimally invasive esophagectomy (MIE) in a single high-volume center between January 2015 and December 2020 were retrospectively reviewed. Patients with BM and isolated brain metastases (iBM) were identified and a survival analysis was performed.

Results

Fifteen out of 339 patients (4,4%) undergoing MIE developed BM of which 9 (60,0%) had iBM. Most patients were diagnosed with squamous cell carcinoma (55,6%), localized in the middle third of the esophagus (66,7%), and had a pathologic complete response (66,7%) after initial treatment. Treatment of iBM consisted of gamma knife (GK) radiosurgery (44,4%), surgical resection (22,2%), GK and surgical resection (11,1%), and best supportive care (22,2%). Median time to diagnose iBM was 8,4 months (range 0,2–37,5) and survival after detection of iBM was 14,3 months (95% CI 0,0–45.9). The 2-year survival rate after detection of iBM was 44,4%.

Conclusions

iBM after esophagectomy for esophageal carcinoma is rare, but when encountered can and should be treated with a curative intent in selected cases in close collaboration with large neurosurgical centers. A large-scale study should be conducted to confirm our findings.

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Data Availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Surgery, Elisabeth-TweeSteden Hospital, Postbus 90151, 5000 LC , Tilburg, The Netherlands

    Sanne K. Stuart, Toon J. L. Kuypers, Ingrid S. Martijnse, Joos Heisterkamp & Robert A. Matthijsen

Authors
  1. Sanne K. Stuart
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  2. Toon J. L. Kuypers
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  3. Ingrid S. Martijnse
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  4. Joos Heisterkamp
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  5. Robert A. Matthijsen
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Contributions

SS, TK, ISM, JH, and RM contributed to the study design and its concept. TK coordinated the procedures necessary for approval by the institutional review board. SS was responsible for the data collection under the supervision of ISM, JH, and RM. SS performed the analysis and wrote the manuscript. All authors discussed the results and commented on the manuscript.

Corresponding author

Correspondence to Robert A. Matthijsen.

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Ethics Approval

This study protocol was approved by the Institutional Ethical Review Board (L1049.2020) and the requirement for informed consent was waived due to the retrospective and anonymized nature of the data.

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The authors declare no competing interests.

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Stuart, S.K., Kuypers, T.J.L., Martijnse, I.S. et al. Patients with Isolated Brain Metastases from Esophageal Carcinoma After Minimally Invasive Esophagectomy May Not Have a Dismal Prognosis. J Gastrointest Canc 54, 751–755 (2023). https://doi.org/10.1007/s12029-022-00870-8

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