Open AccessInfluence of circumferential resection margin on prognosis in distal esophageal and gastroesophageal cancer approached through the transhiatal route
Author(s) -
Scheepers J. J. G.,
Van Der Peet D. L.,
Veenhof A. A. F. A.,
Cuesta M. A.
Publication year - 2009
Publication title -
diseases of the esophagus
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.115
H-Index - 63
eISSN - 1442-2050
pISSN - 1120-8694
DOI - 10.1111/j.1442-2050.2008.00898.x
Subject(s) - medicine , esophagectomy , esophagus , esophageal cancer , resection margin , univariate analysis , proportional hazards model , hazard ratio , gastroesophageal junction , surgery , malignancy , survival analysis , cancer , gastroenterology , adenocarcinoma , multivariate analysis , resection , confidence interval
SUMMARY We studied the influence of circumferential resection margin (CRM) involvement on survival in patients with malignancies of the distal esophagus and gastroesophageal junction. One hundred ten consecutive patients undergoing a laparoscopic or open transhiatal esophagectomy for malignancy of the distal 5 cm of the esophagus, or a Siewert I gastroesophageal junction tumor were analyzed, retrospectively. Only patients with potentially resectable tumors were included. CRM status was defined as clear or involved (microscopic tumor within 1 mm of the resection margin). Statistical analysis was done by means of univariate and multivariate analysis using the Kaplan–Meier method and Cox proportional hazard model. One hundred ten patients were analyzed. Sixty patients underwent open transhiatal esophagectomy, and 50 patients underwent laparoscopic transhiatal esophagectomy. There were 6 (5%) T 1 , 18 (16%) T 2 , and 86 (89%) T 3 tumors. CRM was clear in 68 (62%) patients and involved in 42 (38%) patients. Median survival in these groups was 50 vs . 20 months ( P = 0.000). Since CRM involvement was only seen in T 3 tumors, this group was analyzed in detail. Median survival in the T 3 CRM ‐ and T 3 CRM + group was 33 vs . 19 months ( P = 0.004). For T 3 N 0 tumors, median survival in CRM ‐ and CRM + was 40 and 22 months, respectively ( P = 0.036). Median survival for T 3 N 1 tumors in CRM ‐ and CRM + was 22 and 13 months, respectively ( P = 0.049). Involvement of the circumferential resection margin was found to be an independent prognostic factor on survival in our study. It predicts a poor prognosis in patients with potentially resectable malignancies of the distal 5 cm of the esophagus and Siewert I adenocarcinomas of the gastro esophageal junction.