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Peer-reviewedCC BY 4.0Annals of Thoracic and Cardiovascular Surgery

Systematic Review and Meta-Analysis of Patients with Esophageal Cancer and Intramural Metastasis

  • Sho Sato1
  • Hideaki Shimada2
  • Yuriko Takeda3
  • Itaru Endo4
  • Takaki Yoshikawa1
4 affiliations
  1. 1Department of Gastrointestinal Surgery, Yokohama City University Gastroenterological Center, Yokohama, Kanagawa, Japan
  2. 2Department of Surgery, Toho University School of Medicine, Tokyo, Japan
  3. 3Department of Biostatistics, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
  4. 4Department of Gastroenterological Surgery, Yokohama City University, Yokohama, Kanagawa, Japan
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Abstract

Purpose: Intramural metastasis is defined as the metastatic spread from a primary tumor to the gastrointestinal tract through the intramural lymphatic system. Although several studies have demonstrated the negative impact of intramural metastasis on survival in esophageal cancer, no systematic review including a large number of patients has been conducted yet.

Methods: Reports on esophageal cancer with intramural metastasis from 1990 to 2025 were collected. A pooled analysis was performed using a random-effects model to estimate the hazard ratio for overall survival in patients with intramural metastasis compared with patients without intramural metastasis.

Results: Eleven studies (4494 patients) were included, in whom 315 patients (7.0%) had conventional intramural metastasis, while 57 patients had discontinuous growth. Among these patients, 4162 were diagnosed with esophageal squamous cell carcinoma. Preoperative chemotherapy was administered to 1153 patients (25.7%). The hazard ratio for overall survival was 2.22, with a 95% confidence interval of 1.81–2.72.

Conclusions: Our analysis suggests that the adverse prognostic association of IM was observed across different treatment eras and remained evident in studies including patients who received neoadjuvant treatment. Future studies should explore optimal treatment strategies for patients with intramural metastasis.

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Cite

BibTeXRIS
BibTeX
@article{sato2026systematic,
  title = {{Systematic Review and Meta-Analysis of Patients with Esophageal Cancer and Intramural Metastasis}},
  author = {Sho Sato and Hideaki Shimada and Yuriko Takeda and Itaru Endo and Takaki Yoshikawa},
  journal = {Annals of Thoracic and Cardiovascular Surgery},
  year = {2026},
  month = oct,
  doi = {10.5761/atcs.ra.26-00153},
  url = {https://doi.org/10.5761/atcs.ra.26-00153},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Systematic Review and Meta-Analysis of Patients with Esophageal Cancer and Intramural Metastasis
AU  - Sho Sato
AU  - Hideaki Shimada
AU  - Yuriko Takeda
AU  - Itaru Endo
AU  - Takaki Yoshikawa
PY  - 2026
DA  - 2026/10/24
JO  - Annals of Thoracic and Cardiovascular Surgery
DO  - 10.5761/atcs.ra.26-00153
UR  - https://doi.org/10.5761/atcs.ra.26-00153
AB  - Purpose: Intramural metastasis is defined as the metastatic spread from a primary tumor to the gastrointestinal tract through the intramural lymphatic system. Although several studies have demonstrated the negative impact of intramural metastasis on survival in esophageal cancer, no systematic review including a large number of patients has been conducted yet.  Methods: Reports on esophageal cancer with intramural metastasis from 1990 to 2025 were collected. A pooled analysis was performed using a random-effects model to estimate the hazard ratio for overall survival in patients with intramural metastasis compared with patients without intramural metastasis.  Results: Eleven studies (4494 patients) were included, in whom 315 patients (7.0%) had conventional intramural metastasis, while 57 patients had discontinuous growth. Among these patients, 4162 were diagnosed with esophageal squamous cell carcinoma. Preoperative chemotherapy was administered to 1153 patients (25.7%). The hazard ratio for overall survival was 2.22, with a 95% confidence interval of 1.81–2.72.  Conclusions: Our analysis suggests that the adverse prognostic association of IM was observed across different treatment eras and remained evident in studies including patients who received neoadjuvant treatment. Future studies should explore optimal treatment strategies for patients with intramural metastasis.
SN  - 1341-1098
SN  - 2186-1005
ER  -