Role of surgery in the management of synchronous metastatic esophageal cancer

Metastatic cancer of the esophagus has a poor prognosis. For many years, surgery had no place in their management and chemo(radio)therapy was the only therapy. In patients with metastatic colon and breast cancer, surgical resection of the metastases was shown to improve long term outcomes. For the upper digestive tract, metastasectomy was first described in gastric cancer. This led to the introduction of surgery for metastatic esophageal cancer. With the progress in chemo(radio)therapy regimens and surgical techniques, complete resection of all disease has become possible particularly in patients with oligometastases. To achieve a survival advantage, obtaining a negative resection margin of the metastases is essential. Preoperative workup should therefore focus on the possibility of a complete resection. Patient selection is crucial and should be discussed in multidisciplinary tumor boards. Prognostic scores exist and can be used to predict the survival of these patients. In this review, studies on the surgical management of synchronous metastases of esophageal cancer are discussed. The results of ongoing randomized trials will help clarify if there is truly a place for surgery for synchronous metastatic disease.